scholarly journals Weight-For-Height Z-Score Gain During Inpatient And Subsequent Linear Growth During Outpatient Treatment Of Young Children With Severe Acute Malnutrition, A Prospective Study From Uganda

2021 ◽  
Author(s):  
Jolly G K Kamugisha ◽  
Betty Lanyero ◽  
Nicolette Nabukeera-Barungi ◽  
Christian Ritz ◽  
Christian Mølgaard ◽  
...  
Keyword(s):  
Prospective Study ◽  
Linear Growth ◽  
Severe Acute Malnutrition ◽  
Regression Coefficients ◽  
Acute Malnutrition ◽  
Z Score ◽  
Score Gain ◽  
Catch Up ◽  
Therapeutic Care ◽  
A Prospective Study

Abstract Background Linear catch-up growth after treatment of severe acute malnutrition (SAM) is low, and little is known about the association between ponderal and subsequent linear growth. Objective The study assessed the association of weight-for-height z-score (WHZ) gain with subsequent linear growth during SAM treatment and examined its modifiers. Methods This was a prospective study, nested in a trial (ISRCTN16454889), among 6–59-mo-old children treated for SAM in Uganda. Weight, total length (TL) and knee-heel length (KHL) were measured at admission, weekly during inpatient-therapeutic-care (ITC), at discharge and fortnightly during outpatient-therapeutic-care (OTC) for 8 weeks. Linear regression was used to assess the association between WHZ gain during ITC and linear growth during OTC. Results Of 400 children, 327 were discharged to OTC and 290 followed-up for 8 weeks. Mean WHZ gains were 0.45 in ITC and 1.24 in OTC, whereas mean height-for-age z-score (HAZ) declined 0.41 during ITC and increased 0.14 during OTC. WHZ gain during ITC was positively associated with HAZ, TL and KHL gains during OTC (regression coefficients (b) [95% CI]: (0.12 [0.09; 0.15] z-score; 3.1 [2.4; 3.8] mm; 0.5 [0.1; 0.7] mm). The regression coefficients were highest for the middle tertile of WHZ gain with respect to HAZ and TL. Admission diarrhea and low plasma citrulline reduced the association between WHZ gain during ITC and HAZ and TL gain during OTC (P < 0.001). In contrast, pneumonia (P = 0.051) and elevated plasma CRP (P < 0.001) increased the association with TL gain, but reduced the association with KHL gain (P < 0.001). Conclusion Among children admitted with SAM, considerable WHZ gain during ITC was followed by very modest linear catch-up growth during OTC, with no indication of a WHZ gain threshold, above which linear growth was higher. To optimize linear growth in these children, early treatment of infections and conditions affecting the gut may be necessary.

Thymus gland size during recovery from complicated severe acute malnutrition: a prospective study of the role of probiotics

2018 ◽  
Vol 39 (2) ◽  
pp. 95-103 ◽  
Author(s):  
Nicolette Nabukeera-Barungi ◽  
Benedikte Grenov ◽  
Henrik Friis ◽  
Betty Lanyero ◽  
Hanifa Namusoke ◽  
...  
Keyword(s):  
Prospective Study ◽  
Severe Acute Malnutrition ◽  
Thymus Gland ◽  
Acute Malnutrition ◽  
Gland Size ◽  
A Prospective Study

scholarly journals Predictors of mortality among hospitalized children with severe acute malnutrition: a prospective study from Uganda

2018 ◽  
Vol 84 (1) ◽  
pp. 92-98 ◽  
Author(s):  
Nicolette Nabukeera-Barungi ◽  
Benedikte Grenov ◽  
Betty Lanyero ◽  
Hanifa Namusoke ◽  
Ezekiel Mupere ◽  
...  
Keyword(s):  
Prospective Study ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Hospitalized Children ◽  
Predictors Of Mortality ◽  
A Prospective Study

scholarly journals Weight and mid-upper arm circumference gain velocities during treatment of young children with severe acute malnutrition, a prospective study in Uganda

BMC Nutrition ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jolly G. K. Kamugisha ◽  
Betty Lanyero ◽  
Nicolette Nabukeera-Barungi ◽  
Harriet Nambuya-Lakor ◽  
Christian Ritz ◽  
...  
Keyword(s):  
Weight Gain ◽  
Prospective Study ◽  
Severe Acute Malnutrition ◽  
Treatment Phase ◽  
Acute Malnutrition ◽  
Upper Arm ◽  
Arm Circumference ◽  
A Prospective Study ◽  
Mid Upper Arm Circumference ◽  
Over Time

