Investigating Differences in Nutritional Parameters in Ugandan Children with Plasmodium falciparum Severe Malaria

Background: In 2018, malaria produced an estimated 272,000 deaths in children <5 years of age, accounting for 67% of all malaria deaths worldwide, with a majority in the WHO African Region. Malnutrition is an important risk factor for malaria. Wasting, Stunting and Underweight are crucial indicators of malnutrition. Annually, 14 million children <5 are classified as wasted and 59 million children are classified as stunted. Objective: The objective of this study is to determine the association between each of the major manifestations of severe malaria (SM) and nutritional parameters – weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) – in children from the Ugandan cities Mulago and Jinja. Methods: To assess differences in WAZ, HAZ, and WHZ by the five types of SM and community controls (CC), we evaluated Z-scores from children <5 years old enrolled in a prospective cohort study (NDI, Neurodevelopmental Impairment in Children with Severe Malaria) at enrollment and 12-month follow-up. Results: WAZ and WHZ at baseline were significantly lower among SM groups than in CC (p<0.001), but there were no significant differences observed at 12-month follow-up. There were no major differences in HAZ between the SM and CC groups. WAZ and HAZ at baseline were significantly lower among High Mortality (HM) versus Low Mortality (LM) groups (p<0.01). At 12-month follow-up, HAZ remained significantly lower in HM versus LM (p<0.01). There were no major differences in WHZ between the HM and LM groups. Compared to those who survived, the 27 children who died had significantly lower WAZ (p<0.05), but no major differences in HAZ or WHZ. Conclusion: Underweight, stunting, and wasting may be risk factors for SM. Overall, a more comprehensive understanding of how SM elicits adverse effects in children is necessary. Nutrition intervention programs must be implemented to prevent child stunting, wasting, underweight, and mortality.

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Malnutrition in Paediatrics: Stationary Screening & Follow-up

Klinische Pädiatrie ◽

10.1055/a-1003-6933 ◽

2019 ◽

Vol 232 (01) ◽

pp. 20-28

Author(s):

Dorothea Werner ◽

Klaus-Peter Zimmer ◽

Gunter P. Eckert ◽

Jan de Laffolie

Keyword(s):

Gastrointestinal Diseases ◽

Tertiary Hospital ◽

Real World Data ◽

Tertiary Centre ◽

Arm Circumference ◽

Z Scores ◽

Mid Upper Arm Circumference ◽

Height For Age ◽

Weight For Age

Abstract Objective The prevalence and follow-up of the clinical real-world data focussing on existing or risk of malnutrition in a tertiary hospital general paediatric ward including 4 months of follow-up was assessed. Methods Measurements included anthropometric measurements, a nutrition interview and an extended version of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP). R Studio 3.4.2 was used for statistical analysis and diagnosing malnutrition by calculating height-for-age (HfAz)-, weight-for-age (WfAz)- weight-for-height (WfHz)-, body mass index-for-age (BMIz) and mid-upper-arm circumference (MUACz)-z-scores with the childsds package with KIGGS and WHO for reference. Results The median age of the 68 participants was 8.00 (4.00–13.00) years. The main reasons for hospitalisation in the tertiary centre were gastrointestinal diseases, diabetes mellitus and rheumatic diseases. At admission 39.71%, at the second examination 36.00% and at the third examination 45.90% were malnourished. 68% of inpatients lost weight during their clinical stay, of which 35.29% lost more than 3% of their initial weight. However, changes were not significantly different. Conclusion A significant share of patients was diagnosed to be malnourished at admission, the majority of patients lost weight during their hospital stay and the 4 months after admission. Due to the far reaching consequences for patients, doctors, health insurance and politics, the early diagnosis and treatment of malnutrition should take greater account in the future.

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Association of Whole Blood Fatty Acids and Growth in Southern Ghanaian Children 2–6 Years of Age

Nutrients ◽

10.3390/nu10080954 ◽

2018 ◽

Vol 10 (8) ◽

pp. 954 ◽

Cited By ~ 3

Author(s):

Mary Adjepong ◽

William Yakah ◽

William Harris ◽

Esi Colecraft ◽

Grace Marquis ◽

...

