scholarly journals An Optimized Dose of Therapeutic Feeding Results in Noninferior Growth in Midupper Arm Circumference Compared with a Standard Dose in Children in Sierra Leone Recovering from Acute Malnutrition

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Kevin B Stephenson ◽  
Sophia E Agapova ◽  
D Taylor Hendrixson ◽  
Aminata Shamit Koroma ◽  
Mark J Manary
Keyword(s):  
Sierra Leone ◽  
Dose Regimen ◽  
Severe Acute Malnutrition ◽  
Standard Dose ◽  
Supplementary Feeding ◽  
Acute Malnutrition ◽  
Fixed Dose ◽  
Dose Cohort ◽  
Arm Circumference ◽  
Time To Relapse

ABSTRACT Background Ready-to-use therapeutic food (RUTF) given at 175 kcal/kg per day throughout severe acute malnutrition (SAM) treatment is recommended. Some treatment programs have diverged from this paradigm in 2 ways: reducing the supplemental food dose to 75 kcal/kg per day when midupper arm circumference (MUAC) is >11.4 cm or simplifying to a fixed-dose regimen. Objective The objective was to determine if transitioning to an optimized, fixed-dose supplementary feeding regimen during SAM treatment when MUAC is >11.4 cm would result in noninferior gain in MUAC compared with standard treatment. Methods Using data from 2 clinical trials conducted in Sierra Leone, a retrospective dual-cohort study was performed. The 2 cohorts included children with SAM who had improved to meet criteria for moderate acute malnutrition (MAM). The standard dose cohort continued to receive weight-based RUTF at 175 kcal/kg per day, while the optimized dose cohort received fixed-dose, 500 kcal/d of supplementary feeding. The primary outcome was a noninferiority margin of 1 mm of MUAC after 4 wk of treatment, while secondary outcomes included rate of anthropometric changes as well as time-to-relapse to SAM or death. Results MUAC after 4 wk was noninferior (Δ: −0.1 mm; 95% CI: −0.05, 0.03; inferiority rejected P = 0.008). Rates of weight gain and MUAC gain were the same in the optimized-dose and standard-dose groups, whereas the rate of length gain was slower in the optimized-dose cohort. Time-to-relapse to SAM or death was not different (HR: 1.05; P = 0.71). Conclusions This study supports the practice of treating children with SAM who have recovered to meet criteria for MAM with a reduced and fixed-dose regimen of RUTF. The results also raise the question of whether this strategy might adversely impact linear growth during SAM treatment.

Time To Relapse of Severe Acute Malnutrition And Its Determinants Among Children Treated In The Health Posts of Hadiya Zone, Southern Ethiopia.

2021 ◽  
Author(s):  
Abera Lambebo ◽  
Desselegn Temiru ◽  
Tefera Belachew
Keyword(s):  
Severe Acute Malnutrition ◽  
Statistical Significance ◽  
Acute Malnutrition ◽  
Southern Ethiopia ◽  
Under Five ◽  
Back Ground ◽  
Relapse Time ◽  
The Mean ◽  
Time To Relapse ◽  
Hadiya Zone

Abstract Back ground: In developing countries including Ethiopia, children under five years old are likely to suffer from repeated bouts of SAM. There is lack of study that documented time to relapse of SAM and its determinants. Objective: This study aimed to identify time of relapse and its determinants among children discharged after treatment for SAM in health facilities of Hadiya Zone, South, Ethiopia Methods: An institution based retrospective cohort study was carried out from data spanning from 2014/2015 to 2019/2020. After checking all the assumptions, multivariable CPH model was fitted to isolate independent determinants of time to relapse. All tests were two sided and statistical significance at P values <0.05. Result: The mean(±SD) time for relapse of SAM among under five children was 22(±9.9) weeks from discharge to relapse time. On multivariable CPH model, the hazard of relapse for SAM was significantly higher for children who had edema (AHR =2.02 ,95%, CI: 1.17-3.50), age of 6-11 months (AHR = 5.2, 95%, CI:1.95-13.87), had discharge low MUAC (AHR = 12,95%, CI: 7.90-19.52)Concussion: The finding showed that children discharged from SAM are likely to have relapse in 3 weeks.

scholarly journals Ethnic and age differences in prediction of mortality by mid-upper arm circumference in children below 3 years of age in Nepal

2018 ◽  
Vol 21 (12) ◽  
pp. 2230-2237 ◽  
Author(s):  
Avni Gupta ◽  
James M Tielsch ◽  
Subarna K Khatry ◽  
Steven C LeClerq ◽  
Luke C Mullany ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Sociodemographic Factors ◽  
Nutrition Intervention ◽  
Acute Malnutrition ◽  
Older Children ◽  
Upper Arm ◽  
Prediction Of Mortality ◽  
Arm Circumference ◽  
Increased Risk ◽  
Mid Upper Arm Circumference

