Evaluation of anthropometric indicators in malnourished children at Nutritional Rehabilitation Center, Gujarat, India

Background: It is very difficult to recognize the cases with mild-to-moderate malnutrition because clinical criteria for their diagnosis are imprecise and are difficult to interpret accurately. The objective of the study was daily weight gain in gram/kg/day in severely malnourished children.Methods: This was a hospital based cross sectional study in which total of 114 consecutive patients of SAM less than 5 years treated for complications of severe acute malnutrition using WHO protocol. The study design included 114 children from the NRC and then followed up the period of 6 months to assess the nutritional status during the period of initial stage and the entire follow up period using available record of anthropometry indicators of the admitted children recruited in the study at the NRC.Results: Mean weight at admission was 6.4 Kg, 6.5 Kg and 6.2 Kg of overall, boys and girls respectively. Mean weight at discharge was 6.8 Kg, 6.7 Kg and 6.6 Kg of overall, boys and girls respectively. Mean MUAC at admission was 10.7 cm, 10.9 cm and 10.6 cm of overall, boys and girls respectively. Mean MUAC at discharge was 10.9 cm, 10.9 cm and 10.8 cm of overall, boys and girls respectively.Conclusions: For treatment of severe acute malnutrition, systematic guidelines required, thus this study indicates that following WHO guidelines, it has become easier to manage SAM in hospital settings, with least possible stay at hospital. The objective of the study was to know the effect of nutritional intervention measures on selected anthropometric indicators of severe acute malnourished children.

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Quality of healthcare for children with severe acute malnutrition in a refugee setting: cross-sectional study in West Nile Region, Uganda

BMJ Open ◽

10.1136/bmjopen-2019-034738 ◽

2020 ◽

Vol 10 (6) ◽

pp. e034738

Author(s):

Marzia Lazzerini ◽

Humphrey Wanzira ◽

Peter Lochoro ◽

Amos Ndunguste ◽

Jerry Ictho ◽

...

Keyword(s):

Health Outcomes ◽

Severe Acute Malnutrition ◽

Cross Sectional Study ◽

Poor Quality ◽

Acute Malnutrition ◽

West Nile ◽

Cross Sectional ◽

Malnourished Children ◽

Cure Rates

Objectives5.0 million annual deaths in low-income and middle-income countries are due to poor quality of care (QOC). We evaluated the QOC provided to malnourished children in West Nile Region in Uganda.DesignCross-sectional study.SettingWest Nile Region, an area hosting over one million refugees.ParticipantsAmong 148 facilities providing nutritional services, 30 randomly selected facilities (20%) and the records of 1467 children with severe acute malnutrition (100% of those attending the 30 facilities during last year) were assessed.OutcomesThe national Nutrition Service Delivery Assessment (NSDA) tool was used to assess capacity areas related to QOC. Case management, data quality and health outcomes were assessed from official health records. Multivariate analysis was performed to explore factors significantly associated with better cure rates.ResultsOf 305 NSDA scores allocated to 30 participating centres, 201 (65.9%) were ‘good’ or ‘excellent’. However, 20 (66.7%) facilities had ‘poor’ ‘quality improvement mechanisms’ and 13 (43.3%) had ‘poor’ ‘human resources’. Overall data quality in official records was poor, while recorded quality of case management was overall fair. Average cure rate was significantly lower than international Sphere standards (50.4% vs 75% p<0.001) with a higher default rate (23.2% vs 15% p<0.001). Large heterogeneity among facilities was detected for all indicators. Refugee-hosting and non-refugee-hosting facilities had a similar cure rate (47.1% vs 52.1%) though transfer rates were higher for those hosting refugees (21.5% vs 1.9%, p<0.001) despite better ‘equipment and supplies’. ‘Good/excellent’ ‘equipment’ and ‘store management’ were significantly associated with better cure rates in outpatient therapeutic centres (+55.9, p<0.001; +65.4, p=0.041, respectively) in multivariate analysis.ConclusionsThough most NSDA capacity areas were rated good or excellent, health outcomes of malnourished children in West Nile Region, both in refugee-hosting and non-refugee-hosting facilities, are significantly below international standards. Effective and sustainable approaches to improve malnourished child health outcomes are needed.