Abstract Background Weight gain is routinely monitored to assess hydration and growth during treatment of children with complicated severe acute malnutrition (SAM). However, changes in weight and mid-upper arm circumference (MUAC) gain velocities over time are scarcely described. We assessed weight and MUAC gain velocities in 6–59 mo-old children with complicated SAM by treatment phase and edema status. Methods This was a prospective study, nested in a randomized/probiotic trial (ISRCTN16454889). Weight and MUAC gain velocities were assessed by treatment phase and edema at admission using linear mixed-effects models. Results Among 400 children enrolled, the median (IQR) age was 15.0 (11.2;19.2) months, 58% were males, and 65% presented with edema. During inpatient therapeutic care (ITC), children with edema vs no edema at admission had negative weight gain velocity in the stabilization phase [differences at day 3 and 4 were − 11.26 (95% CI: − 20.73; − 1.79) g/kg/d and − 13.09 (95% CI: − 23.15; − 3.02) g/kg/d, respectively]. This gradually changed into positive weight gain velocity in transition and eventually peaked at 12 g/kg/d early in the rehabilitation phase, with no difference by edema status (P > 0.9). During outpatient therapeutic care (OTC), overall, weight gain velocity showed a decreasing trend over time (from 5 to 2 g/kg/d), [difference between edema and non-edema groups at week 2 was 2.1 (95% CI: 1.0;3.2) g/kg/d]. MUAC gain velocity results mirrored those of weight gain velocity [differences were − 2.30 (95% CI: − 3.6; − 0.97) mm/week at week 1 in ITC and 0.65 (95% CI: − 0.07;1.37) mm/week at week 2 in OTC]. Conclusions Weight and MUAC gain velocities among Ugandan children with complicated SAM showed an increasing trend during transition and early in the rehabilitation phase, and a decreasing trend thereafter, but, overall, catch-up growth was prolonged. Further research to establish specific cut-offs to assess weight and MUAC gain velocities during different periods of rehabilitation is needed.

scholarly journals Examining Response to Treatment of Severe Acute Malnutrition in Children 6–59 Months Old in Afghanistan, Chad, Mali, and Niger (P12-002-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Erin Boyd
Keyword(s):  
Weight Gain ◽  
Health Center ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Daily Weight Gain ◽  
Z Score ◽  
Factors Affecting ◽  
Number Of Children ◽  
Status Number ◽  
Significant Factors

Abstract Objectives Identify the most significant factors affecting the trajectory of recovery from severe acute malnutrition (SAM), as measured by average daily weight gain in each child 6–59 months of age who were diagnosed and treated for SAM and treated, adjusting for covariates including: breastfeeding status, number of children in household, illness, and distance to health center. Hypothesis 1a: Children 6–59 months enrolled in SAM treatment have slower times to recovery and slower weight gain if they are admitted for treatment at a lower anthropometric cut-off admission (weight for height z-score < −4) than children admitted for treatment at a higher anthropometric cut-off (weight for height z-score ≥ −4). Hypothesis 1b: Older children (24–59 months) recover more quickly than younger children (6–23 months) controlling for ration size. Methods A retrospective panel data analysis on children 6–59 months enrolled in standard outpatient treatment for severe acute malnutrition (SAM) between 2014 and 2016 was conducted. The study period was between September-December 2018. Children were exhaustively sampled. Children with edema, children with implausible z-scores for W/H (<−5 and >5) and H/A (<−6 and >6), children who were referred for inpatient therapeutic feeding to a stabilization center, and children from the same household, except in the case of twins, were eliminated from the analysis. There was one database per country. A total of 1384 children between 6–59 months were included in the analysis. Results The most significant factors affecting the proportional weight gain include age at enrollment (P = 0.001, 95%CI = −0.00—0.00) and Weight for height z-score (WHZ) (P = 0.00, 95%CI = 0.04—0.05) in each child 6–59 months of age who were diagnosed with SAM and treated, adjusting for covariates including: breastfeeding status, number of children in household, illness, and distance to health center. Sex of child did not significantly affect proportional weight gain (P = 0.404, 95%CI = −0.012–0.005). Conclusions The existing protocol to treat severe acute malnutrition should be modified to treat younger children and children who are admitted with a lower weight for height z-score due to different vulnerabilities. Funding Sources The research was conducted as part of a dissertation at The Friedman School of Nutrition Science and Policy at Tufts University. Data were obtained from World Vision.

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