scholarly journals Severe and moderate acute malnutrition detection in a rural hospital pediatric outpatient clinic and their comparison with the IAP charts: a two-year study

2017 ◽  
Vol 5 (1) ◽  
pp. 110
Author(s):  
Deepali Abhijit Ambike ◽  
Sandhya Vishal Haribhakta ◽  
Subhash Shankar Poyekar ◽  
Aishwarya Santosh Pingley ◽  
Jyotsna Madhu Naidu
Keyword(s):  
Outpatient Clinic ◽  
Severe Acute Malnutrition ◽  
Adverse Outcomes ◽  
Rural Hospital ◽  
Acute Malnutrition ◽  
P Value ◽  
Rehabilitation Centre ◽  
Cross Sectional ◽  
Set Up ◽  
Moderate Acute Malnutrition

Background: Children with moderate acute malnutrition (MAM) have an increased list of mortality, infections and impaired physical and cognitive development compared to well-nourished children. The Objectives of this study were to diagnose Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) using WHO growth charts as a criterion and to compare the WHO classification with the IAP classification in the diagnosis of SAM and MAM.Methods: A two-year duration cross-sectional study conducted in Pediatric outpatient clinic of a rural hospital from January 2013 to December 2014. In case of moderate acute malnutrition (MAM) was diagnosed as weight-for-height >-3 but <-2 Z scores of the median according to WHO growth standards. We defined MAM as mid-upper am circumference (MUAC) of >11.0 cm and <12.5 cm with no bilateral pitting edema and SAM as MUAC less than 11.5 cm. We compared the values with the IAP charts for diagnosis of malnutrition. Our set up is not a nutrition rehabilitation centre, feeding programmes were not implemented.Results: The distribution of prevalence of SAM and MAM differs significantly across three age groups studied (P-value <0.001). However, it did not differ significantly between boys and girls aged between 6 months to 6 years (P-value >0.05). Of 90 SAM cases, 55 cases (61.1%) had Grade 1 IAP grade of malnutrition, 28 cases (31.1%) had Grade 2 IAP grade of malnutrition, 7 cases (7.8%) had Grade 3 IAP grade of malnutrition. None of the SAM cases fell in Grade 4 IAP. The distribution of prevalence of SAM and MAM differs significantly across various IAP grades of malnutrition (P-value <0.001).Conclusions: The IAP charts used for diagnosing malnutrition did not have any comparative value with the WHO charts used for the SAM MAM detection. WHO grading of SAM and MAM is more sensitive than IAP grading in early diagnosis of under nutrition and facilitate early treatment. Not having a targeted nutrition-specific intervention to address MAM in this set up places these children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered.

scholarly journals Incidence Correction Factors for Moderate and Severe Acute Child Malnutrition From 2 Longitudinal Cohorts in Mali and Burkina Faso

2020 ◽  
Vol 189 (12) ◽  
pp. 1623-1627
Author(s):  
Francisco M Barba ◽  
Lieven Huybregts ◽  
Jef L Leroy
Keyword(s):  
Burkina Faso ◽  
Low Income ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Incidence Data ◽  
Moderate Acute Malnutrition ◽  
Cluster Randomized ◽  
Definition Of ◽  
Mid Upper Arm Circumference

Abstract Child acute malnutrition (AM) is an important cause of child mortality. Accurately estimating its burden requires cumulative incidence data from longitudinal studies, which are rarely available in low-income settings. In the absence of such data, the AM burden is approximated using prevalence estimates from cross-sectional surveys and the incidence correction factor $K$, obtained from the few available cohorts that measured AM. We estimated $K$ factors for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) from AM incidence and prevalence using representative cross-sectional baseline and longitudinal data from 2 cluster-randomized controlled trials (Innovative Approaches for the Prevention of Childhood Malnutrition—PROMIS) conducted between 2014 and 2017 in Burkina Faso and Mali. We compared K estimates using complete (weight-for-length z score, mid-upper arm circumference (MUAC), and edema) and partial (MUAC, edema) definitions of SAM and MAM. $K$ estimates for SAM were 9.4 and 5.7 in Burkina Faso and in Mali, respectively; K estimates for MAM were 4.7 in Burkina Faso and 5.1 in Mali. The MUAC and edema–based definition of AM did not lead to different $K$ estimates. Our results suggest that $K$ can be reliably estimated when only MUAC and edema-based data are available. Additional studies, however, are required to confirm this finding in different settings.