Keyword(s):

Fatty Acids ◽

Growth Parameters ◽

Dietary Fatty Acids ◽

Northern Ghana ◽

Z Score ◽

Omega 3 ◽

Omega 6 ◽

Z Scores ◽

Height For Age ◽

Weight For Age

In Ghana, stunting rates in children below 5 years of age vary regionally. Dietary fatty acids (FAs) are crucial for linear growth. The objective of this study was to determine the association between blood FAs and growth parameters in southern Ghanaian children 2–6 years of age. A drop of blood was collected on an antioxidant treated card and analyzed for FA composition. Weight and height were measured and z-scores calculated. Relationships between FAs and growth were analyzed by linear regressions and factor analysis. Of the 209 subjects, 22% were stunted and 10.6% were essential FA deficient (triene/tetraene ratio > 0.02). Essential FA did not differ between stunted and non-stunted children and was not associated with height-for-age z-score or weight-for-age z-score. Similarly, no relationships between other blood fatty acids and growth parameters were observed in this population. However, when blood fatty acid levels in these children were compared to previously reported values from northern Ghana, the analysis showed that blood omega-3 FA levels were significantly higher and omega-6 FA levels lower in the southern Ghanaian children (p < 0.001). Fish and seafood consumption in this southern cohort was high and could account for the lower stunting rates observed in these children compared to other regions.

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Sustained Positive Deviant Child Care Practices and Their Effects on Child Growth in Viet Nam

Food and Nutrition Bulletin ◽

10.1177/15648265020234s204 ◽

2002 ◽

Vol 23 (4_suppl2) ◽

pp. 16-25 ◽

Cited By ~ 40

Author(s):

U. Agnes Trinh Mackintosh ◽

David R. Marsh ◽

Dirk G. Schroeder

Keyword(s):

Child Growth ◽

Program Completion ◽

Viet Nam ◽

Nutrition Program ◽

Cross Sectional ◽

Total N ◽

Z Scores ◽

Growth Promoting ◽

Height For Age ◽

Weight For Age

Save the Children's (SC) successful integrated nutrition program in Viet Nam, the poverty alleviation and nutrition program (PANP), uses the positive deviance (PD) approach to identify key growth promoting behaviors and provides participatory adult education allowing mothers to develop skills related to these behaviors. We investigated whether improvements seen during a PANP intervention (1993–1995) were sustained three and four years after SC's departure. Cross-sectional surveys were administered to 46 randomly selected households in four communes that had previously participated in the PANP and 25 households in a neighboring comparison community in 1998 and 1999. Two children per household, an older child who had participated in the PANP and a younger sibling who had not, were measured (total n = 142 children), and their mothers were interviewed. Older SC children tended to be better nourished than their counterparts. Their younger siblings were significantly better nourished than those in the comparison group, with adjusted mean weight-for-age Z scores of −1.82 versus −2.45 ( p = .007), weight-for-height Z scores of −0.71 versus −1.45 ( p < .001), and height-for-age Z scores of −2.11 and −2.37 (ns, p = .4), respectively. SC mothers reporting feeding the younger siblings more than their counterparts did (2.9 versus 2.2 main meals per day, p < .001, and 96.2% versus 52% offering snacks, p < .01]. SC mothers reported washing their hands “often” more than comparison mothers (100% vs. 76%, p < .001). Growth-promoting behaviors identified through PD studies and practiced through neighborhood-based rehabilitation sessions persisted years after program completion. These sustained behaviors contributed to better growth of younger siblings never exposed to the program.

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Water, sanitation and hygiene practices associated with improved height-for-age, weight-for-height and weight-for-age z-scores in Nepal.

