Evaluation of the treatment guidelines, practices and outcomes of complicated severe acute malnutrition in children aged 0-59 months in sub-Saharan Africa: a study protocol for the SAMAC study

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.

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Role of Brown Adipose Tissues / Beige Adipose Tissue (BAT/bAT) relevant genes expression and polymorphism in regulating human body weight

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.05.10.06 ◽

2020 ◽

Vol 5 (10) ◽

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Tetralogy Of Fallot ◽

Congenital Heart ◽

Severe Acute Malnutrition ◽

Sub Saharan Africa ◽

Acute Malnutrition ◽

Medical Progress ◽

Brown Adipose ◽

Sub Saharan

Introduction: Tetralogy of Fallot is the most common cyanogenic congenital heart disease. In sub-Saharan Africa, the incidence of the disease is unknown. Hospital studies show that it is the most common cyanogenic congenital heart disease. This heart disease, which varies in severity, has benefited from considerable medical progress over the last fifty years. The main objective of the work is to study management modalities of this heart disease in Senegal. Method: This retrospective study conducted from first January 2010 to thirty-one December 2015 in the pediatric cardiology department of the Albert Royer National Children Hospital of Dakar (CHNEAR), involves 125 children diagnosed with tetralogy of Fallot. Results: Tetralogy of Fallot accounted for 18.6% of congenital heart disease. Inbreeding and trisomy 21 were the main risk factors. Cyanosis was the main sign of disease discovery (33.2%) followed by anoxic malaise. Pulsed oxygen saturation averaged 70%. Severe acute malnutrition was detected in 21.8% of our patients. Ultrasound showed a regular pattern in 81 patients (64.8%) and an irregular pattern in 44 cases (35.2%). Modified Blalock surgery was performed in 16 patients (12.8%) and a surgical cure in 43 patients (34.4%). We reported 20 (16%) deaths in this series. Conclusion: The results of our series show an improvement in the management of Fallot tetralogy in Senegal, but the data is insufficient. Effort must be made in the context of disease screening and early surgical management.

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Pharmacokinetics and Safety of Zidovudine, Lamivudine, and Lopinavir/Ritonavir in HIV-infected Children With Severe Acute Malnutrition in Sub-Saharan Africa

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0000000000003055 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Maxensia Owor ◽

Camlin Tierney ◽

Lauren Ziemba ◽

Renee Browning ◽

John Moye ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Sub Saharan Africa ◽

Acute Malnutrition ◽

Sub Saharan

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The recovery rate from severe acute malnutrition among under-five years of children remains low in sub-Saharan Africa. A systematic review and meta-analysis of observational studies

PLoS ONE ◽

10.1371/journal.pone.0229698 ◽

2020 ◽

Vol 15 (3) ◽

pp. e0229698

Author(s):

Hanna Demelash Desyibelew ◽

Mulat Tirfie Bayih ◽

Adhanom Gebreegziabher Baraki ◽

Abel Fekadu Dadi

Keyword(s):

Systematic Review ◽

Recovery Rate ◽

Observational Studies ◽

Severe Acute Malnutrition ◽

Meta Analysis ◽

Sub Saharan Africa ◽

Acute Malnutrition ◽

Under Five ◽

Sub Saharan

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HIV prevalence and mortality among children undergoing treatment for severe acute malnutrition in sub-Saharan Africa: a systematic review and meta-analysis

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/j.trstmh.2008.10.029 ◽

2009 ◽

Vol 103 (6) ◽

pp. 541-548 ◽

Cited By ~ 81

Author(s):

Pamela Fergusson ◽

Andrew Tomkins

Keyword(s):

Systematic Review ◽

Severe Acute Malnutrition ◽

Meta Analysis ◽

Hiv Prevalence ◽

Sub Saharan Africa ◽

Acute Malnutrition ◽

Sub Saharan

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A Scoping Review on Nutrition Challenges Among People Living With HIV/AIDS in Sub-Saharan Africa

Global Journal of Health Science ◽

10.5539/gjhs.v11n12p109 ◽

2019 ◽

Vol 11 (12) ◽

pp. 109 ◽

Cited By ~ 1

Author(s):

Tafadzwa Dzinamarira ◽

Gashema Pierre ◽

Itai Chitungo ◽

Michael Habtu ◽

Rosemary Okova

Keyword(s):

Food Insecurity ◽

Severe Acute Malnutrition ◽

Sub Saharan Africa ◽

Acute Malnutrition ◽

Future Research ◽

People Living With Hiv ◽

African Countries ◽

Sub Saharan ◽

Living With Hiv ◽

Hiv Aids

The connection between under-nutrition and HIV is bidirectional. It affects the quality of life, as well as the survival of affected people. While this is the case, there are various nutritional challenges, which are faced by people living with HIV/AIDS (PLWH), and which hamper the fight against the scourge. This study therefore sought to map literature on the nutritional challenges among PLWH in sub-Saharan Africa and guide future research in nutritional management to improve health outcomes for PLWH. A systematic search was done from the following sources: PubMed, the Cochrane Database of Systematic Reviews, EBSCOhost (CINAHL and Academic Search Complete), Web of Science, and Google Scholar. In addition, information was obtained both from unpublished studies, which included book chapters, reference lists, theses and conference papers. Eleven (11) studies met the inclusion criteria, and were used for data extraction. The studies were based in different countries, which form part of the Sub Saharan Africa. One of the studies was carried out in Senegal, two studies were carried out in various West African countries, one study was carried out in Burkina Faso; one study was carried out in Ethiopia and one of the studies was carried out in different countries forming part of the Sub Saharan Africa. Two of the studies were carried out in Zambia, one in Zimbabwe, one in Cameroon, and one in Ghana. Most of the studies established the main nutrition challenge facing PLWH to be food insecurity. Based on the findings of the study, it can be concluded that some of the main nutrition challenges include food insecurity, lack of nutritional support among PLWH, late detection of HIV, huge cost of treating severe acute malnutrition, and lack of feeding supplementations.

