Clinical Improvement After Oral Magnesium Supplementation in Children with Severe Acute Malnutrition-An Observational Study

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.

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

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20211072 ◽

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.

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

Medical & Clinical Research ◽

10.33140/mcr.03.02.05 ◽

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%).

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