10.21203/rs.2.17090/v3 ◽

2020 ◽

Author(s):

Som Kumar Shrestha ◽

Don Vicendese ◽

Bircan Erbas

Keyword(s):

Nutritional Status ◽

Water Purification ◽

Rural Areas ◽

Interactive Effects ◽

P Value ◽

Child Undernutrition ◽

Sanitation And Hygiene ◽

Z Scores ◽

Height For Age ◽

Weight For Age

Abstract Background: Evidence of the influence of water, sanitation and hygiene (WASH) behaviors on childhood nutritional status is inconsistent. Few studies have examined their interactive effects. This study aimed to examine associations and interactions between WASH variables and preschool child undernutrition. Methods: Data from a nationally representative sample of 2352 children assessed during the 2016 Nepal Demographic and Health Survey were analyzed by multi-variable linear regression to understand the association between height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores and WASH variables. Interactions between WASH variables, sex and area of residence on childhood nutritional status were also examined. Results: The mean z-score [standard deviation] for children’s WAZ, HAZ and WHZ scores were -1.33 [1.1], -1.52 [1.3] and -0.65 [1.1], respectively. A unit increase in cluster sanitation coverage was associated with an increase of 0.30 (95%CI: 0.12 to 0.48) for WAZ and 0.28 (95%CI: 0.001 to 0.56) for HAZ scores. Household water purification practice was associated with an increase of 0.24 (95%CI: 0.07 to 0.41) in WHZ score. Handwashing practice with water and soap was associated with an increase of 0.15 (95%CI: 0.04 to 0.25) in WAZ and 0.13 (95%CI: 0.01 to 0.24) in WHZ scores. The effect of water purification practice was higher for rural areas compared to urban settings for HAZ scores (p-value for interaction=0.02). Conclusions: Consistent with findings from other countries in the South Asian region, findings of this study highlight the potential importance of good WASH practices, and therefore the potential of WASH interventions, to contribute to improved nutritional status in rural Nepal.

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Midday Meals as an Early Childhood Nutrition Intervention: Evidence from Plantation Communities in Sri Lanka

10.21203/rs.3.rs-122527/v1 ◽

2020 ◽

Author(s):

Udeni De Silva Perera ◽

Brett A. Inder

Keyword(s):

Developing Countries ◽

Early Childhood ◽

Sri Lanka ◽

Random Effects ◽

Nutrition Intervention ◽

Child Malnutrition ◽

Vulnerable Communities ◽

Tea Plantations ◽

Height For Age ◽

Weight For Age

Abstract Background: High rates of child malnutrition are a major public health concern in developing countries, particularly among vulnerable communities. Midday meals programs can be effective for combatting childhood malnutrition among older children. However, their use in early childhood is not well documented, particularly within South Asia. Anthropometric measures and other socioeconomic data were collected for children below the age of five years living in selected Sri Lankan tea plantations, to assess the effectiveness of midday meals as a nutrition intervention for improving growth among young children.Methods: The study exploits a natural experiment whereby the provision of the midday meals program is exogenously determined at the plantation level, resulting in comparable treatment and control groups. Longitudinal data is regularly collected on heights and weights of children, between 2013-2015. Standardized weight-for-age, height-for-age, BMI-for-age and weight-for-height are calculated following WHO guidelines, and binary variables for stunting, wasting and underweight are constructed. All modelling uses STATA SE 15. Random-effects regression with instrumental variables is used for modelling standardized growth variables whilst random-effects logistic regression is used for binary outcome variables. Robustness analysis involves different estimation methods and subsamples. Results: The dataset consists of longitudinal data from a total of 1279 children across three tea plantations in Sri Lanka, with 799 children in the treatment group and 480 in the control group. Results show significant positive effects of access to the midday meals program, on the growth of children. A child with access to the midday meals intervention reports an average standardized weight-for-age 0.03 (±0.01) and height-for-age 0.05 (±0.01) units higher than a similar child without access to the intervention. Importantly, access to the intervention reduces the likelihood of being underweight by 0.45 and the likelihood of wasting by 0.47. The results are robust to different model estimations and across different subsamples by gender, birthweight and birth-year cohort. Qualitative data analysis suggests a high viability of implementing similar programs within tea plantations in Sri Lanka.Conclusions: Midday meals programs targeting early childhood can be an effective intervention to address high rates of child malnutrition, particularly among vulnerable communities in developing countries like Sri Lanka.