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Prevalence and predictors of hypocalcaemia in severe acute malnutrition

Public Health Nutrition ◽

10.1017/s1368980020001895 ◽

2020 ◽

Vol 23 (17) ◽

pp. 3181-3186

Author(s):

Chabungbam Smilie ◽

Dheeraj Shah ◽

Prerna Batra ◽

Rafat S Ahmed ◽

Piyush Gupta

Keyword(s):

Vitamin D ◽

Severe Acute Malnutrition ◽

Tertiary Care ◽

Abdominal Distension ◽

Cross Sectional Study ◽

Acute Malnutrition ◽

Care Hospital ◽

Clinical Predictors ◽

Cross Sectional ◽

Malnourished Children

AbstractObjective:To determine the prevalence and predictors of hypocalcaemia in under-five children (1–59 months) hospitalised with severe acute malnutrition (SAM).Design:A cross-sectional study was designed to determine the prevalence of hypocalcaemia among children hospitalised with SAM. Serum Ca and 25-hydroxycholecalciferol (25-(OH)D) were estimated. Hypocalcaemia was defined as serum Ca (albumin-adjusted) <2·12 mmol/l. To identify the clinical predictors of hypocalcaemia, a logistic regression model was constructed taking hypocalcaemia as a dependent variable, and sociodemographic and clinical variables as independent variables.Setting:A tertiary care hospital in Delhi, between November 2017 and April 2019.Participants:One-hundred and fifty children (1–59 months) hospitalised with SAM were enrolled.Results:Hypocalcaemia was documented in thirty-nine (26 %) children hospitalised with SAM, the prevalence being comparable between children aged <6 months (11/41, 26·8 %) and those between 6 and 59 months (28/109, 25·7 %) (P = 0·887). Vitamin D deficiency (serum 25-(OH)D <30 nmol/l) and clinical rickets were observed in ninety-eight (65·3 %) and sixty-three (42 %) children, respectively. Hypocalcaemia occurred more frequently in severely malnourished children with clinical rickets (OR 6·6, 95 % CI 2·54, 17·15, P < 0·001), abdominal distension (OR 4·5, 95 % CI 1·39, 14·54, P = 0·012) and sepsis (OR 2·6, 95 % CI 1·00, 6·57, P = 0·050).Conclusion:Rickets and hypocalcaemia are common in children with SAM. Routine supplementation of vitamin D should be considered for severely malnourished children. Ca may be empirically prescribed to severely malnourished children with clinical rickets, abdominal distension and/or sepsis.

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A Study of Serum Electrolytes in Malnourished Children

Asian Journal of Clinical Pediatrics and Neonatology ◽

10.47009/ajcpn.2020.8.1.10 ◽

2020 ◽

Vol 8 (1) ◽

pp. 41-43

Author(s):

Mohd Zakir Mohiuddin Owais ◽

N.L Sridhar

Keyword(s):

Severe Acute Malnutrition ◽

Cross Sectional Study ◽

Acute Malnutrition ◽

Cross Sectional ◽

Electrolyte Disturbances ◽

Malnourished Children ◽

Serious Infections ◽

Life Threatening ◽

The Mean

Background: Severe acute malnutrition (SAM) is one of the most common health problems. SAM children are more prone to serious infections that culminate in different co-morbid conditions and result in electrolyte disturbances. Objective: To study the electrolyte profile in severely malnourished children. Subjects and Methods:This was Hospital based cross sectional study. Duration: 1 year from June 2018 to May 2019. Setting: Department of Pediatrics. Participants: 50 Children.Detailed history and physical examination were made. Anthropometric measurements, such as weight and height, were recorded. On admission, electrolytes were performed and children were classified as either hypo / hypernatramic or hypo / hyperkalemic, which depend on the levels of the electrolytes.Result:The Hyponatremia was high with 72% on the day 1, and hypernatremia was 6%, on day 3 hyponatremia was 60% and hypernatremia was 4% and on day 8 Normal sodium was seen in around 68% of the children. The mean sodium significantly improved from day 1 to day 8 with a mean of 135.8±9.9 on the day 8th. The Hypokalemia was highest with 38% on the day 1, Hyperkalemia was seen in 28% of the patients on day 3 and normal potassium was seen in 80% of the children on the day 8th. The mean potassium significantly improved from day 1 to 8 with a mean of 5.5±1.24 on the day 8th. Conclusion:Most of the children with SAM and electrolyte derangements also had diarrhoea. Therefore determination of the electrolyte profile of all patients with SAM immediately on admission and proceeding days after admission is vital as it helps the clinician to decide on the most appropriate fluids to give to help reduce on the morbidity and mortality associated with life threatening electrolyte derangements.

