Review of the safety and efficacy of vitamin A supplementation in the treatment of children with severe acute malnutrition

Abstract Introduction About 20 million children suffer from severe acute malnutrition each year. The World Health Organization recommends the outpatient therapeutic program as a standard treatment protocol for the management of uncomplicated severe acute malnutrition and for children who are transferred from inpatient cares after recovery. This study aimed to assess the treatment outcome of severe acute malnutrition and determinants of survival in children admitted to outpatient therapeutic program at public health institutions, Afar Regional State. Methods Institution-based prospective cohort study was conducted on 286 children aged 6–59 months admitted to the outpatient therapeutic program, from April to September 2017, at selected public health institutions in Afar Regional State. For the comparison of time to recovery among the different groups of children on the outpatient therapeutic program, Kaplan-Meir curve was used and significance test for these differences was assessed by the log-rank test. Then, a proportional hazard in the Cox model was used to identify independent predictors of survival. p value < 0.05 was considered significant. Results Of 286 children, 238 (83.2%; 95% CI (79, 88)), 18 (6.3%), 14 (4.9%), 8 (2.8%), and 8 (2.8%) cases were cured, defaulters, non-responder, died, and transfer to inpatient care, respectively. The overall mean rate of weight gain was 10.5(± 3.45) g/kg/day, and mean length of stay was 44.15(± 8.77) days. The recovery rate of children whose mothers travel less than 2 h to the health institution was about three times (AHR, 2.91; 95% CI (2.18, 3.88)) higher than children whose mothers travel 2 h and above. Compared with children who received vitamin A supplementation, children who lack supplementation were less likely (AHR, 0.39; 95% CI (0.25, 0.59)) to be cured. Moreover, the rate of recovery from outpatient therapeutic program among children who received antibiotics was about 1.4 times (AHR, 1.38; 95% CI (1.01, 1.89)) higher compared with children who did not receive of antibiotics. Conclusion This study showed that nearly eight children in every ten had recovered from severe acute malnutrition. Therefore, considering the distance of health facility from children’s residence, improving vitamin A supplementation and antibiotics are vital in improving the rate of recovery. Further research is also required to identify and address barriers to the provision of antibiotics and vitamin A supplementation.

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Nutrient and Anti-nutrient Profile of a Local Formula from Sorghum, Peanut, Honey and Ghee (Metu2) for Treatment of Severe Acute Malnutrition

Journal of Food Research ◽

10.5539/jfr.v7n2p25 ◽

2018 ◽

Vol 7 (2) ◽

pp. 25

Author(s):

Amegovu K. Andrew ◽

Peter Yiga ◽

Kuorwel K. Kuorwel ◽

Timothy Chewere

Keyword(s):

Vitamin A ◽

Energy Content ◽

Severe Acute Malnutrition ◽

Essential Fatty Acids ◽

High Energy ◽

Acute Malnutrition ◽

World Health ◽

Home Based ◽

North Eastern ◽

Eastern Uganda

World over, we are still struggling with persistent acute malnutrition levels; an estimated 17 million preschool children suffer from SAM, roughly the same figures as reported in 2013, a trend depicting insufficient progress towards the 2025 World Health Assembly. One such affected area is Karamoja Region in North Eastern Uganda. Partly, the trend could be attributed to unsustainable interventions like RUTF. Formulas from locally available foods could provide not only an affordable but also a culturally acceptable and effective home based solution. Locally available sorghum, peanut, honey and ghee in North Eastern Uganda, is such a potential local formula. The nutritional and anti-nutritional profile of this local formula(metu2) was compared to plumpy-nut. Standard official analytical methods were used. Proximate composition was comparable and within the WHO recommendations for therapeutic formulas. Local formula(metu2) had a comparatively high energy content, 528kcal/100g to 509kcal in plumpynut. Vitamin A and K contents were below the WHO recommendations in local formula while Na, Mg and essential fatty acids were comparable and within the contents needed for SAM recovery. Zn was comparatively higher in plumpy-nut but levels in both formulas were below the recommendations. Trypsin inhibitors, phytates and condensed tannins were higher in local formula while aflatoxins were within the limits but not for plumpynut. Though lacking in critical K, Zn and Vitamin A, local formula(metu2) was comparable to plumpy-nut and its efficacy to sustain recovery from SAM needs to be studied.