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A Randomized Clinical Trial of Home Intervention for Children With Failure to Thrive

PEDIATRICS ◽

10.1542/peds.95.6.807 ◽

1995 ◽

Vol 95 (6) ◽

pp. 807-814 ◽

Cited By ~ 3

Author(s):

Maureen M. Black ◽

Howard Dubowitz ◽

Jacqueline Hutcheson ◽

Julie Berenson-Howard ◽

Raymond H. Starr

Keyword(s):

Low Income ◽

Motor Development ◽

Failure To Thrive ◽

Home Visitors ◽

Child Interaction ◽

Home Intervention ◽

Height For Age ◽

Weight For Age

Objective. To evaluate the efficacy of a home-based intervention on the growth and development of children with nonorganic failure to thrive (NOFTT). Design. Randomized clinical trial. Participants. The NOFTT sample included 130 children (mean age, 12.7 months; SD, 6.4) recruited from urban pediatric primary care clinics serving low income families. All children were younger than 25 months with weight for age below the fifth percentile. Eligibility criteria included gestational age of at least 36 weeks, birth weight appropriate for gestational age, and no significant history of perinatal complications, congenital disorders, chronic illnesses, or developmental disabilities. Children were randomized into two groups: clinic plus home intervention (HI) (n = 64) or clinic only (n = 66). There were no group differences in children's age, gender, race, or growth parameters, or on any of the family back-ground variables. Most children were raised by single, African-American mothers who received public assistance. Eighty-nine percent of the families (116 of 130) completed the 1-year evaluation. Interventions. All children received services in a multidisciplinary growth and nutrition clinic. A community-based agency provided the home intervention. Families in the HI group were scheduled to receive weekly home visits for 1 year by lay home visitors, supervised by a community health nurse. The intervention provided maternal support and promoted parenting, child development, use of informal and formal resources, and parent advocacy. Measurements. Growth was measured by standard procedures and converted to z scores for weight for height and height for age to assess wasting and stunting. Cognitive and motor development were measured with the Bayley Scales of Infant Development, and language development was measured by the Receptive/Expressive Emergent Language Scale. Both scales were administered at recruitment and at the 12-month follow-up. Parent-child interaction was measured by observing mothers and children during feeding at recruitment and at the 12-month follow-up, and the quality of the home was measured by the Home Observation Measure of the Environment 18 months after recruitment. Analyses. Repeated-measures multivariate analyses of covariance were used to examine changes in children's growth and development and parent-child interaction. Analyses of covariance were used to examine the quality of the home. Independent variables were intervention status and age at recruitment (1.0 to 12.0 vs 12.1 to 24.9 months). Maternal education was a covariate in all analyses. When changes in developmental status and parentchild interaction were examined, weight for height and height for age at recruitment were included as covariates. Results. Children's weight for age, weight for height, and height for age improved significantly during the 12-month study period, regardless of intervention status. Children in the HI group had better receptive language over time and more child-oriented home environments than children in the clinic-only group. The impact of intervention status on cognitive development varied as a function of children's ages at recruitment, with younger children showing beneficial effects of home intervention. There were no changes in motor development associated with intervention status. During the study period, children gained skills in interactive competence during feeding, and their parents became more controlling during feeding, but differences were not associated with intervention status. Conclusions. Findings support a cautious optimism regarding home intervention during the first year of life provided by trained lay home visitors. Early home intervention can promote a nurturant home environment effectively and can reduce the developmental delays often experienced by low income, urban infants with NOFTT. Subsequent investigations of home intervention should consider alternative options for toddlers with NOFTT.

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Differences between WHO Growth Standards and China Growth Standards in Assessing the Nutritional Status of Children Aged 0–36 Months Old

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010251 ◽

2019 ◽

Vol 17 (1) ◽

pp. 251

Author(s):

Qianling Tian ◽

Xiao Gao ◽

Tingting Sha ◽

Qiong He ◽

Gang Cheng ◽

...

