Assessment, outcomes and implications of multiple anthropometric deficits in children

BackgroundMalnutrition in children is widely prevalent around the world. It has been observed that malnourished children with multiple anthropometric deficits have higher mortality. However, adequate studies are not available on the outcome and recovery of these children.Nandurbar, a tribal district from Maharashtra, India, shows high prevalence of all three forms of malnutrition, often occurring simultaneously. A project previously undertaken in Nandurbar from July 2014 to June 2016 studied the effect of various therapeutic feeds in treatment of children with uncomplicated severe acute malnutrition (SAM). In this study, we analyse secondary data from it to correlate effects of stunting, wasting and underweight on treatment recovery.MethodsAnalysis was done on 5979 children with SAM using linear and logistic regression on R software for recovery rates and weight gain in children with SAM with single versus multiple anthropometric deficits, their relation to age, sex, and recovery from severe stunting by gain in height.ResultsThe mean age of children was 35 months and 53.1% of the children were males. 2346 (39.2%) children recovered at the end of the 8-week treatment. 454 (7.6%) had single anthropometric deficit (SAM only), 3164 (52.9%) had two anthropometric deficits (SAM and severe underweight (SUW)) and 2355 (39.4%) children had three anthropometric deficits (SAM, SUW and severe stunting). Out of the 5979 children with SAM, only 52 (0.9%) of children were not underweight (severe or moderate).44.94% of children with SAM who were severely stunted recovered, compared with 35.52% of children who were not (p<0.001). After controlling for confounders, severe stunting was found to increase the odds of recovery by 1.49. Severely stunted children with SAM also showed faster recovery and weight gain by 1.93 days (p<0.012) and 0.29 g/kg/day (p<0.001), respectively. Recovery was higher in females and younger age group. Recovery was also found to depend on the therapeutic feed, with children receiving medical nutrition therapy showing better recovery for severely stunted children.ConclusionOur findings corroborate previous literature that stunting is a way for the body to deal with chronic stress of nutritional deprivation and provides a survival advantage to a child.

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Nutrition Assessment of Under-Five Children in Sudan: Tracking the Achievement of the Global Nutrition Targets

Children ◽

10.3390/children8050363 ◽

2021 ◽

Vol 8 (5) ◽

pp. 363

Author(s):

Mohamed Abu-Manga ◽

Ayoub Al-Jawaldeh ◽

Abdul Baseer Qureshi ◽

Amira M. Elmunier Ali ◽

Damiano Pizzol ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Secondary Data ◽

Well Being ◽

Acute Malnutrition ◽

Survey Method ◽

Micronutrient Deficiencies ◽

Severe Stunting ◽

Under Five ◽

The Government ◽

Global Nutrition

Background: Malnutrition places a heavy burden on the health, well-being, and sustainable development of populations in Sudan, especially a country affected by conflict, which continues to experience high levels of food insecurity, undernutrition, and micronutrient deficiencies; 3.3 million are acutely malnourished, with 522,000 children suffering from severe acute malnutrition and approximately 2.2 million children requiring treatment for moderate acute malnutrition. This study aims to describe the nutritional status of children under five years old and identify the progress toward the achievement of the Global Nutrition Targets. Methods: This is a secondary data analysis of a quantitative survey, using the second-round of the Simple Spatial Survey Method (S3M II) in Sudan in the period 2018–2019. The analysis used an area-based sampling methodology in all 18 Sudanese states. Data from the WHO Tracking Tools of the Global Nutrition Targets was used to reflect the progress in achieving the targets in Sudan. Results: Global stunting prevalence was at 36.35 percent including moderate stunting prevalence and severe stunting prevalence (21.25 percent and 15.06 percent respectively). Global wasting prevalence was 13.6 percent including moderate wasting prevalence and severe wasting prevalence (10.8 percent and 2.7 percent respectively). Sudan has made great progress in achieving the target of increasing exclusive breastfeeding. However, despite the welcome commitments by the Government and all stakeholders, Sudan is still struggling to implement strategies, policies, and regulatory measures to address malnutrition and achieve the Global Nutrition Targets in 2025 and the Sustainable Developmental Goals in 2030. Therefore, more than ever, there is a need for comprehensive, multi-sectoral action to address malnutrition in all its forms.

