A cohort analysis of survival and outcomes in severely anaemic children with moderate to severe acute malnutrition in Malawi

Introduction Moderate to severe acute malnutrition (SAM/MAM) and severe anaemia are important and associated co-morbidities in children aged less than five years. Independently, these two morbidities are responsible for high risk of in-hospital and post-discharge deaths and hospital readmissions. The primary objective of this study is to investigate the risk of death among severely anaemic children with moderate to severe acute malnutrition compared to children with severe anaemia alone. Methods This was a retrospective analysis of data collected from a large prospective study that was investigating severe anaemia in children aged less than 5 years old. The study was conducted at Queen Elizabeth Central Hospital in Blantyre and Chikhwawa district hospital in southern Malawi. Children aged less than five years old; with severe anaemia were screened and enrolled. Each child was followed up for eighteen months at one, three, six, twelve and eighteen months after enrolment. Data were analysed using STATA 15. Results Between July 2002 and July 2004, 382 severely anaemic children were enrolled in the main study. A total of 52 children were excluded due to missing anthropometric data. Out of the 330 included, 53 children were moderately to severely malnourished and 277 were not. At the end of the 18-month follow period, 28.3% of children with MAM/SAM died compared to 13% of children without MAM/SAM (RR 2.1, CI 0.9–4.2, p = 0.03). Similarly, children with moderate to severe malnutrition reported a significantly higher number of malaria infection cases (33.9%) compared to children with severe anaemia alone (27.9%, p = 0.02). However, the number of hospitalizations and recurrence of severe anaemia was similar and not statistically significant between the two groups (RR 0.8 (0.4–1.4), p = 0.6 and RR 1.1 (0.3–2.8), p = 0.8). Conclusion Among children with severe anaemia, those who also had moderate to severe malnutrition had a twofold higher risk of dying compared to those who did not. It is therefore crucial to investigate acute malnutrition among severely anaemic children, as this might be treatable factor associated with high mortality.

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Study of Anaemia in Children with Severe Acute Malnutrition

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v37i3.18480 ◽

2018 ◽

Vol 37 (3) ◽

pp. 250-253 ◽

Cited By ~ 1

Author(s):

Deepak Dwivedi ◽

Veerendra Singh ◽

Jyoti Singh ◽

Sangita Sharma

Keyword(s):

Severe Acute Malnutrition ◽

Tertiary Care ◽

Severe Anaemia ◽

Acute Malnutrition ◽

Folic Acid Deficiency ◽

Care Hospital ◽

Macrocytic Anaemia ◽

Normal Children ◽

Co Morbidity ◽

Morphologic Type

Introduction: Severe anaemia is a leading cause of paediatric morbidity, hospitalization, and mortality and it is very important co morbidity in children with severe acute malnutrition. Severe Acute Malnutrition (SAM) with anaemia has been shown to have 2.62 times higher mortality as compared to SAM with no anaemia. So this study was done to evaluate this co-morbidity further. The aim of present study was to determine the prevalence and type of anaemia and to evaluate the possible aetiologies of anaemia in severe acute malnourished (SAM) children.Material and Methods: In tertiary care hospital a cross sectional study was conducted over a period of 8 month with 100 cases of SAM children and 101 cases of normal children. In both cases disorders of primary haematological problem were excluded. Auto analysers were used to measure blood counts. Blood smear was analysed by pathology consultant of institute and recorded for all patients with anaemia. Grade of anaemia and morphologic type of anaemia was analysed. Data were entered in Excel spreadsheets and analysed using SPSS 20.0.Results: Patient with SAM 42% had moderate anaemia and 19% had severe anaemia in contrast 41.6% and 16.8% in NON SAM child respectively. Predominant morphologic type in SAM patient was macrocytic anaemia (33%), while in controls microcytic anaemia (40.6%) was more prevalent.Conclusion: There was a high prevalence of anaemia in SAM children. Major morphologic type in SAM children was macrocytic anaemia which may indirectly show vitamin B12 or folic acid deficiency in these children.

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Performance and costing of nutrition intervention measures on admitted children in malnutrition treatment center: a case study from Jharkhand, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20204375 ◽

2020 ◽

Vol 7 (10) ◽

pp. 4048

Author(s):

Rajesh Kumar Sinha ◽

Asha Kiran ◽

Vivek Kashyap ◽

Praveen Kumar

Keyword(s):