Keyword(s):

Nutritional Status ◽

World Health ◽

Growth Standards ◽

The World ◽

Z Scores ◽

Nutritional Status Of Children ◽

Height For Age ◽

Weight For Age ◽

China’S Growth

Background: At present, whether to use the World Health Organization’s (WHO) growth standards or native growth standards to assess the nutritional status in a given population is unclear. This study aimed to compare the differences between the WHO’s growth standards and China’s growth standards in assessing the nutritional status of children aged 0~36 months. Methods: We used z-scores to evaluate the nutritional status of children. The weight-for-age z-scores (WAZs), length/height-for-age z-scores (LAZ/HAZs), and weight-for-length/height z-scores (WLZ/WHZs) were calculated using the WHO’s growth standards and China’s growth standards. MeNemar’s test was used to compare the nutritional status of children. Results: The results in this study showed that there were differences between the WHO’s standards and China’s standards in assessing children’s nutritional status except for stunting and obesity. The prevalence of underweight assessed using China’s standards was higher than when using the WHO’s standards (except when 3 and 36 months old). The prevalence of wasting was significantly higher when assessed using China’s standards than when using the WHO’s standards from 12 to 36 months. The prevalence of overweight was higher when assessed using the WHO’s standards from 3 to 8 months. Conclusions: Both the WHO’s and China’s growth standards are useful measures in assessing children’s nutritional status but with key significant differences. Therefore, caution should be taken in selecting appropriate measures in a given population.

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Catch-up growth in children after repair of Tetralogy of Fallot

Cardiology in the Young ◽

10.1017/s1047951111002009 ◽

2012 ◽

Vol 22 (5) ◽

pp. 507-513 ◽

Cited By ~ 6

Author(s):

Fabio Carmona ◽

Lucas S. Hatanaka ◽

Marco A. Barbieri ◽

Heloisa Bettiol ◽

Roseli B. D. Toffano ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

Economic Status ◽

Growth Restriction ◽

Socio Economic Status ◽

Z Scores ◽

Catch Up ◽

Residual Lesions ◽

Height For Age ◽

Weight For Age

AbstractPurposeTo evaluate the growth of children after repair of Tetralogy of Fallot, as well as the influence of residual lesions and socio-economic status.MethodsA total of 17 children, including 10 boys with a median age of 16 months at surgery, were enrolled in a retrospective cohort, in a tertiary care university hospital. Anthropometric (as z-scores), clinical, nutritional, and social data were collected.ResultsWeight-for-age and weight-for-height z-scores decreased pre-operatively and recovered post-operatively in almost all patients, most markedly weight for age. Weight-for-height z-scores improved, but were still lower than birth values in the long term. Long-term height-for-age z-scores were higher than those at birth, surgery, and 3 months post-operatively. Most patients showed catch-up growth for height for age (70%), weight for age (82%), and weight for height (70%). Post-operative residual lesions (76%) influenced weight-for-age z-scores. Despite the fact that most patients (70%) were from low-income families, energy intake was above the estimated requirement for age and gender in all but one patient. There was no influence of socio-economic status on pre- and post-operative growth. Bone age was delayed and long-term-predicted height was within mid-parental height limits in 16 children (93%).ConclusionChildren submitted to Tetralogy of Fallot repair had pre-operative acute growth restriction and showed post-operative catch-up growth for weight and height. Acute growth restriction could still be present in the long term.

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HIV Pediatric Care Quality in Togo's Health Facilities in 2014

Journal of Child Science ◽

10.1055/s-0038-1635088 ◽

2018 ◽

Vol 08 (01) ◽

pp. e11-e17

Author(s):

K. Azoumah ◽

F. Agbéko ◽

K. Djadou ◽

K. Segbedji ◽

A. Géraldo ◽

...

