scholarly journals Exploring trust in religious leaders and institutions as a mechanism for improving retention in child malnutrition interventions in the Philippines: a retrospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036091
Author(s):  
Lincoln Leehang Lau ◽  
Warren Dodd ◽  
Han Lily Qu ◽  
Donald C Cole
Keyword(s):  
Severe Acute Malnutrition ◽  
The Philippines ◽  
Mixed Effects ◽  
Mixed Effects Model ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Secondary Outcome ◽  
Religious Leaders ◽  
Extreme Poverty ◽  
Factors Associated

ObjectivesIn the context of persistent child malnutrition in the Philippines, the objective of this study was to examine how different dimensions of trust affected programme retention and physiological outcomes when a faith-based organisation (FBO) addressed moderate and severe acute malnutrition among children from households experiencing extreme poverty.SettingWe retrospectively analysed survey data collected by International Care Ministries (ICM) in 2012–2013 across 150 communities in eight provinces (Negros Oriental, Negros Occidental, Bohol, Palawan, Sarangani, South Cotabato, Sultan Kudarat and Zamboanga del Norte) of the Philippines.Study participantsCaregivers of 1192 children experiencing moderate acute malnutrition and severe acute malnutrition between the ages of 6 and 60 months.InterventionA 16-week child malnutrition treatment programme called Malnourished Child Outreach offered by ICM in partnership with local religious leaders and institutions.Primary and secondary outcome measuresProgramme dropout and weight-for-height z-score (WHZ) at the end of the programme for enrolled children were the two outcomes of interest. A logistic mixed-effects model was built to assess factors associated with programme dropout and a linear mixed-effects model for factors associated with WHZ at the end of the programme.ResultsTrust in religious leaders or institutions (−0.87 (95% CI: −1.43,–0.26)) was negatively associated with programme dropout, suggesting that with increasing levels of trust, decreasing proportions of children dropped out of treatment. Retention in the programme led to improved WHZ among participating children (−0.38 (95% CI: −1.43, 0.26)). Various measures of social capital, including trust in religious and public institutions, were not associated with WHZ at the end of the programme.ConclusionsLeveraging pre-existing trust in religious leaders and institutions among households experiencing extreme poverty is one way that ICM, and potentially other FBOs, can promote retention in child nutrition interventions among vulnerable populations.

scholarly journals Comorbidities and Factors Associated with Mortality among Children under Five Years Admitted with Severe Acute Malnutrition in the Nutritional Unit of Jinja Regional Referral Hospital, Eastern Uganda

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Desire Banga ◽  
Melvis Baren ◽  
Namale Vivian Ssonko ◽  
Franck Katembo Sikakulya ◽  
Yves Tibamwenda ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Referral Hospital ◽  
Acute Malnutrition ◽  
Health Concern ◽  
Regional Referral Hospital ◽  
Children Under Five ◽  
Under Five ◽  
Factors Associated ◽  
Eastern Uganda ◽  
Children Under 5

Background. Mortality among children with severe acute malnutrition remains an immense health concern in the hospitals in developing countries, but its attributes are not completely assessed in various hospital settings. The aim of this study was to determine the proportion of mortality, the comorbidities, and factors associated with in-hospital mortality among children under five years of age admitted with severe acute malnutrition at Jinja Regional Referral Hospital, Eastern Uganda. Methods. This was a hospital-based analytical and descriptive prospective cohort study conducted in the nutritional unit of Jinja Regional Referral Hospital. A total of 338 children and their caretakers who met the criteria were consecutively enrolled into the study. Descriptive statistics were used to each of the independent factors, and comorbidities were subjected to chi-squared test followed by logistic regression analysis to assess its association incidence of mortality among children. All independent variables with p values ≤ 0.05 were entered into a multivariate model for factors and comorbidities independently. Factors and comorbidities with p values ≤ 0.05 were considered as associates of mortality among children. Results. Of the 338 children under 5 years of age enrolled, 49 (14.5%) died, although the majority of children were diagnosed with dehydration, 128 (37.9%); pneumonia, 127(37.6%); and malaria, 87(25.7%). Anemia ( aRR = 2.9 , 95% CI: 1.23-6.62, p = 0.01 ), bacteremia ( aRR = 10.0 , 95% CI: 3.62-29.01, p = 0.01 ), HIV ( aRR = 4.8 , 95% CI: 1.42-16.30, p < 0.01 ), TB ( aRR = 4.3 , 95% CI: 1.28-14.49, p < 0.02 ), and shock ( aRR = 60.9 , 95% CI: 9.05-410.28, p < 0.01 ) were the comorbidities significantly associated with a likelihood of mortality. Conclusions. The mortality among children under 5 years of age admitted with severe acute malnutrition is still high (14.5% versus 5%). The comorbidities are significantly associated with mortality. The clinicians are recommended to follow-up closely patients with severe acute malnutrition and to focus on the critical comorbidities identified.