Severe Acute Malnutrition ◽

Average Length ◽

Nutrition Intervention ◽

Acute Malnutrition ◽

Treatment Center ◽

Medical Complication ◽

Average Weight ◽

Post Discharge ◽

Target Weight ◽

Intervention Measures

Background: Children with severe acute malnutrition (SAM) having medical complications require immediate care at malnutrition treatment centers (MTC). Thus, it becomes important to assess the effect and treatment cost of such children in these facilities. Hence, the present study was done with these aims in two MTCs in Jharkhand, India.Methods: A retrospective record review was done of the children admitted to these two MTCs between 1st April 2017 and 31st March 2018. A predesigned proforma was used to collect child related information. The data collected was entered in Microsoft excel sheet and analysed.Results: Majority of the admitted children (90.6%) were in 6-23 months age group. 358 (51.5%) children were females. Only, 194 (27.9%) children admitted were SAM had any medical complication. 690 (99.3%) children were discharged of whom 499 (72.3%) were discharged after achieving the target weight. The average weight gain during their stay was 8.1±2.4 g/kg/day and average length of stay was 16.7±3.2 days. Post discharge follow up rates were found to be low and only 130 (18.8%) children completed all three follow ups. Average cost per SAM child treated was Rs. 18,599 (US$ 272) and per SAM child cured was Rs. 25,904 (US$ 379).Conclusions: MTCs are effective in managing medically complicated SAM children. However, improvements are necessary to ensure that more such children should be treated at facility level, complimented with a community based programme for managing uncomplicated SAM children to improve coverage and ensure continuum of care.

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The effects of malnutrition on cardiac function in African children

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-309188 ◽

2015 ◽

Vol 101 (2) ◽

pp. 166-171 ◽

Cited By ~ 11

Author(s):

Jonathan A Silverman ◽

Yamikani Chimalizeni ◽

Stephen E Hawes ◽

Elizabeth R Wolf ◽

Maneesh Batra ◽

...

Keyword(s):

Heart Rate ◽

Cardiac Function ◽

Severe Acute Malnutrition ◽

Resistance Index ◽

Stroke Volume Index ◽

Acute Malnutrition ◽

Volume Index ◽

Severe Malnutrition ◽

Systemic Vascular Resistance Index ◽

Malnourished Children

ObjectiveCardiac dysfunction may contribute to high mortality in severely malnourished children. Our objective was to assess the effect of malnutrition on cardiac function in hospitalised African children.DesignProspective cross-sectional study.SettingPublic referral hospital in Blantyre, Malawi.PatientsWe enrolled 272 stable, hospitalised children ages 6–59 months, with and without WHO-defined severe acute malnutrition.Main outcome measuresCardiac index, heart rate, mean arterial pressure, stroke volume index and systemic vascular resistance index were measured by the ultrasound cardiac output monitor (USCOM, New South Wales, Australia). We used linear regression with generalised estimating equations controlling for age, sex and anaemia.ResultsOur primary outcome, cardiac index, was similar between those with and without severe malnutrition: difference=0.22 L/min/m2 (95% CI −0.08 to 0.51). No difference was found in heart rate or stroke volume index. However, mean arterial pressure and systemic vascular resistance index were lower in children with severe malnutrition: difference=−8.6 mm Hg (95% CI −12.7 to −4.6) and difference=−200 dyne s/cm5/m2 (95% CI −320 to −80), respectively.ConclusionsIn this largest study to date, we found no significant difference in cardiac function between hospitalised children with and without severe acute malnutrition. Further study is needed to determine if cardiac function is diminished in unstable malnourished children.

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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

Research in Health Science ◽

10.22158/rhs.v1n1p41 ◽

2016 ◽

Vol 1 (1) ◽

pp. 41 ◽

Cited By ~ 1

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

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

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Biomarkers of post-discharge mortality among children with complicated severe acute malnutrition

Scientific Reports ◽

10.1038/s41598-019-42436-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 11

Author(s):

James M. Njunge ◽

Agnes Gwela ◽

Nelson K. Kibinge ◽

Moses Ngari ◽

Lydia Nyamako ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Post Discharge

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Severe Malnutrition and Anemia Are Associated with Severe COVID in Infants

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa084 ◽

2020 ◽

Author(s):

Rajesh Kulkarni ◽

Uday Rajput ◽

Rahul Dawre ◽

Naresh Sonkawade ◽

Sameer Pawar ◽

...