Keyword(s):

Care Quality ◽

Health Facilities ◽

World Health ◽

Hiv Care ◽

Pediatric Care ◽

People Living With Hiv ◽

Average Delay ◽

Z Scores ◽

Weight For Age

AbstractIn 2013, children living with human immunodeficiency virus (HIV)(CLHIV) and on antiretroviral therapy (ART) in Togo accounted for 7.6% of people living with HIV on ART. Management faces many challenges due to insufficient qualified human resources. This study aimed to assess the availability of care offered to these children in health facilities. This was a retrospective descriptive study on 244 CLHIV (under 15 years) who were on ART and randomly selected in 26 sites providing HIV medical care in Togo from July 22 to September 06 2014. Evaluation forms on children's clinical, biological, and therapeutic parameters were analyzed. Forty percent of CLHIV were between the ages of 5 and 9 years. The average age was 5 years at testing for diagnosis; 49% of children were in the World Health Organization (WHO) stage III–IV. The sex ratio (male/female [M/F]) was 1:1. Almost 71% of CLHIV were underweight (weight-for-age < − 2 Z scores Severely underweight : weight-for-age < − 3 Z scores). The patient height was not recorded in 81.6% of the cases. According to the guidelines, the criteria to be on ART were met for 90.2% of children. The average delay (from diagnosis) to be on ART was 216 days. First-line regimens were mostly zidovudine/lamivudine/nevirapine (AZT/3TC/NVP) (47.0%) and stavudine/lamivudine/nevirapine (d4T/3TC/NVP) (38.7%). Follow-up was characterized by a low rate of achievement of the biological semi-annual evaluation (19.8%), child compliance for 62.7%, a cotrimoxazole prophylaxis for 70.2%, and tuberculosis screening for 64.8%. The lost-to-follow-up (LFU) proportion was 8.9%. HIV pediatric diagnosis is still an issue in Togo. Early maternal and child healthcare and HIV care are not optimal. Recruitment and capacity building of health professionals, delegation of tasks to paramedics, and innovative motivation processes could improve care for HIV-infected children.

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Effect of Nutritional Status on Response to Treatment with Artemisinin-Based Combination Therapy in Young Ugandan Children with Malaria

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01727-10 ◽

2011 ◽

Vol 55 (6) ◽

pp. 2629-2635 ◽

Cited By ~ 18

Author(s):

Wendy J. Verret ◽

Emmanuel Arinaitwe ◽

Humphrey Wanzira ◽

Victor Bigira ◽

Abel Kakuru ◽

...

Keyword(s):

Blood Smear ◽

Parasite Clearance ◽

Response To Treatment ◽

Malnourished Children ◽

Antimalarial Therapy ◽

Hiv Exposed ◽

The Relationship ◽

Height For Age ◽

Weight For Age

ABSTRACTThe relationship between malnutrition and malaria in young children is under debate, and no studies evaluating the association between malnutrition and response to artemisinin-based combination therapies (ACTs) have been published. We evaluated the association between malnutrition and response to antimalarial therapy in Ugandan children treated with ACTs for repeated episodes of malaria. Children aged 4 to 12 months diagnosed with uncomplicated malaria were randomized to dihydroartemisinin-piperaquine (DP) or artemether-lumefantrine (AL) and followed for up to 2 years. All HIV-exposed and HIV-infected children received trimethoprim-sulfamethoxazole prophylaxis (TS). The primary exposure variables included height-for-age and weight-for-agezscores. Outcomes included parasite clearance at days 2 and 3 and risk of recurrent parasitemia after 42 days of follow-up. Two hundred ninety-two children were randomized to DP or AL, resulting in 2,013 malaria treatments. Fewer than 1% of patients had a positive blood smear by day 3 (DP, 0.2%; AL, 0.6% [P= 0.18]). There was no significant association between height-for-age or weight-for-agezscores and a positive blood smear 2 days following treatment. For children treated with DP but not on TS, decreasing height-for-agezscores of <−1 were associated with a higher risk of recurrent parasitemia than a height-for-agezscore of >0 (hazard ratio [HR] for height-for-agezscore of <−1 and ≥−2 = 2.89 [P= 0.039]; HR for height-for-agezscore of <−2 = 3.18 [P= 0.022]). DP and AL are effective antimalarial therapies in chronically malnourished children in a high-transmission setting. However, children with mild to moderate chronic malnutrition not taking TS are at higher risk for recurrent parasitemia and may be considered a target for chemoprevention.

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