scholarly journals Nurses’ knowledge towards severe acute malnutrition management protocol and its associated factors

2019 ◽  
Vol 8 (2) ◽  
pp. 219
Author(s):  
Abdu Oumer
Keyword(s):  
Associated Factors ◽  
Severe Acute Malnutrition ◽  
Knowledge Score ◽  
Malnourished Child ◽  
University Hospital ◽  
Acute Malnutrition ◽  
P Value ◽  
Cross Sectional ◽  
Targeted Interventions ◽  
Management Protocol

<span>For appropriate management of severe acute malnutrition skilled, knowledgeable and concerned health professionals are critical for child survival. </span><span>Thus assessing the knowledge of nurses towards management protocol of severe acute malnutrition is crucial step for targeted interventions. </span><span>This study aimed to assess Knowledge towards Severe Acute Malnutrition Management Protocol and its Associated Factors among Nurses working in Hiwot Fana Specialized University Hospital, 2018. Cross-sectional study was conducted among eligible 132 nurses. Data were collected using self-administered questionnaire prepared from the national SAM management guideline of Ethiopia. SPSS version 20.0 software using frequency, tables, graphs, percentages and mean was used. Student t test and analysis of variance with F statistics and P value was computed. Overall, 65 (49.2%) of nurses had poor knowledge on SAM management. More than half, 100 (75.8%) of the nurses had experience in SAM management previously. Males were more likely to be knowledgeable (AOR=1.27) as compared to females. Nurses with the previous experience of managing malnourished child had 1.70) times more likely to be knowledgeable as compared to their counterparts. Having SAM training was associated with having higher knowledge score (AOR=1.56). Having SAM training was found to have significantly higher knowledge score (p=0.034). Knowledge level of nurses towards SAM management is not satisfactory. Those who ever involved in SAM management, having recent malnutrition training and gender were predictors of high knowledge score. There should be regular capacity building schemes for nurses especially for those who are involved in management of SAM at emergency or SAM unit.</span>

scholarly journals A study on assessment of nutrition and health status of the children one year after discharge from the Nutritional Rehabilitation Centre in South India

2018 ◽  
Vol 5 (8) ◽  
pp. 3492
Author(s):  
C. Chandra Sekhar ◽  
D. Surendra Babu ◽  
C. Sravana Deepthi ◽  
Shakeer Kahn Patan ◽  
Khadervali N. ◽  
...  
Keyword(s):  
Health Status ◽  
Nutritional Status ◽  
Severe Acute Malnutrition ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Severe Malnutrition ◽  
Rehabilitation Centre ◽  
Community Based ◽  
Cross Sectional ◽  
Danger Signs

Background: Nutrition rehabilitation centers (NRCs) were started to control severe malnutrition and follow-up of children with severe acute malnutrition is essential because mortality rate of 10-30% has been reported after discharge from hospital.Methods: A community based cross sectional study with the objectives to assess the current health status of the children discharged from the NRC and to assess the healthy practices learned by mothers during their stay at NRC. We included children those discharged from May to October 2013. The children were approached house to house visit and assessed for their health status with a pretested semi structured questionnaire. Mothers of the children were also interviewed for the knowledge and practices of the dietary and child care.Results: Among 67 children, 8 (11.9%) children could not be traced and 7 (10.4%) were reported dead, 52 were included 27 were boys and 25 were girls with a mean age of 35 months. The current nutritional status was 71.2% were not in very low weight, 17.3% were moderately underweight, and 11.5% were still severely underweight. Children who had more number of follow-ups had a better nutritional status which was significant (p<0.0001). 94% of the mothers had knowledge about correct feeding practices and food preparations; 86.5% were aware of good hygiene; 75% aware of the danger signs. Only 59.5% of the mothers could recollect the structured play therapy.Conclusions: Community based followup of the children following discharge from NRC and appropriate feedback to the mothers is very much essential for sustained results.

scholarly journals Impact of effective counselling on management of moderate acute malnutrition in a community

2020 ◽  
Vol 7 (2) ◽  
pp. 321
Author(s):  
Vikas Arya ◽  
Ajay Gaur ◽  
Neetu S. Agarwal ◽  
Harsha Chouhan
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
P Value ◽  
Case Group ◽  
Average Weight ◽  
Group Counselling ◽  
Target Weight ◽  
Dietary Counselling ◽  
Trained Counsellor ◽  
Moderate Acute Malnutrition