AbstractObjectiveTo assess ethnicity- and age-modified associations between mid-upper arm circumference (MUAC) and mortality in Nepalese children and whether sociodemographic factors explain these associations.DesignSecondary data analysis of children followed until 3 years of age. Estimated mortality hazard ratios (HR) for MUAC<11·5cm (recommended cut-off for identifying severe acute malnutrition among children ≥6 months old) compared with ≥11·5cm in younger (<6 months) and older children (≥6 months) of Pahadi and Madhesi ethnicity, adjusting for sex, socio-economic status (SES) and mother’s education using Cox proportional hazard models.SettingSarlahi, Nepal (21 October 2001–2 February 2006).SubjectsChildren (n 48 492) enrolled in the Nepal Nutrition Intervention Project, Sarlahi-4.ResultsAmong children aged ≥6 months, MUAC<11·5 cm was associated with increased risk of mortality in both Pahadis (HR=4·01; 95 % CI 1·42, 11·76) and Madhesis (HR=5·60; 95 % CI 3·87, 8·11) compared with those with MUAC≥11·5 cm, after adjusting for sex, SES and maternal literacy. Among children <6 months old, MUAC<11·5 cm was not associated with mortality in Pahadis with (HR=1·12; 95 % CI 0·72, 1·73) or without adjusting (HR=1·17; 95 % CI 0·75, 1·18) as compared with Madeshis (adjusted HR=1·76; 95 % CI 1·35, 2·28).ConclusionsAmong older children, MUAC<11·5 cm is associated with subsequent mortality in both ethnicities regardless of other characteristics. However, among children aged <6 months, it predicted mortality only among Madhesis, while sociodemographic factors were more strongly associated with mortality than MUAC<11·5cm among Pahadis.

Treatment of severe acute malnutrition with oat or standard ready-to-use therapeutic food: a triple-blind, randomised controlled clinical trial

Gut ◽  
2020 ◽  
Vol 69 (12) ◽  
pp. 2143-2149 ◽  
Author(s):  
David Taylor Hendrixson ◽  
Claire Godbout ◽  
Alyssa Los ◽  
Meghan Callaghan-Gillespie ◽  
Melody Mui ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Vegetable Oil ◽  
Severe Acute Malnutrition ◽  
Milk Powder ◽  
Acute Malnutrition ◽  
Growth Time ◽  
Controlled Clinical Trial ◽  
Hydrogenated Vegetable Oil ◽  
Therapeutic Food ◽  
Time To Graduation

ObjectiveWe hypothesised that an alternative RUTF (ready-to-use therapeutic food) made with oats (oat-RUTF) would be non-inferior to standard RUTF (s-RUTF).DesignThis was a randomised, triple-blind, controlled, clinical non-inferiority trial comparing oat-RUTF to s-RUTF in rural Sierra Leone. Children aged 6–59 months with severe acute malnutrition (SAM) were randomised to oat-RUTF or s-RUTF. s-RUTF was composed of milk powder, sugar, peanut paste and vegetable oil, with a hydrogenated vegetable oil additive. Oat-RUTF contained oats and no hydrogenated vegetable oil additives. The primary outcome was graduation, an increase in anthropometric measurements such that the child was not acutely malnourished. Secondary outcomes were rates of growth, time to graduation and presence of adverse events. Intention to treat analyses was used.ResultsOf the 1406 children were enrolled, graduation was attained in 404/721 (56%) children receiving oat-RUTF and 311/685 (45%) receiving s-RUTF (difference 10.6%, 95% CI 5.4% to 15.8%). Death, hospitalisation or remaining with SAM was seen in 87/721 (12%) receiving oat-RUTF and in 125/685 (18%) receiving s-RUTF (difference 6.2%, 95% CI 2.3 to 10.0, p=0.001). Time to graduation was less for children receiving oat RUTF; 3.9±1.8 versus 4.5±1.8 visits, respectively (p<0.001). Rates of weight in the oat-RUTF group were greater than in the s-RUTF group; 3.4±2.7 versus 2.5±2.3 g/kg/d, p<0.001.ConclusionOat-RUTF is superior to s-RUTF in the treatment of SAM in Sierra Leone. We speculate that might be because of beneficial bioactive components or the absence of hydrogenated vegetable oil in oat-RUTF.Trial registration numberNCT03407326.

scholarly journals Complicated severe acute malnutrition: anthropometric status from Southern Rajasthan, India

2017 ◽  
Vol 4 (4) ◽  
pp. 1466
Author(s):  
Rupali Jain ◽  
Rameshwar Lal Suman ◽  
Suresh Goyal ◽  
B. L. Meghwal ◽  
Suresh Kumar Meena
Keyword(s):  
Severe Acute Malnutrition ◽  
Tertiary Hospital ◽  
Acute Malnutrition ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
Arm Circumference ◽  
Treatment Centre ◽  
Health And Development ◽  
Mid Upper Arm Circumference ◽  
Anthropometric Status

Background: Childhood under-nutrition is an important public health and development challenge in India. Undernourished children have significantly higher risk of mortality and morbidity. Objective of present study was to identify the anthropometric status of complicated Severe acute malnutrition (SAM) in Southern Rajasthan, India.Methods: It was a retrospective study conducted in children admitted at Malnutrition Treatment Centre attached to a tertiary hospital. Basic socio-demographic and anthropometric records of all children between 6 months to 5 years of age were analysed.Results: Out of the total 1554 SAM children admitted in last two years, 855 (55.01%) were males and 699 (44.98%) were females. Mean weight was 6.17±1.59 kg, mean height was 71.65±8.6 cm and Mid upper arm circumference (MUAC) was 10.99±1.53 cm. Among these, 1375 (88.48%) children fulfilled weight for height (WFH) criteria, 919 (59.13%) fulfilled MUAC criteria and 246 (15.83%) had edema. On WFH Zscore analysis, 53% had <-3SD and <-4SD, 19.88% had <-5SD, 9.97% had <-6SD, 3.47% had <-7SD and 1.67% had <-8SD. Also, we observed that lower values of MUAC ranging from <11.5cm to <9cm. MUAC of 11.5-10cm was in 43.43% of children and 15% had MUAC <10cm. Among the children of all age group, we observe that males of 6-24 months of age are more significantly affected as compared to females.Conclusions: The study highlights the fact that extreme grades of malnutrition exist in our area ranging upto Z-score of -8SD and beyond, and is not limited to -3SD and -4SD. Also, males are the more affected of the two sexes in our rural and tribal area setting. 

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