scholarly journals The impact of rickets on growth and morbidity during recovery among children with complicated severe acute malnutrition in Kenya: A cohort study

2017 ◽  
Vol 14 (2) ◽  
Author(s):  
Moses M. Ngari ◽  
Johnstone Thitiri ◽  
Laura Mwalekwa ◽  
Molline Timbwa ◽  
Per Ole Iversen ◽  
...  
2016 ◽  
Vol 38 (1) ◽  
pp. 27-36 ◽  
Author(s):  
Cecile Cames ◽  
Marie Varloteaux ◽  
Ndeye Ngone Have ◽  
Alhadji Bassine Diom ◽  
Philippe Msellati ◽  
...  

Objectives: To assess the acceptability of ready-to-use food (RUF)-based outpatient protocols in HIV-infected children and adolescents with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Methods: Plumpy Nut and Plumpy Sup were supplied every 2 weeks and prescribed by weight to SAM and MAM children, respectively. Forty-three children, 24 MAM and 19 SAM, were enrolled. Organoleptic appreciation, feeding modalities, and perceptions surrounding RUF were recorded at week 2. Sachets were counted to measure adherence throughout the study. Results: Median age was 12.2 years (interquartile range: 9.3-14.8), and 91% were on antiretroviral treatment. Overall, 80%, 76%, 68%, and 68% of children initially rated RUF color, taste, smell, and mouth feeling as good. However, feelings of disgust, refusal to eat, fragmentation of intake, self-stigma, and sharing within the household were commonly reported. Eighteen MAM and 7 SAM experienced weight recovery. Recovery duration was 54 days (31-90) in MAM versus 114 days (69-151) in SAM children ( P = .02). Their rate of RUF consumption compared to amount prescribed was approximately 50% from week 2 to week 10. Nine failed to gain weight or consume RUF and were discontinued for clinical management, and 9 dropped out due to distance to the clinic. Conclusion: Initial RUF acceptability was satisfactory. More than half the children had successful weight recovery, although adherence to RUF prescription was suboptimal. However, further research is needed to propose therapeutic foods with improved palatability, alternative and simpler intervention design, and procedures for continuous and tailored psychosocial support in this vulnerable population. Trial registration: NCT01771562 (Current Controlled Trials).


2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Ermias Sisay Chanie ◽  
Getasew Legas ◽  
Shimeles Biru Zewude ◽  
Maru Mekie ◽  
Dagne Addisu Sewyew ◽  
...  

Abstract Background Although severe acute malnutrition is a major public issue among HIV infected children, there is no prior evidence in Ethiopia. Hence, this study aims to assess the time to develop severe acute malnutrition and its predictors among children living with human immunodeficiency virus in Ethiopia, 2012. Methods An institution based retrospective cohort study was conducted in South Gondar hospitals among 363 HIV infected children from February 10, 2014, to January 7, 2021. Epi-data version 3.1 was used to enter data, which was then exported to STATA version 14 for analysis. Besides, WHO (World Health Organization) Anthro Plus software was used to assess the nutritional status of the children. A standardized data extraction tool was used to collect the data. The Kaplan Meier survival curve was used to estimate the median survival time. The Cox-proportional hazard model assumption was checked via the Schoenfeld residual ph test and a stph plot. Bivariable and multivariable Cox proportional hazard models were employed at 95% confidence intervals (CI). A variable having a p-value < 0.05 was considered a statistically significant predictor of severe acute malnutrition. Results A total of 363 children living with HIV, 97 (26.72%) developed severe acute malnutrition during the follow-up period. The overall incidence rate was 5.4 (95% CI: 4.7–5.9) person per year with a total of 21, 492 months or 1791 years of observation. Moreover, the median survival time was 126 months. Treatment failure [AHR =3.4 (95% CI: 2.05–5.75)], CD4 count below threshold [AHR =2.5 (95% CI: 1.64–3.95)], and WHO stage III & IV [AHR =2.9 (95% CI: 1.74–4.73)] were all significant predictors of severe acute malnutrition. Conclusion The time to develop severe acute malnutrition was found to be very low. Treatment failure, CD4 count below threshold, and WHO stage III were all significant predictors of severe acute malnutrition. Hence, emphasizing those predictor variables is essential for preventing and controlling the occurrence of severe acute malnutrition among HIV infected children.


2019 ◽  
Vol 210 ◽  
pp. 26-33.e3 ◽  
Author(s):  
Benedikte Grenov ◽  
Betty Lanyero ◽  
Nicolette Nabukeera-Barungi ◽  
Hanifa Namusoke ◽  
Christian Ritz ◽  
...  

EBioMedicine ◽  
2019 ◽  
Vol 45 ◽  
pp. 464-472 ◽  
Author(s):  
Celine Bourdon ◽  
Natasha Lelijveld ◽  
Debbie Thompson ◽  
Prasad S. Dalvi ◽  
Gerard Bryan Gonzales ◽  
...  

2020 ◽  
Author(s):  
Teshale Ayele Mega ◽  
Firehiwot Belayneh Usamo ◽  
Getandale Zeleke Negera

Abstract BackgroundAbacavir (ABC) and Zidovudine(AZT) based regimens are the preferred first line nucleoside reverse transcriptase (NRTIs) backbones being widely utilized for managing HIV infection in children. However, there is a dearth of data regarding the clinical outcomes and associated risk factors in Ethiopia. We compared the proportion of mortality and the rate of occurrence of Opportunistic Infections (OIs) with ABC versus AZT based regimens in a cohort of HIV-infected children. MethodsA 42 months retrospective cohort study was conducted. A total of 179 records were reviewed by including data from October 2014 to April 2017. Data were collected on socio-demographic, clinical characteristics of patients and drug related variables. Data were analyzed using STATA13.1. Kaplan-Meier and Cox regression were used to compare survival experience and identify independent predictors. Propensity score matching analysis was conducted to elucidate the average treatment effects of each regimen over OIs.ResultOf 179 patients, 98 (54.7%) were females. The mean (+SD) age of the study subjects was 6.53 ± 2.83 years. Through 42 months analysis, a total of 4 patients (1 (1.14%) from ABC group and 3 (3.3%) from AZT group (p=0.339)) were died. The incidence of opportunistic infections attributed to ABC group was 8.77/100,000 person years (py) and that of AZT was 6.9/100,000py. The incidence rate ratio (IRR) for OIs was (IRR=0.87, 95% CI [0.49-1.53] (p=0.304). Baseline CD4 count (AHR= 0.99, 95% CI [0.98-0.99]), Severe acute malnutrition AHR=15.92, 95% CI [5.34-47.50], and exposure to tuberculosis treatment (AHR=2.93, 95% CI [1.39-6.17]) were the independent predictors for the development of OIs. ConclusionABC and AZT based ART regimens seem to have comparable survival benefit among HIV-infected children in Ethiopia. Therefore, both regimens might be used as an alternative in resource limited settings.


2020 ◽  
Vol 42 ◽  
pp. e2020003 ◽  
Author(s):  
Mekonen Adimasu ◽  
Girum Sebsibie ◽  
Fikrtemariam Abebe ◽  
Getaneh Baye ◽  
Kerebih Abere

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.


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