Background: Moderate Acute Malnutrition (MAM) is defined as Weight for Height between -2SD to -3SD, and/or Mid Upper Arm Circumference (MUAC) 11.5 cm to 12.5 cm. Effect of not treating MAM has a significant impact on Severe Acute Malnutrition (SAM) burden. Management of MAM is possible through supplementary feeding or Community centre counselling.Methods: Present study was a prospective case control study done in 2013-14 in 200 children in adjacent communities. Community in which intervention (dietary counselling) was planned, it was labelled as case group. For dietary counselling ‘structured group counselling’ method was selected in which at a time parents of six MAM children were involved. Counselling was done by a trained counsellor using all techniques proposed by IYCF. Counselling sessions were scheduled at 0, 1, 3 and 6 months.Results: 60% children of case group moved to improved or well- nourished nutritional status (p-value 0.00001). Amongst improved group, weight for height improvement is statistically significant (p-value 0.001), average weight attained is 2-3 kg in 6 months with average weight gain of 1.5-3 grams/kg/day. MUAC improvement was also found to be statistically significant (p-value 0.003), there was 47% improvement in case group with average MUAC gain is 0.6 cm to 1 cm in 6 months (0.13 cm/month). Also, there is early rise in weight for height then MUAC. Average duration to achieve target weight for height is 4.3 months in case group as compare to 5.3 months in control group.Conclusions: Structured and integrated group counselling using all counselling skills by a trained counsellor should be an integral part of managing MAM in community. Weight for height should be primary indicator in early phase of response as compare to MUAC in measuring impact of counselling.

scholarly journals Anemia and metabolic acidosis as risk factor of mortality in children with severe acute malnutrition

2020 ◽  
Vol 4 (3) ◽  
pp. 60-68
Author(s):  
Katharina Yosephin Lakonawa ◽  
I Gusti Lanang Sidiartha ◽  
I Gusti Ayu Putu Eka Pratiwi
Keyword(s):  
Logistic Regression ◽  
Metabolic Acidosis ◽  
Severe Acute Malnutrition ◽  
Multivariate Logistic Regression Analysis ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
P Value ◽  
Tertiary Referral Hospital ◽  
Cross Sectional ◽  
Logistic Regression Test

Mortality is still high among children with severe acute malnutrition who require hospitalization. This study investigated the factors independently related to the mortality among hospitalized children with severe acute malnutrition. A cross-sectional study was conducted in a single tertiary referral hospital in Bali, Indonesia from January 2017 to December 2018. A logistic regression test was used to analyze the factors independently related to mortality. Significantly differences were considered if P-value less than 0.05. A total of 138 children with severe acute malnutrition was fulfilled the study criteria, 83 children (60.1%) were male, 79 children (57.2%) were a toddler and 133 children (96.4%) were classified as marasmus. The mortality was found in 60 children (43.4%). On multivariate logistic regression analysis found anemia (aOR 8.6, 95%CI: 2.4 to 30.5, P = 0.001) and metabolic acidosis (aOR 3.4, 95%CI: 1.3 to 9.1, P = 0.01) were statistically significant. It can be concluded that the mortality rate among children with severe acute malnutrition is still high and anemia as well as metabolic acidosis are factors independently related to this mortality.

scholarly journals Program and Caseload Implications of Adopting the Global MUAC Criteria for Community Management of Acute Malnutrition in Children Under 5 Years Old in Ethiopia

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 157-157
Author(s):  
Yosef Asefaw ◽  
Seifu Hagose ◽  
Girmay Ayana ◽  
Solomon Hailu ◽  
Tadess Kebebe ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Number Of Children ◽  
Funding Sources ◽  
Malnourished Children ◽  
The Mean ◽  
Gates Foundation ◽  
Moderate Acute Malnutrition ◽  
Cluster Randomized