scholarly journals Association of azotemia with hypoglycemia in severe acute malnutrition how much concerning?

2016 ◽  
Vol 4 (1) ◽  
pp. 246
Author(s):  
Syed Manazir Ali ◽  
Hari Shankar Meshram
Keyword(s):  
Odds Ratio ◽  
Associated Factors ◽  
Severe Acute Malnutrition ◽  
Control Design ◽  
Case Control ◽  
Morbidity And Mortality ◽  
Acute Malnutrition ◽  
P Value ◽  
Factors Associated ◽  
Predicting Factors

Background: Hypoglycemia is a known complication of SAM which is to be managed early to prevent morbidity and mortality. There is lack of literature regarding hypoglycemia and its associated factors in SAM children. This study aimed to evaluate predicting factors associated with hypoglycemia in children with severe acute malnutrition (SAM) in NRC.Methods: In this case-control design, we compared clinical and laboratory characteristics of children with and without hypoglycemia taken from a population of 299 children with SAM admitted in NRC.Results: Prevalence of hypoglycemia in SAM was 14%. Amongst the association it was found that deranged creatinine (P value of 0.002, odds ratio 2.9, 95% C.I.1.48 - 5.97) and deranged urea (P value 0.0001, odds ratio 3.6, 95% C.I. 1.79 - 7.2) were statistically significant. Diarrhoea (P value 0.7, odds ratio 1.14, 95% C.I. 0.57 - 2.26), leucocytosis (P value 0.23, odds ratio 0.54, 95% C.I. 0.21 - 2.26), leucopenia ( P value 0.6, odds ratio 0.42, 95% C.I. 0.05 - 3.35) were found statistically insignificant.Conclusions: Azotemia in SAM was found significantly associated with hyponatremia. 

scholarly journals Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective cohort study from Kampala, Uganda

2020 ◽  
Author(s):  
Damalie Nalwanga ◽  
Victor Musiime ◽  
Samuel Kizito ◽  
John Baptist Kiggundu ◽  
Anthony Batte ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hiv Infection ◽  
Treatment Guidelines ◽  
Severe Acute Malnutrition ◽  
Routine Care ◽  
Acute Malnutrition ◽  
World Health ◽  
Children Under Five ◽  
Under Five ◽  
Factors Associated

Abstract Background Mortality among children under five years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under five years of age admitted to the NRH for routine care of SAM. Methods This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14. Results: Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2% (95% CI 19.9-30.4%) died. In-hospital mortality was 20.7% (95% CI15.9-25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2-4.2), p=0.014), bacteraemia (AHR 9 (95% CI 3.4-23.0), p<0.001, and low glomerular filtration rate (eGFR), AHR 3.2; (95% CI 1.7-6.3), p=0.001). Conclusions A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have eGFR below 60 mL/min/1.73m 2 or have bacteraemia, are more likely to die. Further studies to explore the relationship between eGFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.

scholarly journals Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective study from Kampala, Uganda

2019 ◽  
Author(s):  
Damalie Nalwanga ◽  
Victor Musiime ◽  
Samuel Kizito ◽  
John Baptist Kiggundu ◽  
Philippa Musoke ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Treatment Guidelines ◽  
Severe Acute Malnutrition ◽  
Routine Care ◽  
Sub Saharan Africa ◽  
Acute Malnutrition ◽  
World Health ◽  
Children Under Five ◽  
Under Five ◽  
Factors Associated

Abstract Background: Mortality among children under five years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under five years of age admitted to the NRH for routine care of SAM. Methods: This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14. Results: Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2 % (95% CI 19.9-30.4%) died. In-hospital mortality was 20.7% (95% CI 15.9-25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2-4.2), p=0.014), bacteraemia (AHR 9 (95% CI 3.4-23.0), p<0.001, and low glomerular filtration rate (GFR), AHR 3.2; (95% CI 1.7-6.3), p=0.001). Conclusions: A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have GFR below 60 mL/min/1.73m2 or are bacteraemic, are more likely to die. Further studies to explore the relationship between GFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.

