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.

scholarly journals Recovery time from severe acute malnutrition and associated factors among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

2020 ◽  
Vol 42 ◽  
pp. e2020003 ◽  
Author(s):  
Mekonen Adimasu ◽  
Girum Sebsibie ◽  
Fikrtemariam Abebe ◽  
Getaneh Baye ◽  
Kerebih Abere
Keyword(s):  
Cohort Study ◽  
Weight Gain ◽  
Retrospective Cohort Study ◽  
Recovery Time ◽  
Retrospective Cohort ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Daily Weight Gain ◽  
Nutritional Recovery ◽  
Length Of Hospitalization

OBJECTIVES: Recovery time from severe acute malnutrition (SAM) is often a neglected topic despite its clinical impact. Although a few studies have examined nutritional recovery time, the length of hospitalization in those studies varied greatly. Therefore, the aim of this study was to determine the recovery time from SAM and to identify predictors of length of hospitalization among under-5 children.METHODS: A retrospective cohort study was conducted among 423 under-5 children with SAM who had been admitted to Yekatit 12 Hospital. Kaplan-Meier analysis was used to estimate time to nutritional recovery, and Cox proportional hazard regression analysis was performed to determine independent predictors.RESULTS: The nutritional recovery rate was 81.3%, and the median recovery time was 15.00 days (95% confidence interval [CI], 13.61 to 16.39). Age, daily weight gain per kilogram of body weight, vaccination status, and the existence of at least 1 comorbidity (e.g., pneumonia, stunting, shock, and deworming) were found to be significant independent predictors of nutritional recovery time. The adjusted hazard ratio (aHR) for nutritional recovery decreased by 1.9% for every 1-month increase in child age (aHR, 0.98; 95% CI, 0.97 to 0.99).CONCLUSIONS: The overall nutritional recovery time in this study was within the Sphere standards. However, approximately 13.0% of children stayed in the hospital for more than 28.00 days, which is an unacceptably large proportion. Daily weight gain of ≥8 g/kg, full vaccination, and deworming with albendazole or mebendazole reduced nutritional recovery time. Conversely, older age, pneumonia, stunting, and shock increased nutritional recovery time.

scholarly journals Predicators for Weight Gain in Children Treated for Severe Acute Malnutrition: A Prospective Study at Nutritional Rehabilitation Center

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Jyoti Sanghvi ◽  
Sudhir Mehta ◽  
Ravindra Kumar
Keyword(s):  
Socioeconomic Status ◽  
Weight Gain ◽  
Severe Acute Malnutrition ◽  
Previous History ◽  
Educational Status ◽  
Acute Malnutrition ◽  
Factors Affecting ◽  
Adequate Diet ◽  
Target Weight ◽  
The Impact

Introduction. Despite being an important health problem in developing countries, there is little information available on factors affecting the severe acute malnutrition, especially nondietary factors. Objective. To study the impact of various factors, especially nondietary ones affecting directly or indirectly the weight gain in children with severe acute malnutrition. Method. A total of 300 children in the age group of 6 to 60 months meeting the WHO criteria for severe acute malnutrition were enrolled in the study. These children were provided special therapeutic diet as recommended by WHO/UNICEF protocol. Children were called for followup every 15 days up to 2 months after discharge to evaluate whether these children have achieved a final target weight gain of 15% of their admission weight. The impact of nondietary factors related to child, mother, and socioeconomic status was evaluated. Data collected through structured questionnaire were analyzed. Result. 172 (57.4%) of the total 300 children did not gain final target weight despite giving adequate diet. We observed that impact of various nondietary factors like mother’s educational status and her knowledge about feeding practices, socioeconomic status, previous history, and present evidence of infection in child was important in determining the weight of child. No association was found with gender of child, BMI of mother, and father’s educational status on the weight gain of child. Conclusion. The findings of this study confirm the association of many nondietary factors with weight gain in children treated for severe acute malnutrition. To reduce malnutrition emphasis should be given on these factors.

scholarly journals MANAGEMENT OF INFANTS LESS THAN SIX MONTHS WITH SEVERE ACUTE MALNUTRITION (SAM).