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Prevalence of hypoglycemia in diarrheal dehydration at hospitalization in severe acute malnutrition

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20181549 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1092 ◽

Cited By ~ 1

Author(s):

Rameshwar Ninama ◽

Chakshu Chaudhry ◽

Rameshwar Lal Suman ◽

Suresh Goyal ◽

Ramprakash Prakash Bairwa ◽

...

Keyword(s):

Blood Glucose ◽

Acute Diarrhea ◽

Severe Acute Malnutrition ◽

Cross Sectional Study ◽

Acute Malnutrition ◽

Severe Dehydration ◽

Cross Sectional ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Average Blood Glucose

Background: Diarrhea is the major cause of death in children below five years of age. Hypoglycemia has been a potential fatal complication of infectious diarrhea in both well-nourished and poorly nourished children. But prevalence of hypoglycemia in diarrheal dehydration is not exactly known. This study was done to evaluate the glycemic status in children having acute diarrhea with dehydration and specifically associated with severe acute malnutrition (SAM).Methods: This descriptive cross-sectional study was conducted during July 2017 to December 2017 at Bal Chikitsalaya Udaipur, Rajasthan, India. Blood glucose levels were assessed in 150 children of acute diarrhea with dehydration, comprising of 100 SAM and 50 Non SAM children.Results: Average blood glucose of SAM children was 89 mg/dl and of non-SAM, it was 120 mg/dl. Average blood glucose was low in SAM as compared to non-SAM in both some dehydration (116.08±21.26) and severe dehydration (66.69±19.80) as well as with or without ORS intake. Overall 18 (12%) of children had hypoglycemia and all were in severe dehydration and not taking ORS. Blood glucose levels were statistically low in severe dehydration and those who were not taking ORS at the time of hospitalization (p = 0.001). In severe dehydration 25% of children had hypoglycemia means every fourth child had low blood glucose <54 mg/dl.Conclusions: Overall prevalence of hypoglycemia is 12% in diarrheal dehydration and 20% in SAM with dehydration. Twenty five percent of severe dehydration children had hypoglycemia, and all have not started ORS. None of the child started ORS developed hypoglycaemia.

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Severe Acute Malnutrition with Anemia and Vitamin Deficiency in Hospitalized Children: Two Centres Cross Sectional Study

Pediatric Education and Research ◽

10.21088/per.2321.1644.6318.1 ◽

2019 ◽

Vol 6 (3) ◽

pp. 141-144

Author(s):

Sunil Kumar Rao ◽

◽

Dhilip Kumar ◽

Rakesh Kumar ◽

Abhishek Abhinay ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Cross Sectional Study ◽

Vitamin Deficiency ◽

Acute Malnutrition ◽

Hospitalized Children ◽

Sectional Study ◽

Cross Sectional

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Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

10.21203/rs.2.14202/v3 ◽

2020 ◽

Author(s):

Umesh Ghimire ◽

Binod Kumar Aryal ◽

Ankush Kumar Gupta ◽

Suman Sapkota Sapkota

Keyword(s):

Odds Ratio ◽

Food Access ◽

Adjusted Odds Ratio ◽

Severe Acute Malnutrition ◽

Cross Sectional Study ◽

Acute Malnutrition ◽

Sectional Study ◽

Cross Sectional ◽

Household Food ◽

Nutritional Status Of Children

Abstract Background: Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6-59 months in the two districts of Nepal. Methods: We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centres (OTCC). The nutritional status of children was assessed using mid-upper arm circumference (MUAC) measurement. To determine which variables predict the occurrence of SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value <0.05 was considered as significant. Results: Out of 398 children, 5.8 percent were severely malnourished and the higher percentage of female children were malnourished. Multivariate analysis showed that severe acute malnutrition was significantly associated with family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23 - 12.71). Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88-10.53) were four times more likely to be severely malnourished. Higher odds of SAM were found among younger age-group (AOR: 12.10; 95% CI: 2.06 - 71.09) children (0 - 12 vs. 24 - 59 months). . Conclusions: The findings of this study indicated that household size, household food access, and the child’s age were the major predictors of severe acute malnutrition. Engaging poor families in kitchen gardening to ensure household food access and nutritious diet to the children, along with health education and promotion to the mothers of young children are therefore recommended to reduce child undernutrition.