Current and Potential Role of Specially Formulated Foods and Food Supplements for Preventing Malnutrition among 6- to 23-Month-Old Children and for Treating Moderate Malnutrition among 6- to 59-Month-Old Children

2009 ◽  
Vol 30 (3_suppl3) ◽  
pp. S434-S463 ◽  
Author(s):  
Saskia de Pee ◽  
Martin W. Bloem
Keyword(s):  
Severe Acute Malnutrition ◽  
Essential Fatty Acids ◽  
Food Supplements ◽  
Complementary Food ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Malnourished Children ◽  
Nutrient Density ◽  
Animal Source ◽  
The Impact

Reducing child malnutrition requires nutritious food, breastfeeding, improved hygiene, health services, and (prenatal) care. Poverty and food insecurity seriously constrain the accessibility of nutritious diets that have high protein quality, adequate micronutrient content and bioavailability, macrominerals and essential fatty acids, low antinutrient content, and high nutrient density. Diets based largely on plant sources with few animal-source and fortified foods do not meet these requirements and need to be improved by processing (dehulling, germinating, fermenting), fortification, and adding animal-source foods, e.g., milk, or other specific nutrients. Options include using specially formulated foods (fortified blended foods, commercial infant cereals, or ready-to-use foods [RUFs; pastes, compressed bars, or biscuits]) or complementary food supplements (micronutrient powders or powdered complementary food supplements containing micronutrients, protein, amino acids, and/or enzymes or lipid-based nutrient supplements (120 to 250 kcal/day), typically containing milk powder, high-quality vegetable oil, peanut paste, sugar, and micronutrients. Most supplementary feeding programs for moderately malnourished children supply fortified blended foods, such as corn–soy blend, with oil and sugar, which have shortcomings, including too many antinutrients, no milk (important for growth), suboptimal micronutrient content, high bulk, and high viscosity. Thus, for feeding young or malnourished children, fortified blended foods need to be improved or replaced. Based on success with ready-to-use therapeutic foods (RUTFs) for treating severe acute malnutrition, modifying these recipes is also considered. Commodities for reducing child malnutrition should be chosen on the basis of nutritional needs, program circumstances, availability of commodities, and likelihood of impact. Data are urgently required to compare the impact of new or modified commodities with that of current fortified blended foods and of RUTF developed for treating severe acute malnutrition.

scholarly journals Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia

2018 ◽  
Vol 15 (9) ◽  
pp. 1807 ◽  
Author(s):  
Stefania Moramarco ◽  
Giulia Amerio ◽  
Jean Kasengele Chipoma ◽  
Karin Nielsen-Saines ◽  
Leonardo Palombi ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Integrated Management ◽  
International Standards ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Average Weight ◽  
Community Based ◽  
Predictors Of Mortality ◽  
Feeding Programs ◽  
Treatment And Prevention

Background: Child malnutrition, in all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012–14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in 2015–17. Methods: The outcomes were compared with International Standards and with those of 2012–14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: The data for 900 under-five year-old malnourished children were analyzed. Rainbow’s 2015–17 outcomes met International Standards, for total and also when stratified for different type of malnutrition. A better performance than 2012–14 was noted in the main areas previously identified as critical: mortality rates were halved (5.6% vs. 3.1%, p = 0.01); significant improvements in average weight gain and mean length of stay were registered for recovered children (p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ <–3 (4.6; 1.3–16.1), and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Secondly, training community volunteers consistently increased the awareness of a child’s HIV status (+30%; p < 0.001). Conclusion: Rainbow SFPs provide an integrated community-based approach for the treatment and prevention of child malnutrition in Zambia, with its effectiveness significantly enhanced after the gaps in activities were filled.

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