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

10.21203/rs.2.10786/v2 ◽

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% 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 (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.

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Quality attributes of maize-based supplementary diets in the in vitro for the management of moderately acute malnourished children

10.21203/rs.3.rs-496153/v1 ◽

2021 ◽

Author(s):

ADESANMI Raymond Ade ◽

OKORIE Ijioma John ◽

NWAMARAH Joy Ugu

Keyword(s):

Severe Acute Malnutrition ◽

Sub Saharan Africa ◽

Acute Malnutrition ◽

Mineral Contents ◽

Supplementary Food ◽

Malnourished Children ◽

Sub Saharan ◽

Child Mortality Rate ◽

Moderate Malnutrition

Abstract Background and aimsModerate Acute Malnutrition (MAM) is a major global health problem threatening the life of approximately 33 million children and affects 15% of under- five children in sub-Saharan Africa. The efforts to reduce the burden of severe acute malnutrition and drop child mortality rate require appropriate dietary management of MAM through promotion of an affordable, readily available and locally produced supplementary food. The aim of this study was therefore to formulate and evaluate the quality of locally produced maize-peanut and maize-soybean supplementary food.ResultProximate composition was moisture (74.62%±0.02; 69.11%±0.01), crude protein (7.59%±0.02; 7.19%±0.02), crude fat (3.81%±0.02; 4.79%± 0.04), crude fiber (0.17%±0.02; 0.28%±0.03), ash (0.11%±0.02; 0.10%±0.02), carbohydrate (88.31%±0.02; 87.63%±0.06) and energy (417.96 ± 0.08; 424.05 ± 0.22) Kcal for MSB and MPN gruels, respectively. The mineral contents were calcium (14.15 ± 0.00; 11.81 ± 0.00) mg, iron (5.54 ± 0.00; 4.84 ± 0.00) mg, zinc (3.98 ± 0.00; 3.13 ± 0.00) mg, and iodine (297.33 ± 1.16; 293.00 ± 2.00) µg for MSB and MPN gruels, respectively. Vitamin contents of MSB and MPN gruels were B1 (2.30 ± 0.02; 2.22 ± 0.03) mg, B3(0.08 ± 0.02; 0.06 ± 0.03) mg, B9 (300.00 ± 26.46; 150.00 ± 17.32) mg, A (1.24 ± 0.05; 1.13 ± 0.04) RE, and K (0.86 ± 0.02; 1.98 ± 0.02) µg, respectively. Tannin (0.90 ± 0.03; 0.93 ± 0.02) %, saponin (0.30 ± 0.04; 0.34 ± 0.03) %, oxalate (0.24 ± 0.02; 0.11 ± 0.01) mg and alkaloid (0.12 ± 0.02; 0.10 ± 0.02) mg contents were not significantly different between MSB and MPN gruels.ConclusionThe formulation diets are suitable as supplementary food for the management of moderate malnutrition in children6-59 months, they provided all the required macro and micronutrients as recommended for children under this condition.

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Management of Renal Cell Carcinoma- Current Practice in Sub-Saharan Africa

Journal of Kidney Cancer and VHL ◽

10.15586/jkcvhl.2019.122 ◽

2019 ◽

Vol 6 (2) ◽

pp. 1-9

Author(s):

Ayun Kotokai Cassell ◽

Mohamed Jalloh ◽

Bashir Yunusa ◽

Medina Ndoye ◽

Mouhamadou Mbodji ◽

...

Keyword(s):

Renal Cell ◽

Radical Nephrectomy ◽

Treatment Guidelines ◽

Cell Cancer ◽

Sub Saharan Africa ◽

Renal Masses ◽

Open Radical Nephrectomy ◽

Sub Saharan ◽

Developed Nations

There is a global variation in the incidence of renal masses with the developed nations having a greater incidence. About 80–90% of renal malignancies are renal cell carcinomas (RCC) which account for 2–4% of all cancers. In Africa and the Middle East, the age-standardized incidence for RCC is 1.8–4.8/100,000 for males and 1.2–2.2/100,000 for females. The management of renal cell cancer is challenging. A multidisciplinary approach is effective for diagnosis, staging, and treatment. Guidelines recommend active surveillance, thermal ablation, partial nephrectomy, radical nephrectomy, cytoreductive nephrectomy and immunotherapy as various modalities for various stages of RCC. However, open radical nephrectomy is most widely adopted as an option for treatment at various stages of the disease in sub-Saharan Africa due to its cost-effectiveness, applicability at various stages, and the reduced cost of follow-up. Nevertheless, most patients in the region present with the disease in the advanced stage and despite surgery the prognosis is poor.

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