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Nursing Process of Enterocutaneous Fistula Patient with Severe Acute Malnutrition in Pediatric Surgical Ward

UI Proceedings on Health and Medicine ◽

10.7454/uiphm.v4i1.241 ◽

2020 ◽

Vol 4 (1) ◽

pp. 8

Author(s):

Sari Rahmawati ◽

Fajar Tri Waluyanti

Keyword(s):

Body Weight ◽

Weight Gain ◽

Severe Acute Malnutrition ◽

Enterocutaneous Fistula ◽

Nursing Intervention ◽

The Body ◽

Acute Malnutrition ◽

Hospital Treatment ◽

Surgical Ward

Objective: This case study aims to prove the effectiveness of nursing intervention, particularly management of nutrition, fluid and electrolyte, ostomy care, and risk for infection management, at managing enterocutaneous fistula patient with severe acute malnutrition in pediatric surgical ward.Methods: This case study was performed by giving nursing care of enterocutaneous fistula patient with severe acute malnutrition for about 13 days based on the patient’s length of stay.Results: The target for weight gain in malnourished children was ≥ 50 grams/kg/week. Within thirteen days, weight of the patient rose 450 grams from 4700 grams to 5150 grams. Patient’s weight gain target was 470 grams in 14 days, this condition showed that increase in body weight was quite appropriate. Fistula output was decreased day by day and feces that came out from from anus has better solid consistency than before.Conclusion: Nutrition management aims to increase body weight during the preoperative period of the client. Hospital treatment managed to increase weight, the child did not experience vomiting and diarrhea from the first day of treatment, and appetite continued to increase every day. This is in accordance with the outcome criteria that has been established for the main problem of imbalanced nutrition: less than the body requirement. Furthermore, children are advised to get follow up care with regular weekly control obligations. Keywords: child; enterocutaneous; fistula; malnutrition; nursing

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Assessment of Clinical Outcome in Children with Severe Thinness on Medical Nutrition Therapy at 8 Weeks and 6 Months

Current Research in Nutrition and Food Science Journal ◽

10.12944/crnfsj.9.2.19 ◽

2021 ◽

Vol 9 (2) ◽

pp. 564-569

Author(s):

Dr Vishal D. Sawant ◽

Dr Varun Viswanathan ◽

Dr Alka Jadhav ◽

Dr Madhubala Jadhav ◽

Dr Swathi Krishna ◽

...

Keyword(s):

Weight Gain ◽

Clinical Outcome ◽

Nutrition Therapy ◽

The Body ◽

Acute Malnutrition ◽

Medical Nutrition Therapy ◽

Micronutrient Deficiencies ◽

Under Nutrition ◽

Medical Nutrition

The term malnutrition involves both over nutrition, accompanying with overweight, obesity, and under-nutrition including acute and chronic malnutrition as well as micronutrient deficiencies. The present study was undertaken to assess clinical outcome at 8 weeks and 6 months in children with Severe Thinness on Medical Nutrition Therapy (MNT). A total of 52 severe thinness (ST) children were enrolled and given MNT. The anthropometry was recorded at every visit and analyzed at two time points viz.8 weeks and 6 months. The body mass index has been measured using formula: weight (kg)/height(metre)2. Mean weight on enrolment was 15.85±4.08 kg. At 8 weeks, mean weight was 17.35±4.55 kg and at 6 months it was 19.33±5.12 kg. Mean height on enrolment was 114.33±14.06 cm while at 8 weeks was 115.27±14.06 cm and at 6 months was 120.21±15.29 cm. Mean BMI on enrolment was 11.92±0.44kg/m2 while at 8 weeks it improved to 12.89±0.67kg/m2; at 6 months, it continued improved to 13.26±0.96kg/m2. Rate of weight gain from enrolment to 8 weeks was 1.67 grams/kg/day and from 8 weeks to 6 months was 0.36 gm/kg/day (P<0.001). At end of 8 weeks, in 73.33% subjects BMI improved to thin and 17.8% became normal while 8.9 % continued to remain ST. At 6 months, 22.22% remained ST, 33.33% subjects remained thin and 44.44% became normal. Improvement in mean weight and mean BMI as well as rate of weight gain was significant indicating the role of indigenously prepared MNT in improving acute malnutrition.

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Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study

BMC Pediatrics ◽

10.1186/s12887-021-02651-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amare Kassaw ◽

Desalegne Amare ◽

Minyichil Birhanu ◽

Aragaw Tesfaw ◽

Shegaw Zeleke ◽

...

Keyword(s):

Public Health ◽

Oxygen Saturation ◽

Retrospective Cohort ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Altered Consciousness ◽

Time To Death ◽

Under Five ◽

Predictors Of Mortality ◽

Malnourished Children

Abstract Background Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers. Methods A facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance. Results Out of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition. Conclusion The overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.