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Vitamin A and iron status of children before and after treatment of uncomplicated severe acute malnutrition

Clinical Nutrition ◽

10.1016/j.clnu.2020.03.016 ◽

2020 ◽

Vol 39 (11) ◽

pp. 3512-3519 ◽

Cited By ~ 2

Author(s):

Suvi T. Kangas ◽

Cécile Salpéteur ◽

Victor Nikièma ◽

Leisel Talley ◽

André Briend ◽

...

Keyword(s):

Vitamin A ◽

Severe Acute Malnutrition ◽

Iron Status ◽

Acute Malnutrition ◽

Before And After

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Effectiveness of Interventions for Managing Acute Malnutrition in Children under Five Years of Age in Low-Income and Middle-Income Countries: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu12010116 ◽

2020 ◽

Vol 12 (1) ◽

pp. 116 ◽

Cited By ~ 2

Author(s):

Jai K. Das ◽

Rehana A. Salam ◽

Marwah Saeed ◽

Faheem Ali Kazmi ◽

Zulfiqar A. Bhutta

Keyword(s):

Weight Gain ◽

Vitamin A ◽

Recovery Rate ◽

Meta Analysis ◽

Prophylactic Antibiotic ◽

Acute Malnutrition ◽

Health Concern ◽

Limited Data ◽

Community Based ◽

Vitamin A Supplementation

Childhood malnutrition is a major public health concern, as it is associated with significant short- and long-term morbidity and mortality. The objective of this review was to comprehensively review the evidence for the management of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) according to the current World Health Organization (WHO) protocol using facility- and community-based approaches, as well as the effectiveness of ready-to-use therapeutic food (RUTF), ready-to-use supplementary food (RUSF), prophylactic antibiotic use, and vitamin A supplementation. We searched relevant electronic databases until 11 February 2019, and performed a meta-analysis. This review summarizes findings from a total of 42 studies (48 papers), including 35,017 children. Limited data show some benefit of integrated community-based screening, identification, and management of SAM and MAM on improving recovery rate. Facility-based screening and management of uncomplicated SAM has no effect on recovery and mortality, while the effect of therapeutic milk F100 for SAM is comparable to RUTF for weight gain and mortality. Local food and whey RUSF are comparable to standard RUSF for recovery rate and weight gain in MAM, while standard RUSF has additional benefits to CSB. Prophylactic antibiotic administration in uncomplicated SAM improves recovery rate and probably improves weight gain and reduces mortality. Limited data suggest that high-dose vitamin A supplementation is comparable with low-dose vitamin A supplementation for weight gain and mortality among children with SAM.

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Efficacy of a High-Dose in Addition to Daily Low-Dose Vitamin A in Children Suffering from Severe Acute Malnutrition with Other Illnesses

PLoS ONE ◽

10.1371/journal.pone.0033112 ◽

2012 ◽

Vol 7 (3) ◽

pp. e33112 ◽

Cited By ~ 13

Author(s):

Samima Sattar ◽

Tahmeed Ahmed ◽

Choudhury Habibur Rasul ◽

Debasish Saha ◽

Mohammed Abdus Salam ◽

...

Keyword(s):

Vitamin A ◽

Low Dose ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

High Dose

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Using stable isotope techniques in nutrition assessments and tracking of global targets post-2015

Proceedings of The Nutrition Society ◽

10.1017/s0029665117000295 ◽

2017 ◽

Vol 76 (4) ◽

pp. 495-503 ◽

Cited By ~ 9

Author(s):

Victor O. Owino ◽

Christine Slater ◽

Cornelia U. Loechl

Keyword(s):

