scholarly journals Poor adherence to TB diagnosis guidelines among under-five children with severe acute malnutrition in central India: A missed window of opportunity?

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248192
Author(s):  
Akash Ranjan Singh ◽  
Amber Kumar ◽  
Hemant Deepak Shewade ◽  
Bhavna Dhingra
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Mantoux Test ◽  
Gastric Aspirate ◽  
Window Of Opportunity ◽  
Care Providers ◽  
Molecular Test ◽  
Under Five ◽  
Under Five Children ◽  
Microbiological Confirmation

Background In India, under-five children with Severe Acute Malnutrition (SAM) are referred to Nutritional Rehabilitation Centers (NRCs). NRCs screen the causes of SAM including tuberculosis (TB). The national TB programme recommends upfront testing with a rapid molecular test if TB is suspected in children. Objective We estimated the yield of and adherence to the TB diagnostic guidelines (clinical assessment and assessment for microbiological confirmation) among under-five children with SAM admitted at NRCs (six in district Sagar and four in district Sheopur) of Madhya Pradesh, India in 2017. We also explored the challenges in screening from the health care providers’ perspective. Methods It was an explanatory mixed method study. The NRC records were reviewed This was followed by three key informant interviews and three focus group discussions among staff of NRC and TB programme. Manual descriptive thematic analysis was performed. Results Of 3230, a total of 2665(83%) children underwent Mantoux test, 2438(75%) underwent physical examination, 2277(70%) were asked about the symptoms suggestive of TB, 1220(38%) underwent chest radiograph and 485(15%) were asked for recent contact with TB. A total of 547(17%) underwent assessment for microbiological confirmation. Of 547, a total of 229 gastric aspirate specimens underwent rapid molecular test (24% positive) and 318 underwent sputum microscopy (44% positive). A total of 223 were diagnosed as TB (195 microbiologically and 28 clinically confirmed) and 209 were initiated on anti-TB treatment. The treatment outcome was favourable (cure or treatment completed) for 70(31%) and not recorded for 121(54%). The main perceived challenges in screening for TB were poor team skills, lack of diagnostic facilities and poor understanding of the guidelines due to inadequate training. Conclusion Though NRCs provided a unique window of opportunity for the screening and management of TB among under-five children with SAM, the utilization of this opportunity remained suboptimal.

scholarly journals Survival Status and Its Determinants among Under-Five Children with Severe Acute Malnutrition Admitted to Inpatient Therapeutic Feeding Centers in South Wollo Zone, Amhara Region, Ethiopia

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Seid Legesse Hassen ◽  
Ayalew Astatkie ◽  
Tefera Chanie Mekonnen ◽  
Getahun Gebre Bogale
Keyword(s):  
Proportional Hazards ◽  
Severe Acute Malnutrition ◽  
Cox Proportional Hazards ◽  
Acute Malnutrition ◽  
Care Providers ◽  
Under Five ◽  
Under Five Children ◽  
Survival Status ◽  
Global Standards ◽  
Table Analysis

Background. Under nutrition is one of the leading causes of morbidity and mortality in under-five children in developing countries including Ethiopia. In Ethiopia, many children with severe acute malnutrition (SAM) are treated at inpatient therapeutic feeding centers. However, the survival status and its determinants are not well understood. Therefore, the aim of this study was to estimate the survival status and its determinants among under-five children with severe acute malnutrition admitted to inpatient therapeutic feeding centers (ITFCs). Methods. A record review was conducted on 414 under-five children who were admitted with severe acute malnutrition to ITFCs in South Wollo Zone, northeast Ethiopia, between September 11, 2014, and January 9, 2016. Data were entered into Epi-Info version 7.2 and analyzed using SPSS version 20. Life table analysis was used to estimate cumulative proportion of survival. The relationship between time to recovery and covariates was determined using Cox-proportional hazards regression model. p<0.05 was used to declare presence of significant association between recovery time and covariates. Results. Of the total children recorded, 75.4% of children were recovered and discharged, 10.3% were defaulters, 3.4% died, 7.4% were nonresponders, and 3.4% were unknown. The mean (±standard deviation) time to recovery was 12 (±5.26) days, whereas the median time to recovery was 11 (interquartile range of 8–15) days. Children’s breastfeeding status at admission (AHR: 1.42, 95% CI: 1.10, 1.83) and children without comorbidities at admission (AHR: 1.44, 95% CI: 1.03, 2.00) had statistically significant effect on time to recovery from SAM. Conclusion. All treatment responses in this study were within the recommended and acceptable range of global standards. Policy makers, health facilities, and care providers may need to focus on the importance of breastfeeding especially for those under two years of age and give emphasis for cases with comorbidities.

scholarly journals Assessment of the Nutritional Status of Under-Five Years (6–59 Months) Children Attending Dalhatu Araf Specialist Hospital Lafia, Nasarawa State, Nigeria