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Development and Acceptability of Locally Made Fish-Based, Ready-to-Use Products for the Prevention and Treatment of Malnutrition in Cambodia

Food and Nutrition Bulletin ◽

10.1177/0379572118788266 ◽

2018 ◽

Vol 39 (3) ◽

pp. 420-434 ◽

Cited By ~ 8

Author(s):

Sanne Sigh ◽

Nanna Roos ◽

Daream Sok ◽

Bindi Borg ◽

Chhoun Chamnan ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Treatment Intervention ◽

Intervention Trial ◽

Overall Acceptability ◽

High Prevalence ◽

Prevention And Treatment ◽

Moderate Acute Malnutrition ◽

Hedonic Scale ◽

Supplementary Foods

Background: Cambodia has a high prevalence of moderate acute malnutrition and severe acute malnutrition (SAM). The SAM treatment requires ready-to-use therapeutic foods (RUTFs), whereas ready-to-use supplementary foods (RUSFs) are used for prevention of acute malnutrition. Three locally produced fish-based products were developed: an RUTF paste (NumTrey-Paste) for treatment and 2 wafer versions, one for prevention (NumTrey-RUSF) and one for treatment (NumTrey-RUTF). Objective: To assess the acceptability of NumTrey-Paste and NumTrey-RUSF in comparison to a standard biscuit product (BP-100) used for the treatment of SAM. Methods: Acceptability of NumTrey-RUSF and NumTrey-Paste was tested in a nonblinded crossover taste trial among children (n = 52), aged ≥ 6 months to 18 years, and their caregivers. Eight organoleptic qualities were assessed on a 5-point hedonic scale, as well as a ranking test. A score of 1 to 3 was categorized as acceptable. The acceptability of NumTrey-RUTF was assessed using the caregivers’ perception during an SAM treatment intervention. Results: Taste trial: The proportion of children categorizing products as overall acceptable was lowest for NumTrey-Paste compared to for BP-100 and NumTrey-RUSF (21% vs 43% [BP-100] and 36% [NumTrey-RUSF]). No difference was found in the proportion of children who ranked BP-100 or NumTrey-RUSF as “liked most” ( P > .05). Acceptability of NumTrey-RUSF ranked highest in appearance and taste (caregiver), whereas acceptability of NumTrey-Paste was ranked lowest in appearance and smell among the products. Intervention trial: The acceptability of NumTrey-RUTF increased from 72% to 86%. Conclusions: The overall acceptability was ranked lowest for a pure paste product. However, filling the paste into a wafer made the product more acceptable.

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Increased risk of acquisition and transmission of ESBL-producing Enterobacteriaceae in malnourished children exposed to amoxicillin

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz487 ◽

2019 ◽

Vol 75 (3) ◽

pp. 709-717 ◽

Cited By ~ 3

Author(s):

Naouale Maataoui ◽

Céline Langendorf ◽

Fatou Berthe ◽

Jumamurat R Bayjanov ◽

Willem van Schaik ◽

...

Keyword(s):

Placebo Group ◽

Severe Acute Malnutrition ◽

Controlled Trial ◽

Acute Malnutrition ◽

Double Blind ◽

Adjusted Risk ◽

Malnourished Children ◽

Nutritional Recovery ◽

Adjusted Risk Ratio ◽

Increased Risk

Abstract Objectives Routine amoxicillin for children with uncomplicated severe acute malnutrition raises concerns of increasing antibiotic resistance. We performed an ancillary study nested within a double-blind, placebo-controlled trial in Niger testing the role of routine 7 day amoxicillin therapy in nutritional recovery of children 6 to 59 months of age with uncomplicated severe acute malnutrition. Methods We screened 472 children for rectal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) as well as their household siblings under 5 years old, at baseline and Week 1 (W1) and Week 4 (W4) after start of therapy, and characterized strains by WGS. ClinicalTrials.gov: NCT01613547. Results Carriage in index children at baseline was similar in the amoxicillin and the placebo groups (33.8% versus 27.9%, P = 0.17). However, acquisition of ESBL-E in index children at W1 was higher in the amoxicillin group than in the placebo group (53.7% versus 32.2%, adjusted risk ratio = 2.29, P = 0.001). Among 209 index and sibling households possibly exposed to ESBL-E transmission, 16 (7.7%) had paired strains differing by ≤10 SNPs, suggesting a high probability of transmission. This was more frequent in households from the amoxicillin group than from the placebo group [11.5% (12/104) versus 3.8% (4/105), P = 0.04]. Conclusions Among children exposed to amoxicillin, ESBL-E colonization was more frequent and the risk of transmission to siblings higher. Routine amoxicillin should be carefully balanced with the risks associated with ESBL-E colonization.

