scholarly journals Prevalence and fluid management of dehydration in children without diarrhoea admitted to Kenyan hospitals: a multisite observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e042079
Author(s):  
Sylvia Omoke ◽  
Mike English ◽  
Jalemba Aluvaala ◽  
David Gathara ◽  
Ambrose Agweyu ◽  
...  
Keyword(s):  
Observational Study ◽  
Fluid Therapy ◽  
Management Practices ◽  
Severe Acute Malnutrition ◽  
Fluid Management ◽  
Case Fatality ◽  
Acute Malnutrition ◽  
Referral Hospitals ◽  
Study Population ◽  
Special Circumstances

ObjectivesTo examine the prevalence of dehydration without diarrhoea among admitted children aged 1–59 months and to describe fluid management practices in such cases.DesignA multisite observational study that used routine in-patient data collected prospectively between October 2013 and December 2018.SettingsStudy conducted in 13 county referral hospitals in Kenya.ParticipantsChildren aged 1–59 months with admission or discharge diagnosis of dehydration but had no diarrhoea as a symptom or diagnosis. Children aged <28 days and those with severe acute malnutrition were excluded.ResultsThe prevalence of dehydration in children without diarrhoea was 3.0% (2019/68 204) and comprised 15.9% (2019/12 702) of all dehydration cases. Only 55.8% (1127/2019) of affected children received either oral or intravenous fluid therapy. Where fluid treatment was given, the volumes, type of fluid, duration of fluid therapy and route of administration were similar to those used in the treatment of dehydration secondary to diarrhoea. Pneumonia (1021/2019, 50.6%) and malaria (715/2019, 35.4%) were the two most common comorbid diagnoses. Overall case fatality in the study population was 12.9% (260/2019).ConclusionSixteen per cent of children hospitalised with dehydration do not have diarrhoea but other common illnesses. Two-fifths do not receive fluid therapy; a regimen similar to that used in diarrhoeal cases is used in cases where fluid is administered. Efforts to promote compliance with guidance in routine clinical settings should recognise special circumstances where guidelines do not apply, and further studies on appropriate management for dehydration in the absence of diarrhoea are required.

scholarly journals Study of social and demographic determinants of severe acute malnutrition in children aged 6-59 months in a tertiary care centre of Odisha, India

2018 ◽  
Vol 6 (1) ◽  
pp. 46
Author(s):  
Pravati Jena ◽  
Soumini Rath ◽  
Manas Kumar Nayak ◽  
Diptirekha Satapathy
Keyword(s):  
Low Socioeconomic Status ◽  
Rural Areas ◽  
Health Care Services ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Acute Malnutrition ◽  
Age Group ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Study Population

Background: The objective is to study the various social and demographic determinants of severe acute malnutrition in children aged 6 months to 59 months in a tertiary care centre of Odisha, India.Methods: This is a hospital based prospective observational study done in a tertiary care centre of Odisha during the period of Nov 2015 to Oct 2017 in which all children with severe acute malnutrition as per WHO criteria in the age group 6 months to 59 months were enrolled and their socioeconomic and demographic details were evaluated.Results: Present study revealed a prevalence of severe acute malnutrition as 2.8%. Males (54.2%) were more affected than females (45.8%). Most common age group affected was 6-12 months (37.4%). Most of the children were from low socioeconomic status (96.4%) and from rural areas (84.8%).63.7% of the study population were unimmunised. Only 12.6% of the participants were exclusively  breast fed.100% of the children in the study population received top feeding with cow’s milk.Conclusions: The prevalence of malnutrition is high in Odisha but most of the causative factors are preventable. Adequate education regarding exclusive breastfeeding, complementary feeding, immunisation, promotion of proper referral and health care services can help to improve nutritional status in the state of Odisha.

scholarly journals An Experience at a Tertiary Level Hospital NRC in Management of Severe Acute Malnutrition in Children Aged between 6-59 Months Adopting World Health Organization Recommendations

2016 ◽  
Vol 1 (1) ◽  
pp. 41 ◽  
Author(s):  
S. Bharathi ◽  
K. Anuradha ◽  
J. Venkateshwar Rao
Keyword(s):  
World Health Organization ◽  
Severe Acute Malnutrition ◽  
Case Fatality ◽  
Acute Malnutrition ◽  
World Health ◽  
Severe Malnutrition ◽  
Rehabilitation Center ◽  
Nutritional Rehabilitation ◽  
Retrospective Case ◽  
Health Organization