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 183-183
Author(s):  
Emmanuel Kigbu Francis ◽  
Titilayo Bamidele ◽  
Micheal Enemali
Keyword(s):  
Nutritional Status ◽  
Severe Acute Malnutrition ◽  
Well Being ◽  
Acute Malnutrition ◽  
Nutritional Knowledge ◽  
Normal Range ◽  
Child Feeding ◽  
Under Five ◽  
Under Five Children ◽  
Nutritional Status Of Children

Abstract Objectives Malnutrition is a major public health challenge in developing countries and as such the nutritional status of children serve as an indicator to rate the overall well-being of a society. In this study, we assessed the nutritional status of under-five children attending Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Methods After ethical clearance, 165 under five children were randomly recruited into the study. The socio-demographic and nutritional information of the children and mother were obtained using structured questionnaires. Anthropometric assessment was done on each child and blood samples analyzed using standard biochemical techniques. The data obtained were statistically analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Results Out of the 165 children recruited for this study, 51.5% were males. 41.2% of the children showed prevalence of Global Malnutrition, 15.8% and 25.5% indicated moderate acute malnutrition (MAM) and Severe Acute Malnutrition (SAM) respectively. 66.1% of the children had Mid-upper arm circumference (MUAC) measures in the normal range of 12.5–14.6 cm. There is a significant relationship between nutritional knowledge of the mother, socioeconomic status, child feeding practices, and the nutritional status of their children (P &lt; 0.05). The biochemical parameters studied reported that average PCV (33.32 ± 4.49) and total protein (34.53 ± 13.26 g/L) were lower than the normal range, glucose (4.52 ± 0.97 mmol/L) and Calcium (2.14 ± 0.25 mmol/L) were within the normal range and Albumin (64.16 ± 16.87 g/L) was above the normal range. Conclusions This study has successfully revealed the nutritional status of under five years children in Nasarawa State, Nigeria. Our findings have critical implications for intervention initiatives among children in Nigeria. Funding Sources Self funded.

scholarly journals TO STUDY THE PREVALENCE AND TYPES OF NUTRITIONAL ANEMIA IN UNDER-FIVE CHILDREN WITH SEVERE ACUTE MALNUTRITION

2020 ◽  
Vol 07 (06) ◽  
pp. 270-273
Author(s):  
Roshan Kumar Jangid ◽  
Arun Kumar ◽  
Anita . ◽  
Chinmaya Mahapatra ◽  
Manoj Yadav ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Under Five ◽  
Under Five Children ◽  
Nutritional Anemia

scholarly journals Treatment Outcome of Severe Acute Malnutrition and associated factors among under-five children in outpatient therapeutics unit in Gubalafto Wereda, North Wollo Zone, Amara Regional State, North Ethiopia, 2019 G.C

2019 ◽  
Author(s):  
Biruk Beletew Abate ◽  
Befkad Dress ◽  
Ayelign Mengesha Kassie ◽  
Mesifn Wudu Kassaw
Keyword(s):  
Treatment Outcome ◽  
Recovery Rate ◽  
Associated Factors ◽  
Service Providers ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Under Five ◽  
Under Five Children ◽  
Therapeutic Program ◽  
Management Protocol

Abstract Background: In Ethiopia uncomplicated severe acute malnutrition is managed through the outpatient therapeutic program at health posts level. This brings the services for the management of Severe Acute Malnutrition closer to the community by making services available at decentralized treatment points within the primary health care settings. So far, evidence on the treatment outcome of the program is limited. Thus, the main aim of this study was to determine the magnitude of treatment outcomes of severe acute malnutrition and associated factors among under-five children at outpatient therapeutic feeding units. Methods: This was a retrospective cohort study conducted on 600 children who had been managed for SAM under OTP in Gubalafto Wereda from April to May/2019. The children were selected using systematic random sampling from 9 health posts. The structured, pre-tested and adapted questionnaire was used to collect the data. The data was entered by using EPI-data Version 4.2 and exported to SPSS version 24.0 for analysis. Bivariate and Multivariate regression was also carried out to determine the association between dependent and independent variables. Results: A total of 600 records of children with a diagnosis of severe acute malnutrition were reviewed. Of these cases of malnutrition, the recovery rate was revealed as 65 %. The death rate, default rate, and medical transfer were 2.0, 16.0, and 17.0 respectively. Children who took immunization were had 6.85 times higher odds of recovery than children who were not immunized (AOR=6.85 at 95% CI (3.68-12.76)). The likelihood of recovery was 3.78 times higher among children with new admission than those with re-admission (AOR=3.78at 95% CI ((1.77-8.07))). Likewise, children provided with amoxicillin were 3.38 times more likely to recover compared to their counterparts who were not provided (AOR=3.38 at 95% CI ((1.61-7.08))). Conclusions: The recovery rate and medical transfer were lower than sphere standard. Presence of cough, presence of diarrhea admission category, provision of amoxicillin, and immunization status were factors identified as significantly associated with treatment outcome of Sever Acute Malnutrition. Building capacity of OTP service providers and regular monitoring of service provision based on the management protocol were recommended.