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Developmental delay and its predictors among children under five years of age with uncomplicated severe acute malnutrition: a cross-sectional study in rural Pakistan

BMC Public Health ◽

10.1186/s12889-021-11445-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Javeria Saleem ◽

Rubeena Zakar ◽

Gul Mehar Javaid Bukhari ◽

Aneela Fatima ◽

Florian Fischer

Keyword(s):

Developmental Delay ◽

Rural Areas ◽

Developmental Delays ◽

Severe Acute Malnutrition ◽

Cross Sectional Study ◽

Acute Malnutrition ◽

Adaptive Skills ◽

Global Development ◽

Sectional Study ◽

Cross Sectional

Abstract Background In developing countries, malnutrition in children and developmental delays are two major challenges for public health. To achieve the vision of the Sustainable Development Goals from the broader perspective of child health, early identification of developmental delays and timely intervention are crucial. The aim of this study is to assess the prevalence of suspected developmental delay and their predictors in children under the age of 5 years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Methods A multicentre cross-sectional study was conducted among 185 children with uncomplicated severe acute malnutrition. We screened children aged 6–59 months for their nutritional status and clinical complications. Children fulfilling the inclusion criteria underwent the Denver Development Screening Tool II (DDST-II). The children’s global developmental profile was calculated according to the established protocols of DDST-II, which are based on four important domains of development: personal and social behaviour, language, gross motor adaptive skills and fine motor adaptive skills. A pretested questionnaire was used to collect data on socio-demographic and nutritional factors for assessing predictors of developmental delay, which were analysed using a multivariate logistic regression model. Results Out of 177 children with severe acute malnutrition, 69 (38.9%) had normal global development and 108 (61.1%) had delayed global development. Significant associations were found between global developmental delay and younger children (6–24 months vs. 25–59 months; AOR = 4.53, 95% CI: 1.56–13.10, p < 0.01), children who were not exclusively breastfed (AOR = 3.07, 95% CI: 1.24–7.56, p = 0.01), and a history of contact with a tuberculosis smear-positive adult (AOR = 2.67, 95% CI: 1.30–5.49, p < 0.01). Conclusion About two thirds of the study participants showed delayed or unstable global development. Thus, according to DDST-II-established protocols, there is a high prevalence of suspected developmental delay among children under the age of five years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Children in their first 2 years of life were at particularly high risk due to insufficient breastfeeding. This emphasizes the need to provide adequate infrastructure and information to parents for the prevention of developmental delay in remote areas.

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Common Mental Disorders in Mothers of Children Attending Out-patient Malnutrition Clinics in Rural North-western Nigeria: A Cross-sectional Study

10.21203/rs.3.rs-77443/v1 ◽

2020 ◽

Author(s):

Aminu Taura Abdullahi ◽

Zubaida Ladan Farouk ◽

Abdulazeez Imam

Keyword(s):

Mental Health ◽

Risk Factors ◽

Common Mental Disorders ◽

Severe Acute Malnutrition ◽

Maternal Mental Health ◽

Cross Sectional Study ◽

Acute Malnutrition ◽

Sectional Study ◽

Cross Sectional ◽

North Western

Abstract BackgroundChildren with uncomplicated severe acute malnutrition are managed routinely within out-patient malnutrition treatment programs. These programs do not offer maternal mental health support services, despite maternal mental health playing a significant role in the nutritional status of children. Additionally, the burden of maternal Common Mental Disorders (CMDs) is poorly described among mothers of children attending these programs. This study thus determined the burden and risk factors for maternal CMDs among children attending out-patient malnutrition clinics in rural North-western Nigeria.MethodsWe conducted a cross-sectional study among 204 mothers of children with severe acute malnutrition who attending eight out-patient malnutrition clinics in Jigawa, North-western Nigeria. We used the World Health Organization Self-Reporting Questionnaire-20 (WHO SRQ-20) screening tool, a recognised and validated proxy measure for CMDs to identify mothers with CMDs. The prevalence of maternal CMDs was determined by identifying the proportion of mothers with SRQ scores of ≥8. Risk factors for CMD were determined using multivariable logistic regression. ResultsMaternal CMD prevalence in children attending these facilities was high at 40.7%. Non-receipt of oral polio vaccine (OPV) (AOR 6.23, 95%CI 1.85 to 20.92) increased the odds for CMD. While spousal age above 40 (AOR 0.95, 95%CI 0.90 to 0.99) and long years spent married (AOR 0.92, 95%CI 0.85 to 0.98) decreased the odds for CMD. ConclusionsOur findings indicate maternal CMD burden is high in out-patient malnutrition clinics in North-western Nigeria. Maternal mental health services would need to be integrated into the community management of acute malnutrition programs to provide more holistic care, and possibly improve long-term outcomes after discharge from these programs

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