Keyword(s):

Respiratory Distress ◽

Severe Acute Malnutrition ◽

Megaloblastic Anemia ◽

Severe Disease ◽

Tertiary Care ◽

Renal Calculi ◽

Acute Malnutrition ◽

Deficiency Anemia ◽

Severe Malnutrition ◽

Neutrophil Lymphocyte Ratio

ABSTRACT Background COVID-19 is uncommon and less severe in children than adults. It is thought that infants may be at higher risk for severe disease than older children. There is a paucity of literature on infants with COVID, particularly those with severe disease. Objective We describe demographic, epidemiologic, clinical, radiological, laboratory features and outcomes of infants with confirmed SARS-CoV-2 infection admitted to a tertiary care teaching hospital in Pune, India Methodology Infants who tested positive for SARS-CoV-2 and were admitted between 1 April 2020 and 7 August 2020 were included in the study. Results A total of 13 infants were admitted during the study period. The median age was 8 months (IQR 6) and nine were male. Common presenting features were fever (n = 8, 62%), poor feeding, irritability, and runny nose (n = 3, 23%). Comorbidities noted were severe acute malnutrition (SAM) in three cases (23%) and nutritional megaloblastic anemia, iron deficiency anemia, sickle thalassemia and renal calculi in one case (8%) each. There was a history of low birth weight in two cases (15%). Pallor was noted in three cases (23%), SAM in three cases (23%) and tachypnea and respiratory distress in four cases (30%). Severe anemia, thrombocytopenia, elevated ferritin, abnormal procalcitonin, abnormal C Reactive Protein and deranged D-dimer was noted in three cases (23%) each. Neutrophil–lymphocyte ratio was normal in all cases. Three infants (43%) had evidence of pneumonia on the chest radiograph, of which one had adult respiratory distress syndrome (ARDS) like pattern, one infant had cardiomegaly and perihilar infiltrates. Hydroxychloroquine and azithromycin were given to five patients (38%), Intravenous Immunoglobulin and methylprednisolone were administered to one patient (8%). One infant died of ARDS with multi-organ dysfunction with refractory shock and hemophagocytic lymphohistiocytosis. Conclusion SAM and anemia may be associated with severe COVID in infants.

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Urinary Organic Acids Increase After Clinical Stabilization of Hospitalized Children With Severe Acute Malnutrition

Food and Nutrition Bulletin ◽

10.1177/0379572119853930 ◽

2019 ◽

Vol 40 (4) ◽

pp. 532-543

Author(s):

Allison I. Daniel ◽

Matilda E. Arvidsson Kvissberg ◽

Edward Senga ◽

Christian J. Versloot ◽

Philliness Prisca Harawa ◽

...

Keyword(s):

Organic Acids ◽

Low Income ◽

Severe Acute Malnutrition ◽

Urinary Metabolites ◽

Acute Malnutrition ◽

Partial Recovery ◽

Nutritional Rehabilitation ◽

Risk Of Death ◽

Urinary Organic Acids ◽

Clinical Stabilization

Background: Despite a reduction of child mortality in low-income countries, acutely ill undernourished children still have an elevated risk of death. Those at highest risk are children with severe acute malnutrition (SAM) who often show metabolic dysregulation that remains poorly understood. Objective: We performed a pilot study to examine changes in urinary organic acids during nutritional rehabilitation of children with SAM, and to identify metabolites associated with the presence of edema or with mortality. Methods: This study included 76 children aged between 6 and 60 months, hospitalized for SAM at the Moyo Nutritional Rehabilitation and Research Unit in Blantyre, Malawi. Urine was collected at admission and 3 days after clinical stabilization and metabolomics were performed using gas chromatography–mass spectrometry. Metabolite concentrations were evaluated with both uni- and multivariate approaches. Results: Most metabolites increased 3 days after clinical stabilization, and total urinary concentration changed from 1.2 mM (interquartile range [IQR], 0.78-1.7) at admission to 3.8 mM (IQR, 2.1-6.6) after stabilization ( P < .0001). In particular, 6 metabolites showed increases: 3-hydroxybutyric, 4-hydroxyhippuric, p-hydroxyphenylacetic, oxoglutaric, succinic, and lactic acids. Urinary creatinine was low at both time points, but levels did increase from 0.63 mM (IQR, 0.2-1.2) to 2.6 mM (IQR,1.6-4.4; P < .0001). No differences in urinary profiles were found between children who died versus those who survived, nor between children with severe wasting or edematous SAM. Conclusions: Total urinary metabolites and creatinine increase after stabilization and may reflect partial recovery of overall metabolism linked to refeeding. The use of urinary metabolites for risk assessment should be furthered explored. Trial registration: TranSAM study (ISRCTN13916953).

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Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali

BMJ Global Health ◽

10.1136/bmjgh-2018-001227 ◽

2019 ◽

Vol 4 (2) ◽

pp. e001227 ◽

Cited By ~ 6

Author(s):

Sheila Isanaka ◽

Dale A Barnhart ◽

Christine M McDonald ◽

Robert S Ackatia-Armah ◽

Roland Kupka ◽

...