2020 ◽  
Vol 27 (06) ◽  
pp. 1113-1118
Author(s):  
Saadia Khan ◽  
Gul Hasan ◽  
Ibad Ali ◽  
Reema Arshad ◽  
Imrana Ali ◽  
...  
Keyword(s):  
Weight Gain ◽  
Breast Feeding ◽  
Maternal Education ◽  
Severe Acute Malnutrition ◽  
National Level ◽  
Acute Malnutrition ◽  
Daily Weight Gain ◽  
Average Weight ◽  
Breast Feed ◽  
Study Results

Objectives: To determine the average weight gain after lactation counseling therapy in infants up to six months of age having severe acute malnutrition. Study Design: Quasi experimental trial. Setting: Stabilization Center Unit, the Children’s Hospital & the Institute of Child Health, Multan. Period: 1st October 2015 to 1st October 2016. Material & Methods: A total of 205 children with SAM were included in this study using non-probability consecutive sampling technique. Mothers of these children were motivated for more than 8 feeds/day, positioning and attachment at breast feeding was advised, demonstrated and monitored. All the data obtained was entered and analyzed by SPSS version 20. Results: Of these 205 study cases, 142 (69.3%) were boys and 63 (30.75) were girls. Mean age of our study cases was 3.75 ± 1.39 months (with minimum age of our study cases was 2 months while maximum age was 6 months). Of these 205 study cases, 101 (49.3 %) were from rural areas while 104 (50.7%) were from urban areas. Mothers of 117 (57.1%) study cases were literate while 88 (42.9%) were illiterate. Majority of our study cases i.e. 129 (62.9%) were from middle income background and 76 (37.1%) were from poor social background. Partial breast feeding was positive in 145 (70.7%) of our study cases and no breast feeding was noted in 60 (29.3%). Mean baseline weight was 2737.07± 585.60 grams. Mean weight at discharge was 2995.37 ± 621.97 grams and mean weight gain was 800.0 ± 258. 29 grams. Average daily weight gain was noted to be 11.27 ± 4.73 g/kg/day. Conclusion: Our study results have shown that lactation counseling therapy significantly improves weight gain in children under 6 months of age with severe acute malnutrition. Mothers of infants presenting with malnutrition must be counselled to breast feed to improve their clinical outcomes. Mean weight gain was significantly associated with maternal education and socioeconomic status. Further studies are suggested from different parts of the country to generate our local data at national level which may be incorporated for national health policy guidelines.

scholarly journals Study to determine gender variation in severe acute malnutrition at nutrition rehabilitation centre

2019 ◽  
Vol 6 (2) ◽  
pp. 602
Author(s):  
Suguna S. ◽  
Vidyasagar V.
Keyword(s):  
Weight Gain ◽  
District Hospital ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Rehabilitation Centre ◽  
Gender Variation ◽  
Nutrition Rehabilitation ◽  
Time Of Admission ◽  
Discharge Criteria

Background: The objective of this study is to know the gender variation in number of admissions, severity of malnutrition at the time of admission, gaining of weight and adherence to follow up in children admitted to nutrition rehabilitation center and during follow up.Methods: This is a retrospective study involving the review of existing programme records. Children who were admitted to nutrition rehabilitation centre, district hospital, Chamarajanagar, Karnataka, India, between January 2017 to December 2017 with severe acute malnutrition were involved in the study. The programme included 2 weeks of in-patient care, and four follow-up visits to the NRC subsequently as follows; 1st visit at 7 days, 2nd at 14 days, 3rd at 1 month and 4th at 2 months after discharge.Results: Among 57 children who admitted to NRC females were 30 (52.6%) and males 27 47.4%). 25 among 57 children (43.9%) could sustain weight gain of >5grams/kg/day as per one of the discharge criteria. 13 (52%) were females and 12 (48%) were males. 32(56%) among 57 admitted children to NRC, could achieve <-1SD during entire programmed. 15(46.8%) were females and 17 (53.1%) were males.Conclusions: There was no gender variation in either number of admission or severity of malnutrition at the time of admission or weight gain during NRC programme.