Abstract Objectives Ethiopia has been hesitant to shift to the global MUAC-based definitions for acute malnutrition given the two to four times potential increase in caseload suggested by several cross-sectional surveys. Thus, the objective of this study was to provide specific evidence on the caseload implications for Ethiopia of aligning with the WHO recommended criteria. Methods A cluster-randomized control study was conducted in four districts of Amhara and Oromia regions of Ethiopia in a total of 36 health posts (HPs). Districts and HPs were selected based on previous high case report. In each district, an equal numbers of HPs were randomly assigned to use either the global MUAC criteria of &lt;11.5 cm for severe acute malnutrition (SAM) and the moderate acute malnutrition (MAM) criteria of ≥11.5cm to &lt;12.5 cm (intervention) or the current Ethiopian criteria of &lt;11 cm for SAM and ≥11 cm to &lt;12 cm for MAM (control). All 6–59 mo children were screened regularly for 16 wks. Malnourished children were admitted to the study according to the criteria assigned to their HP. Results A total of 349 SAM and 986 MAM new cases were admitted during the 16 wk recruitment. Of the new SAM cases, 225 were in intervention and 124 were in control HPs. The ratio of SAM in intervention compared to control HPs was 1.78 (1.14–2.42, 95%CI), which indicates an increase in admissions of 78% (P = 0.019). The mean (±SD) monthly SAM admissions per HPs were 1.71 (0.53) in control and 2.97 (3.31) in intervention (P = 0.191). For MAM, 592 cases were in intervention and 394 were in control for a ratio of 1.50 (1.11–1.89). The global MUAC criteria increased caseload by 50% (P = 0.015) compared to control. The mean monthly new MAM admissions per HPs were 5.47 (4.02) in control and 8.22 (3.28) in intervention (P = 0.045). The mean number of children served during biweekly combined sessions for SAM and MAM was 19.67 (9.28) in intervention and 13.08 (8.28) in control (P = 0.026). For sessions restricted to SAM, a mean of 4.26 (4.11) was served in intervention and 1.92 (1.88) in control (P = 0.028). Conclusions The increases in cases and workload resulting from shifting from Ethiopia's current national SAM and MAM admission and discharge criteria to the WHO criteria are likely to be on a smaller scale than is usually claimed based on various cross-sectional surveys. Most HPs were not overwhelmed due to the shift. Funding Sources Bill and Melinda Gates Foundation.

scholarly journals Impact of Socioeconomic Inequalities on Child Malnutrition

2020 ◽  
pp. 114-119
Author(s):  
Zamir Ahmed Qambrani ◽  
Asif Nadeem Jamali ◽  
Habibullah Siyal ◽  
Sarah Azhar ◽  
Hafiz Syed Imran-ul Haque ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Tertiary Care Hospital ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Acute Malnutrition ◽  
Severe Malnutrition ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
Chi Square Analysis

Socioeconomic status and the education of mother plays important role in providing better health care and nutrition to children. To the best of our knowledge the major population of Pakistan belongs to middle class and identification of malnutrition in our setups may help the policy makers to develop certain parameters to provide better nutrition to children under 5 years of age. The aims of current study were to analyze the prevalence of malnutrition and their association with different socioeconomic status in tertiary care hospital of Hyderabad. Study Design: Cross sectional. Place and Duration of Study: Study was performed at nutritional stabilization center of pediatric department of tertiary care hospital Hyderabad during the month of July 2019 to January 2020. Methodology: Preformed proforma was designed to record the data of participants. Hospital protocols using WHO guidelines (17) i.e. 10 steps for in-patient care of severe malnutrition were started & followed with feeding F-75 & F-100. Data was analyzed on SPSS-20. Results: The minimum age recorded was 8 months and maximum was found to be 45 months (3 years 9 months). 72% were females and 70% of participants had Weight to height ratio below normal. Prevalence of severe acute malnutrition was found to be 35.2%. After admission and management protocols 91.6% were recovered however, mortality was observed in 8.9% participants. Chi square analysis of all socioeconomic groups showed highly significant results with severe acute malnutrition (p-value= 0.001). Conclusion: Current study concluded a high prevalence of SAM in Pakistani population that is about 35.2%, out of which majority was from lower socioeconomic class.

scholarly journals “No weight for height” case detection strategies for therapeutic feeding programs: sensitivity to acute malnutrition and target composition based on representative surveys in humanitarian settings

BMC Nutrition ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Benjamin Guesdon ◽  
Alexia Couture ◽  
Elise Lesieur ◽  
Oleg Bilukha
Keyword(s):  
Severe Acute Malnutrition ◽  
Significant Proportion ◽  
Acute Malnutrition ◽  
Case Detection ◽  
Cross Sectional ◽  
Feeding Programs ◽  
Target Composition ◽  
Malnourished Children ◽  
Moderate Acute Malnutrition ◽  
Detection Strategies