Stable Isotope ◽

Vitamin A ◽

Severe Acute Malnutrition ◽

Dietary Assessment ◽

Health Assessment ◽

Assessment Tools ◽

Acute Malnutrition ◽

Activity Measurement ◽

Energy Agency ◽

Isotope Techniques

Stable isotopes are non-radioactive, safe and are applied for various purposes in human health assessment in trace amounts that minimally disturb normal physiology. The International Atomic Energy Agency supports the use of stable isotope techniques to design and evaluate interventions addressing malnutrition in all its forms with focus on infant and young child feeding; maternal and adolescent nutrition; diet quality; prevention and control of non-communicable diseases; healthy ageing and gut function. These techniques can be used to objectively measure: (1) amount of human milk consumed and whether an infant is exclusively breastfed; (2) body composition in the context of re-feeding programmes for moderate and severe acute malnutrition and as an indicator of the risk for obesity; (3) bioavailability and bioconversion of pro-vitamin A and vitamin A body stores following vitamin A intervention programmes; (4) absorption and retention of iron, zinc and protein; (5) total energy expenditure for validation of physical activity measurement and dietary assessment tools and (6) diagnosis of Helicobacter pylori. Stable isotope techniques will be invaluable in the tracking of global targets on exclusive breast-feeding childhood obesity and anaemia among women. Efforts are underway to make nuclear techniques more affordable, field-friendly and less invasive, and to develop less sophisticated but precise equipment. Advocacy for the wide adoption of the techniques is needed.

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The effect of timely initiation of complementary feeding and vitamin A supplementation on acute malnutrition among children aged 6–59 months attending Hamusit Health Centre, Northwest Ethiopia, 2021: A cross-sectional study

Heliyon ◽

10.1016/j.heliyon.2021.e08449 ◽

2021 ◽

pp. e08449

Author(s):

Ermias Sisay Chanie ◽

Zeleke Dagne ◽

Melkamu Senbeta ◽

Tahir Eyayu ◽

Samuel Nebiyu ◽

...

Keyword(s):

Vitamin A ◽

Complementary Feeding ◽

Health Centre ◽

Cross Sectional Study ◽

Northwest Ethiopia ◽

Acute Malnutrition ◽

Sectional Study ◽

Cross Sectional ◽

Timely Initiation ◽

Vitamin A Supplementation

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Time to recovery from severe acute malnutrition and its predictors: a multicentre retrospective follow-up study in Amhara region, north-west Ethiopia

BMJ Open ◽

10.1136/bmjopen-2019-034583 ◽

2020 ◽

Vol 10 (2) ◽

pp. e034583

Author(s):

Adhanom Gebreegziabher Baraki ◽

Temesgen Yihunie Akalu ◽

Haileab Fekadu Wolde ◽

Wubet Worku Takele ◽

Worku Nigussu Mamo ◽

...

Keyword(s):

Vitamin A ◽

Severe Acute Malnutrition ◽

Female Gender ◽

Acute Malnutrition ◽

Amhara Region ◽

North West ◽

Follow Up Study ◽

Health Institutions ◽

Using Data

ObjectivesThis study aimed to determine the time to recovery from severe acute malnutrition (SAM) and its predictors in selected public health institutions in Amhara Regional State, Ethiopia.DesignAn institution-based retrospective follow-up study was conducted using data extracted from 1690 patient cards from September 2012 to November 2016.SettingSelected government health institutions in the Amhara region, Ethiopia.ParticipantsChildren treated in therapeutic feeding units for SAM were included.Outcome measuresTime to recovery from SAM.ResultsOne thousand and fifty children have recovered from SAM, 62.13% (95% CI 59.8% to 64.5%). The median time to recovery was 16 days (IQR=11–28). Female gender (adjusted HR (AHR)=0.81, 95% CI 0.67 to 0.98), oedematous malnutrition (AHR=0.74 95% CI 0.59 to 0.93), pneumonia (AHR=0.66, 95% CI 0.53 to 0.83), tuberculosis (AHR=0.53, 95% CI 0.36 to 0.77), HIV/AIDS (AHR=0.47, 95% CI 0.28 to 0.79), anaemia (AHR=0.73, 95% CI 0.60 to 0.89) and receiving vitamin A (AHR=1.43, 95% CI 1.12 to 1.82) were notably associated with time to recovery.ConclusionsThe time to recovery in this study was acceptable but the proportion of recovery was far below the minimum standard. Special emphasis should be given to the prevention and treatment of comorbidities besides the therapeutic feeding. Supplementing vitamin A would also help to improve the recovery rate.

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