scholarly journals Evaluation of anthropometric indicators in malnourished children at Nutritional Rehabilitation Center, Gujarat, India

2019 ◽  
Vol 6 (4) ◽  
pp. 1410
Author(s):  
Dhara Patel ◽  
Nisha Upadhyay
Keyword(s):  
Severe Acute Malnutrition ◽  
Nutritional Intervention ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Daily Weight Gain ◽  
Cross Sectional ◽  
Clinical Criteria ◽  
Anthropometric Indicators ◽  
Malnourished Children ◽  
Intervention Measures

Background: It is very difficult to recognize the cases with mild-to-moderate malnutrition because clinical criteria for their diagnosis are imprecise and are difficult to interpret accurately. The objective of the study was daily weight gain in gram/kg/day in severely malnourished children.Methods: This was a hospital based cross sectional study in which total of 114 consecutive patients of SAM less than 5 years treated for complications of severe acute malnutrition using WHO protocol. The study design included 114 children from the NRC and then followed up the period of 6 months to assess the nutritional status during the period of initial stage and the entire follow up period using available record of anthropometry indicators of the admitted children recruited in the study at the NRC.Results: Mean weight at admission was 6.4 Kg, 6.5 Kg and 6.2 Kg of overall, boys and girls respectively. Mean weight at discharge was 6.8 Kg, 6.7 Kg and 6.6 Kg of overall, boys and girls respectively. Mean MUAC at admission was 10.7 cm, 10.9 cm and 10.6 cm of overall, boys and girls respectively. Mean MUAC at discharge was 10.9 cm, 10.9 cm and 10.8 cm of overall, boys and girls respectively.Conclusions: For treatment of severe acute malnutrition, systematic guidelines required, thus this study indicates that following WHO guidelines, it has become easier to manage SAM in hospital settings, with least possible stay at hospital. The objective of the study was to know the effect of nutritional intervention measures on selected anthropometric indicators of severe acute malnourished children.

scholarly journals STUDY OF NUTRITIONALAND IMMUNIZATION STATUS IN CHILDREN 6 MONTHS TO 3 YEARS ATTENDING IMMUNIZATION CLINIC, UHTC, IGIMS, PATNA.

2020 ◽  
pp. 1-3
Author(s):  
Abha Kumari ◽  
Sanjay Kumar Choudhary* ◽  
Sanjay Kumar
Keyword(s):  
Breast Feeding ◽  
Low Socioeconomic Status ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Great Effort ◽  
Exclusive Breast Feeding ◽  
Number Of Children ◽  
Immunization Status ◽  
Good Nutrition ◽  
Moderate Acute Malnutrition

Background: In the rst three years of life, good nutrition plays an important role in forming a good foundation that has impact on child's future physical and mental development. In this study we are focussing on the nutritional and immunization status in children 6months to 3 years attending immunization clinic,UHTC,IGIMS,PATNA with special emphasis to identify moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) cases. Methods : It is an observational study carried out immunization clinic at UHTC,I.G.I.M.S. Patna included 400 cases age between 6 months to 3 years This study was conducted from January 2019 to June 2019 in immunization clinic UHTC, IGIMS Patna. Results:Incidence of SAM and MAM is 7.5% and 30.75 % respectively. Female predominance was seen in SAM and MAM i.e. 53.4% and 54.6% respectively. Signicant association of under-nutrition was found with LBW (p<0.05), not giving exclusive breast feeding up to 6 months of life (p<0.05) and, Low socioeconomic status (p<0.001). Higher numbers of females were unvaccinated. Conclusions: Despite our great effort for improving maternal and child health, signicant number of children are malnourished and unimmunized. So, for their better health we need to start from birth, institutional delivery, exclusive breast feeding, immunization, and timely introduction of complementary feeds, marriages at appropriate age, proper antenatal visits and birth spacing.

scholarly journals Comparing azithromycin to amoxicillin in the management of uncomplicated severe acute malnutrition in Burkina Faso: a pilot randomized trial