Abstract Background One newly proposed approach to determining eligibility of children aged 6–59 months for therapeutic feeding programs (TFPs) is to use mid-upper arm circumference (MUAC) < 115 mm, bilateral oedema or Weight-for-Age Z-score (WAZ) < − 3 as admission criteria (MUAC+SWAZ). We explored potential consequences of this approach on the eligibility for treatment, as compared with the existing WHO normative guidance. We also compared sensitivity and specificity parameters of this approach for detecting wasted children to the previously described “Expanded MUAC” approach. Methods We analyzed data from 558 population representative cross-sectional cluster surveys conducted since 2007. We retrieved all children classified as severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and those who are both wasted and stunted (WA + ST), and calculated proportions of previously eligible children who would now be excluded from treatment, as well as proportions of non-malnourished children among those who would become eligible. We also analyzed the expected changes in the number and demographics (sex, age) of the selected populations of children according to the different admission approaches. Results Both MUAC+SWAZ and Expanded MUAC case detection approaches substantially increase the sensitivity in detecting SAM, as compared to an approach which restricts detection of SAM cases to MUAC< 115 mm and oedema. Improved sensitivity however is attained at the expense of specificity and would require a very large increase of the size of TFPs, while still missing a non-negligible proportion (20–25%) of the SAM caseload. While our results confirm the sensitivity of the MUAC+SWAZ case detection approach in detecting WA + ST (over 80%), they show, on the other hand, that about half of the additional target detected by using SWAZ criterion will be neither SAM nor WA + ST. Conclusions These results suggest that recently promoted approaches to case detection inflate TFPs’ targets through the allocation of treatment to large numbers of children who have not been shown to require this type of support, including a significant proportion of non-acutely malnourished children in the MUAC+SWAZ approach. Considering the scarcity of resources for the implementation of TFPs, the rationale of abandoning the use of WHZ and of these alternative case detection strategies need to be critically reviewed.

scholarly journals Acceptability of Outpatient Ready-To-Use Food-Based Protocols in HIV-Infected Senegalese Children and Adolescents Within the MAGGSEN Cohort Study

2016 ◽  
Vol 38 (1) ◽  
pp. 27-36 ◽  
Author(s):  
Cecile Cames ◽  
Marie Varloteaux ◽  
Ndeye Ngone Have ◽  
Alhadji Bassine Diom ◽  
Philippe Msellati ◽  
...  
Keyword(s):  
Cohort Study ◽  
Children And Adolescents ◽  
Clinical Management ◽  
Antiretroviral Treatment ◽  
Psychosocial Support ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Controlled Trials ◽  
Intervention Design ◽  
Moderate Acute Malnutrition

Objectives: To assess the acceptability of ready-to-use food (RUF)-based outpatient protocols in HIV-infected children and adolescents with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Methods: Plumpy Nut and Plumpy Sup were supplied every 2 weeks and prescribed by weight to SAM and MAM children, respectively. Forty-three children, 24 MAM and 19 SAM, were enrolled. Organoleptic appreciation, feeding modalities, and perceptions surrounding RUF were recorded at week 2. Sachets were counted to measure adherence throughout the study. Results: Median age was 12.2 years (interquartile range: 9.3-14.8), and 91% were on antiretroviral treatment. Overall, 80%, 76%, 68%, and 68% of children initially rated RUF color, taste, smell, and mouth feeling as good. However, feelings of disgust, refusal to eat, fragmentation of intake, self-stigma, and sharing within the household were commonly reported. Eighteen MAM and 7 SAM experienced weight recovery. Recovery duration was 54 days (31-90) in MAM versus 114 days (69-151) in SAM children ( P = .02). Their rate of RUF consumption compared to amount prescribed was approximately 50% from week 2 to week 10. Nine failed to gain weight or consume RUF and were discontinued for clinical management, and 9 dropped out due to distance to the clinic. Conclusion: Initial RUF acceptability was satisfactory. More than half the children had successful weight recovery, although adherence to RUF prescription was suboptimal. However, further research is needed to propose therapeutic foods with improved palatability, alternative and simpler intervention design, and procedures for continuous and tailored psychosocial support in this vulnerable population. Trial registration: NCT01771562 (Current Controlled Trials).

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