Keyword(s):

Cost Effectiveness ◽

Dietary Supplements ◽

Severe Acute Malnutrition ◽

Morbidity And Mortality ◽

Acute Malnutrition ◽

Tree Model ◽

Risk Of Death ◽

Life Years ◽

Wide Range ◽

Moderate Acute Malnutrition

IntroductionModerate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6–35 months of age in Mali.MethodsWe conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn–soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal–legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.ResultsCompared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.ConclusionMAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.Trial registrationNCT01015950.

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Treatment Outcome of Severe Acute Malnutrition and Its Determinants among Pediatric Patients in West Ethiopia

International Journal of Pediatrics ◽

10.1155/2018/8686501 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Muluken Berhanu Mena ◽

Mohammed Gebre Dedefo ◽

Bruke Berhanu Billoro

Keyword(s):

Logistic Regression ◽

Treatment Outcome ◽

Pediatric Patients ◽

Hospital Admissions ◽

Severe Acute Malnutrition ◽

Statistical Significance ◽

Acute Malnutrition ◽

Severe Malnutrition ◽

P Value ◽

Multivariable Logistic Regression

Background. Malnutrition is a silent killer that is underreported, underaddressed, and as a result underprioritized. It is reported that severe acute malnutrition is the commonest reason for pediatrics hospital admission in many poor countries; 25 to 30% of children with severe malnutrition die during hospital admissions. Objective. To determine treatment outcome of severe acute malnutrition and identify its determinants among pediatric patients in pediatrics ward of Nekemte Referral Hospital. Methods. A retrospective hospital-based cross-sectional study was done from November 2015 to April 2017. Data had been collected by using checklist for recording information from patient card and register book. Association between independent variables and depend variable was assessed using bivariate and stepwise multivariable logistic regression, respectively. Level of statistical significance was declared at p value < 0.05. Results. Out of 205 admitted children with severe acute malnutrition, 137 (66.8%) cases were cured from SAM, 9 (4.4%) cases were died because of SAM, and (16.6%) cases were defaulter from SAM management, and 25 (12.2%) cases were transferred out. Multivariable logistic regression showed that children admitted with both edema and wasting AOR = 8.30, 95% CI (1.72, 40.09) P=0.008, children without hypothermia AOR = 2.91, 95%CI (1.10, 7.69) P=0.031, children who stay 8-14 days AOR = 3.86, 95%CI (1.01, 14.75) P=0.048, children without pneumonia AOR = 7.82, 95%CI (2.74, 222.29) P=0.001, children without anemia AOR = 3.22, 95%CI (1.04, 9.97) P=0.042, and children without HIV AOR = 9.21, 95% CI (2.20, 38.54) P=0.002 were more likely to be cured from severe acute malnutrition. Conclusion. Treatment outcome of severe acute malnutrition in this study is good. It shows that around three-fourths of the children were cured. Factors such as admission criteria, hypothermia, length of stay, pneumonia, anemia, and presence of HIV were associated with treatment response.

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A Multi-Component Transition of Care Improvement Project to Reduce Hospital Readmissions Following Ischemic Stroke

The Neurohospitalist ◽

10.1177/19418744211036632 ◽

2021 ◽

pp. 194187442110366

Author(s):

Ann M. Leonhardt-Caprio ◽

Craig R. Sellers ◽

Elizabeth Palermo ◽

Thomas V. Caprio ◽

Robert G. Holloway

Keyword(s):

Ischemic Stroke ◽

Hospital Readmission ◽

Hospital Readmissions ◽

Cost Of Care ◽

Post Discharge ◽

Readmission Rates ◽

Improvement Project ◽

Risk Of Death ◽

Hospital Readmission Rates ◽

Number Of Patients

Background: Ischemic stroke (IS) is a common cause of hospitalization which carries a significant economic burden and leads to high rates of death and disability. Readmission in the first 30 days after hospitalization is associated with increased healthcare costs and higher risk of death and disability. Efforts to decrease the number of patients returning to the hospital after IS may improve quality and cost of care. Methods: Improving care transitions to reduce readmissions is amenable to quality improvement (QI) initiatives. A multi-component QI intervention directed at IS patients being discharged to home from a stroke unit at an academic comprehensive stroke center using IS diagnosis-driven home care referrals, improved post-discharge telephone calls, and timely completion of discharge summaries was developed. The improvement project was implemented on July 1, 2019, and evaluated for the 6 months following initiation in comparison to the same 6-month period pre-intervention in 2018. Results: Following implementation, a statistically significant decrease in 30-day all-cause same-hospital readmission rates from 7.4% to 2.8% ( p = .031, d = 1.61) in the project population and from 6.6% to 3% ( p = .010, d = 1.43) in the overall IS population was observed. Improvement was seen in all process measures as well as in patient satisfaction scores. Conclusions: An evidence-based bundled process improvement intervention for IS patients discharged to home was associated with decreased hospital readmission rates following IS.

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