2021 ◽  
Author(s):  
Kieran S O'Brien ◽  
Ali Sié ◽  
Clarisse Dah ◽  
Millogo Ourohire ◽  
Moussa Ouédraogo ◽  
...  
Keyword(s):  
Single Dose ◽  
Weight Gain ◽  
Adverse Events ◽  
Burkina Faso ◽  
Randomized Trial ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Promising Alternative

Introduction. Given the potential for asymptomatic infection in children with uncomplicated severe acute malnutrition (SAM), the World Health Organization recommends a broad-spectrum antibiotic like amoxicillin. Azithromycin is a promising alternative to amoxicillin as it can be administered as a single dose and has efficacy against several pathogens involved in the burden of infectious disease and mortality in this population. In this pilot study, we aimed to establish the feasibility of a larger randomized controlled trial and to provide preliminary evidence comparing the effect of azithromycin to amoxicillin on weight gain in children with uncomplicated SAM. Methods. This pilot randomized trial enrolled children 6-59 months old with uncomplicated SAM at 6 healthcare centers in Burkina Faso. Participants were randomized to a single dose of azithromycin or a 7-day course of amoxicillin. All participants received ready-to-use therapeutic food and were followed weekly until nutritional recovery and again at 8 weeks. The primary feasibility outcomes included enrollment potential, refusals, and loss to follow-up. The primary clinical outcome was weight gain (g/kg/day) over the 8-week period. Outcome assessors were masked. Results. Between June and October 2020, 312 children were screened, 301 were enrolled with 0 refusals, and 282 (93.6%) completed the 8-week visit. Average weight gain was 2.5 g/kg/day (SD 2.0) in the azithromycin group and 2.6 (SD) 1.7) in the amoxicillin group (Mean Difference -0.1, 95% CI -0.5 to 0.3, P = 0.63). Fewer adverse events were reported in the azithromycin group (Risk Ratio 0.50, 95% CI 0.31 to 0.82, P = 0.006). Conclusions. No differences were found in weight gain between groups. Given the ability to administer a single dose and the potential for fewer adverse events, azithromycin may be an alternative to amoxicillin for uncomplicated SAM. With strong enrollment and follow-up, a larger trial in this setting is feasible.

scholarly journals Changes in serum phosphorous level during inpatient treatment of children with severe acute malnutrition

2019 ◽  
Vol 6 (3) ◽  
pp. 1080
Author(s):  
Dakshayani B. ◽  
Divyashree P. ◽  
Sarala Sabapathi ◽  
Mallesh Kariyappa
Keyword(s):  
Weight Gain ◽  
Inpatient Treatment ◽  
Prospective Observational Study ◽  
Severe Acute Malnutrition ◽  
Serum Phosphate ◽  
Acute Malnutrition ◽  
Stabilization Phase ◽  
Catch Up ◽  
Therapeutic Diets ◽  
Phosphorous Level

Background: SAM children have increased requirements for phosphorus during recovery. If requirements are not met, they may develop refeeding hypophosphatemia leading to increased morbidity and mortality. However, no much studies known about the effect of current therapeutic diets (F-75 and F-100) on serum phosphate in SAM children.Methods: Prospective observational study, in which measuring serum phosphate at admission, at end of stabilization phase and at discharge in SAM children between 6-59 months.Results: Among 35 children enrolled, mean serum phosphate was 4.3 ±0.6 mg/dl at admission, 4.1± 0.8mg/dl at end of stabilization phase and 4.4±0.7mg/dl at discharge. 17% of children had hypophosphatemia at admission, 31% at end of stabilization phase and 17% at discharge. mean weight gain in hypophosphatemia and normophosphatemia groups are 1.3±1.46mg/kg/day and 2.51±2.63mg/kg/day (p=0.1) respectively. Mean duration of stay in hypophosphatemia and normophosphatemia groups are 11.6±1.26 and 10.26±1.54 days respectively (p=0.016).Conclusions: Hypophosphatemia was common among children with SAM at admission and increased at end of stabilization phase. Serum phosphate remains subnormal in about 1/5th of the children at discharge. This could be problematic for further recovery as phosphorus is needed for catch-up growth and bioavailability of phosphorus is low in local diets. Hence, authors suggest phosphorus supplementation in SAM children.

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