scholarly journals Treatment outcomes of severe acute malnutrition and Predictors of Recovery in Under-Five children treated within Outpatient Therapeutic Program in Ethiopia: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Zebenay Workneh Workneh Bitew ◽  
Ayinalem Alemu ◽  
Teshager Worku
Keyword(s):  
Treatment Outcomes ◽  
Recovery Rate ◽  
Severe Acute Malnutrition ◽  
Meta Analysis ◽  
Grey Literature ◽  
Sub Saharan Africa ◽  
Acute Malnutrition ◽  
Under Five ◽  
Under Five Children ◽  
Feeding Programs

Abstract Introduction Severe acute malnutrition affects around 17 million under-five children in the world, of which the highest burden is accounted by Sub-Saharan Africa where Ethiopia is found. Besides few individualized, inconsistent and inconclusive studies, there is no nationally representative study conducted on treatment outcomes of SAM in outpatient therapeutic feeding programs in Ethiopia. This study aimed at estimating the pooled treatment outcomes and predictors of recovery rate among under- five children with SAM in Ethiopia. Methods Both electronic databases (PubMed, Medline (EBSCOhost), EMBASE (Elsevier), CINAHL (EBSCOhost), web of science, Scopus, Science Direct and Food Science and Technology Abstracts (FSTA)) and grey literature sources (Google scholar, Mednar, World Cat and google) were used to retrieve articles. The random effect model was used to estimate the pooled treatment outcomes. Hazard ratios were used to determine the predictors of recovery rate. Cochran’s Q, I 2 , and univariate Meta regression were done for heterogeneity as well as Begg’s & Egger’s tests for publication bias. Results Nineteen articles with a total number of 23395 under-five children with SAM were used for this meta-analysis. The pooled recovery, death, defaulter and non-recovery rates were 70% (95% CI: 64.45, 75.72), 1.69% (95% CI: 1.06, 2.31), 9.7% (95%CI: 7, 12.4), 15.14% (95% CI: 10.11, 20.16), respectively. Diarrhea (HR=0.8, 95% CI: 0.75, 0.94), no edema (HR=0.41, 95% CI: 0.33, 0.50) and amoxicillin (HR=1.81, 95% CI: 1.18, 2.44) were independent predictors of recovery rate of children with SAM in Ethiopia. Publication year was found to be the potential source of heterogeneity among the included studies. Conclusion The treatment outcomes of children with SAM from outpatient therapeutic feeding programs of Ethiopia are lower than the sphere guidelines, WHO and national recommendations. Diarrhea and no edema antagonized the recovery rate of children while amoxicillin enhanced the recovery rate of children from SAM. Community health workers need to be trained. Especial attention should be given while treating children with diarrhea and severe wasting. Community mobilization is also recommended to increase community awareness about the therapeutic foods.

scholarly journals Individual and Household Risk Factors for Severe Acute Malnutrition among Under-Five Children in the Analamanga Region, Madagascar

2018 ◽  
Vol 7 (1) ◽  
pp. 17 ◽  
Author(s):  
David Rakotonandrasana Harimbola, PhD, MD ◽  
Kaori Mizumoto, PhD
Keyword(s):  
Risk Factors ◽  
Health Literacy ◽  
Health Services ◽  
Working Mothers ◽  
Severe Acute Malnutrition ◽  
Community Support ◽  
Acute Malnutrition ◽  
Under Five ◽  
Under Five Children ◽  
Creative Commons

Background and Objectives: Despite some progress made in the fight against malnutrition in Madagascar, hospitals’ mortality due to severe acute malnutrition (SAM) remains high. This study explores the risk factors for SAM among children hospitalized with SAM in the Analamanga region of Madagascar.Methods: We conducted an interview based qualitative study of 14 mothers of under-five children with SAM admitted to the hospital’s pediatric unit and living in the Analamanga region. Data were analyzed using thematic analysis method.Results: There were direct, intermediate and basic causes of malnutrition shared with other health care settings. Low health literacy such as limited knowledge and optimistic perception of malnutrition, and lack of health service information resulted in delayed hospital visit for care of SAM. Vulnerable working mothersdo not benefit from available community support structure. Mothers are unable to practice what they learned because financial difficulties at the household level occupy their time.Conclusions and Global Health Implications: Consideration of vulnerable working mothers’ access to existing health services and interventions to address health literacy are important to prevent SAM at the community level. Study findings would be of interest to practitioners and policy makers in the region and perhaps in other resource limited settings.Key words: SAM • Health Literacy • Utilization of Health Services • Working Mothers • MadagascarCopyright © 2018 Harimbola and Mizumoto. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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