<p><em>Objectives:<strong> </strong></em><em>To study the outcome indicators of a nutritional rehabilitation center and to assess its performance.</em></p><p><em>Design: </em><em>Retrospective case study.</em></p><p><em>Period:</em><em> One year period from Jan 2014 to Dec 2014.</em></p><p><em>Methods:<strong> </strong></em><em>Data of 254 children aged between 6-59</em><em> </em><em>months with severe acute malnutrition admitted in nutritional rehabilitation center at department of pediatrics, Gandhi hospital, was</em><em> </em><em>analyzed retrospectively. Identification and treatment of severe acute malnutrition was done according to world health organization recommendations.</em></p><p><em>Results:<strong> </strong></em><em>The recovery rate, death rate, defaulter rate, mean (SD) weight gain &amp; mean (SD) duration of stay in the nutritional rehabilitation center were 51.42%, 3.54%, 28.57%, 8g/kg/day, 14.2 days respectively.</em></p><p><em>Conclusions:<strong> </strong></em><em>Nutritional rehabilitation centers are effective in management of severe malnutrition and also in decreasing the case fatality rates.</em></p>

scholarly journals Outcome of Standardized Case Management of Under-5 Children with Severe Acute Malnutrition in Three Hospitals of Dhaka City in Bangladesh

2013 ◽  
Vol 37 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Ashraf Uddin Ahmed ◽  
Taslim Uddin Ahmed ◽  
Md Sultan Uddin ◽  
Md Haider Ali Chowdhury ◽  
Mohamnmed Hamidur Rahman ◽  
...  
Keyword(s):  
Case Management ◽  
Management Practices ◽  
Family Income ◽  
Protein Energy Malnutrition ◽  
Case Fatality ◽  
Acute Malnutrition ◽  
World Health ◽  
Comprehensive Treatment ◽  
Dhaka City ◽  
Management Procedures

Objects: A hospital based descriptive study was carried out among under-5 children suffering from severe protein-energy-malnutrition (PEM) Methodology: This was a descriptive analytical study conducted during June 2002 to May 2003 in three purposively selected hospitals of Dhaka city, Bangladesh. Results: Mean±SD age of the children was 15.1±10.9 months, majority being under three years (91.5%), 47.2% were female, and 51% did not receive or complete immunization according to their age. No significant age and sex difference was found among the admitted children in different hospitals. Most of their parents were illiterate (mothers 71%, fathers 56%) with low family income and social status. Marasmus cases were 61%, followed by kwashiorkor 25% and marasmic kwashiorkor 14%. The children were managed broadly according to standard protocol based on the guideline of World Health Organization but adopted/modified by the individual hospitals. Overall outcome of the patients were: recovery 62.4%, default 21.4%, death 13.7% and transfer 2.6%. Mean duration of hospital stay was 14.2±9.9 (ranging from 0 to 59) days. Recovery rate was better among male (67.3%) than female (56.8%) children, p=0.033. Default rate was higher among female (27.3%) than male (16.1%) children, p=0.007. Case fatality rate was highest (40%, p=0.001) in children suffering from septicaemia. Conclusion: Evidences of faulty case management practices viz. over use of intravenous fluids and blood transfusion, inappropriate diets, less use of micronutrients, incorrect antibiotics were observed occasionally in all the three hospitals. Updated and comprehensive treatment guidelines need to be implemented, and every hospital should review its own clinical management procedures and performance with a view to improving practice. DOI: http://dx.doi.org/10.3329/bjch.v37i1.15345 BANGLADESH J CHILD HEALTH 2013; VOL 37 (1) : 5-13

scholarly journals Changes in plasma phosphate during in-patient treatment of children with severe acute malnutrition: an observational study in Uganda1

2016 ◽  
Vol 103 (2) ◽  
pp. 551-558 ◽  
Author(s):  
Hanifa Namusoke ◽  
Anne-Louise Hother ◽  
Maren JH Rytter ◽  
Pernille Kæstel ◽  
Esther Babirekere-Iriso ◽  
...  
Keyword(s):  
Observational Study ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Patient Treatment ◽  
Plasma Phosphate

scholarly journals Etiological factors of severe acute malnutrition and impact of nutrition rehabilitation centre: a prospective observational study from Bhavnagar

2021 ◽  
Vol 8 (4) ◽  
pp. 652
Author(s):  
Vibhuti D. Gamit ◽  
Jayendra R. Gohil ◽  
Adithya Nikhileshwar B. ◽  
Tanmay P. Vagh
Keyword(s):  
Weight Gain ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Severe Acute Malnutrition ◽  
Birth Spacing ◽  
Acute Malnutrition ◽  
Rehabilitation Centre ◽  
Etiological Factors ◽  
Nutrition Rehabilitation

Background: Severe acute malnutrition (SAM) causes almost half of childhood deaths in children <5 years in developing countries. In India, as National Family Health Survey (NFHS), prevalence of SAM has increased from 6.4 in NFHS-3 (2005-2006) to 7.5% in NFHS-4 (2015-1016); [5.8 to 9.5% Gujarat]. The aim of study was to determine the etiological factors and outcome of SAM and the benefit of nutrition rehabilitation centre (NRC) among 6 months to 5 years children at the Pediatrics, NRC ward, Sir T. General Hospital.Methods: A prospective observational study of 151 SAM children over nine months. Etiological factors were determined by history and relevant investigations, exclude other systemic disorders. Therapeutic nutrition was provided for 14 days. Cases were followed up two weekly for 2 months by monitoring weight after NRC admission.Results: Association was found between Small for gestational age (64.9%), joint family (59.6%) and low birth spacing (59.6%) as etiological factors leading to SAM. 81.5% children gained weight during 14 days NRC stay. Weight gain was noted at follow-up. Defaulter rate increased from 9.9% at discharge to 28.5% at 2 months follow-up. Weight was static for 9% children. 34.4% children were from rural area and 65.6% from urban area. 23.8% children had received pre lacteal feed. Timing of complementary feeding was incorrect in 29%. There were no deaths.Conclusions: Small for gestational age, joint family, low birth spacing, and incorrect feeding practices and urban residence were etiological factors. NRC stay (defaulter rate 26%), produced weight gain in SAM children. 