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

Current Developments in Nutrition ◽

10.1093/cdn/nzz035.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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Predictors of recovery in children aged 6–59 months with uncomplicated severe acute malnutrition: a multicentre study

Public Health Nutrition ◽

10.1017/s1368980020004723 ◽

2020 ◽

pp. 1-9

Author(s):

Sam Marconi David ◽

Preethi N Ragasudha ◽

Sunita Taneja ◽

Sanjana Brahmawar Mohan ◽

Sharad D Iyengar ◽

...

Keyword(s):

Peer Support ◽

Employment Status ◽

Tamil Nadu ◽

Severe Acute Malnutrition ◽

Controlled Trial ◽

Secondary Data ◽

Treatment Phase ◽

Female Child ◽

Hazard Ratio ◽

Acute Malnutrition

Abstract Objective: To identify predictors of recovery in children with uncomplicated severe acute malnutrition (SAM). Design: This is a secondary data analysis from an individual randomised controlled trial, where children with uncomplicated SAM were randomised to three feeding regimens, namely ready-to-use therapeutic food (RUTF) sourced from Compact India, locally prepared RUTF or augmented home-prepared foods, under two age strata (6–17 months and 18–59 months) for 16 weeks or until recovery. Three sets of predictors that could influence recovery, namely child, family and nutritional predictors, were analysed. Setting: Rural and urban slum areas of three states of India, namely Rajasthan, Delhi and Tamil Nadu. Participants: In total, 906 children (age: 6–59 months) were analysed to estimate the adjusted hazard ratio (AHR) using the Cox proportional hazard ratio model to identify various predictors. Results: Being a female child (AHR: 1·269 (1·016, 1·584)), better employment status of the child’s father (AHR: 1·53 (1·197, 1·95)) and residence in a rental house (AHR: 1·485 (1·137, 1·94)) increased the chances of recovery. No hospitalisation (AHR: 1·778 (1·055, 2·997)), no fever, (AHR: 2·748 (2·161, 3·494)) and ≤ 2 episodes of diarrhoea (AHR: 1·579 (1·035, 2·412)) during the treatment phase; availability of community-based peer support to mothers for feeding (AHR: 1·61 (1·237, 2·097)) and a better weight-for-height Z-score (WHZ) at enrolment (AHR: 1·811 (1·297, 2·529)) predicted higher chances of recovery from SAM. Conclusion: The probability of recovery increases in children with better WHZ and with the initiation of treatment for acute illnesses to avoid hospitalisation, availability of peer support and better employment status of the father.

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The effects of malnutrition on cardiac function in African children

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-309188 ◽

2015 ◽

Vol 101 (2) ◽

pp. 166-171 ◽

Cited By ~ 11

Author(s):

Jonathan A Silverman ◽

Yamikani Chimalizeni ◽

Stephen E Hawes ◽

Elizabeth R Wolf ◽

Maneesh Batra ◽

...

Keyword(s):

Heart Rate ◽

Cardiac Function ◽

Severe Acute Malnutrition ◽

Resistance Index ◽

Stroke Volume Index ◽

Acute Malnutrition ◽

Volume Index ◽

Severe Malnutrition ◽

Systemic Vascular Resistance Index ◽

Malnourished Children

ObjectiveCardiac dysfunction may contribute to high mortality in severely malnourished children. Our objective was to assess the effect of malnutrition on cardiac function in hospitalised African children.DesignProspective cross-sectional study.SettingPublic referral hospital in Blantyre, Malawi.PatientsWe enrolled 272 stable, hospitalised children ages 6–59 months, with and without WHO-defined severe acute malnutrition.Main outcome measuresCardiac index, heart rate, mean arterial pressure, stroke volume index and systemic vascular resistance index were measured by the ultrasound cardiac output monitor (USCOM, New South Wales, Australia). We used linear regression with generalised estimating equations controlling for age, sex and anaemia.ResultsOur primary outcome, cardiac index, was similar between those with and without severe malnutrition: difference=0.22 L/min/m2 (95% CI −0.08 to 0.51). No difference was found in heart rate or stroke volume index. However, mean arterial pressure and systemic vascular resistance index were lower in children with severe malnutrition: difference=−8.6 mm Hg (95% CI −12.7 to −4.6) and difference=−200 dyne s/cm5/m2 (95% CI −320 to −80), respectively.ConclusionsIn this largest study to date, we found no significant difference in cardiac function between hospitalised children with and without severe acute malnutrition. Further study is needed to determine if cardiac function is diminished in unstable malnourished children.

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