The Prevalence of Refeeding Syndrome among Children with Severe Acute Malnutrition: An Observational Study in Kenyatta National Hospital, Kenya

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Observational Study ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Hiv Status ◽  
National Hospital ◽  
Refeeding Syndrome ◽  
Kenyatta National Hospital ◽  
Study Participants ◽  
Lost To Follow Up

Background: Refeeding syndrome is a complication of severe acute malnutrition occurring during initial feeding because of electrolyte changes; mostly potassium, phosphorus and magnesium. The highest mortality in sam is observed between 48-72 hours of initiating feeds, the same time that refeeding syndrome occurs. Objectives: To establish prevalence of refeeding syndrome among children with sam in kenyatta national hospital, find out its associated factors and outcomes. Design: Observational study; Setting: Kenyatta national hospital paediatric wards Study Participants: Children 6-59 months diagnosed with severe acute malnutrition interventions: potassium, phosphorus and magnesium levels were measured at admission and repeated 48 hours after feed initiation. Anthropometric measurements, oedema, dehydration, HIV status, type of feed were evaluated and patients followed for outcomes. Main outcome measures: Recovery, persistence, undetermined, death. Results: Total of 160 children with sam recruited. Prevalence of refeeding syndrome was 21% (95% ci 15.2 to 28.4). refeeding syndrome was significantly associated with HIV (p=0.032). odds of refeeding syndrome increased six-fold with HIV infection (or=5.99, 95% ci 1.23 to 29.1) after age and sex adjustment of the 34 children who developed refeeding syndrome, 65% recovered with treatment, 3% died, 12% had persistently low electrolytes despite treatment while 20% were lost to follow up. Conclusion: Prevalence of refeeding syndrome in kenyatta national hospital among children admitted with sam was 21% with HIV being significantly associated with its development (p=0.032). The outcomes of those who developed refeeding syndrome were recovery (65%), mortality (3%), lost to follow up (20%) and persistence (12%).

scholarly journals Prevalence, outcome and quality of care among children hospitalized with severe acute malnutrition in Kenyan hospitals: A multi-site observational study

PLoS ONE ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. e0197607 ◽  
Author(s):  
Susan Gachau ◽  
Grace Irimu ◽  
Philip Ayieko ◽  
Samuel Akech ◽  
Ambrose Agweyu ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Observational Study ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition

scholarly journals Improved care and survival in severe malnutrition through eLearning

2019 ◽  
Vol 105 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Sunhea Choi ◽  
Ho Ming Yuen ◽  
Reginald Annan ◽  
Michele Monroy-Valle ◽  
Trevor Pickup ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Case Fatality ◽  
Scaling Up ◽  
Nutrition Intervention ◽  
Acute Malnutrition ◽  
Severe Malnutrition ◽  
Healthcare Facilities ◽  
Poor Countries ◽  
Almost All

BackgroundScaling up improved management of severe acute malnutrition (SAM) has been identified as the nutrition intervention with the greatest potential to reduce child mortality but it requires improved operational capacity.ObjectiveTo investigate whether an eLearning course, which can be used at scale in resource-poor countries, leads to improved diagnosis, clinical management and survival of children with SAM.DesignA 2-year preintervention and postintervention study between January 2015 and February 2017.SettingEleven healthcare facilities: nine in Ghana, one in Guatemala, and one in El Salvador.InterventionScenario-based eLearning course ‘Caring for infants and young children with severe malnutrition’.Main outcome measuresIdentification of children with SAM, quality of care, case-fatality rate.MethodsMedical record reviews of children aged 0–60 months attending eleven hospitals between August 2014 and July 2016, observations in paediatric wards, and interviews with senior hospital personnel.ResultsPostintervention there was a significant improvement in the identification of SAM: more children had the requisite anthropometric data (34.9% (1300/3723) vs 15.9% (629/3953)) and more were correctly diagnosed (58.5% (460/786) vs 47.1% (209/444)). Improvements were observed in almost all aspects of the WHO ‘Ten Steps’ of case-management, and case-fatality fell from 5.8% (26/449) to 1.9% (14/745) (Post-pre difference=−3.9%, 95% CI −6.6 to −1.7, p<0.001).ConclusionsHigh quality, interactive eLearning can be an effective intervention in scaling up capacity building of health professionals to manage SAM effectively, leading to a reduction in mortality.

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