scholarly journals Preparation of Ready to Use Supplementary Food for Treating Moderate Acute Malnutrition in Children Aged 6 to 59 Months

2020 ◽  
Vol 14 (3) ◽  
pp. 22
Author(s):  
Patricia M. Ntsama ◽  
Julie Judith T. Tsafack ◽  
Gabriel Nama Medoua ◽  
Carl M F Mbofung
Keyword(s):  
Sensory Evaluation ◽  
Severe Acute Malnutrition ◽  
Protein Digestibility ◽  
Acute Malnutrition ◽  
Balanced Diet ◽  
Malnourished Children ◽  
Threatening Condition ◽  
Life Threatening ◽  
Moderate Acute Malnutrition ◽  
Moderate Malnutrition

<p>Children with moderate malnutrition have a high risk of mortality and MAM is associated with a high number of nutrition-related deaths. If some of these children suffering from MAM do not receive adequate support, they may progress towards severe acute malnutrition (SAM), which is a life-threatening condition. Therefore, the management of MAM should be a public health priority<strong></strong></p><p>A well-balanced diet was prepared based on the recommendation of WHO for the treatment of moderate acute malnourished children aged 6 -59 months.  According to the formulae, nine products of RUSF were prepared using cereals, legumes, seeds, oil, sugar, and vitamin and mineral premix. Three products of RUSF MSPe, PBPe, and ISPe were found to be better among the nine products by the mothers after sensory evaluation.</p><p>Based on sensory evaluation in children, RUSF   MSPe was found to be the best among the three products. The product was analyzed for proximate composition, mineral, vitamin, digestibility of protein.  The protein, fat, carbohydrate, dietary fiber, total ash, vitamin C, Vitamin A,  iron, calcium and zinc of 100 g of the product were found to be  15.9g, 33.7g, 44.3g, 6.6g, 2.2g, 54.6 mg, 855 µg,  14.1 mg,  66.6 g and  12.4 µg respectively. The diet can supply 544.5 Kcal/100 g. The energy contributed by the protein, fat, and carbohydrate was found to be 11.68%, 55.7%, and 32.62% of total Kcals respectively. The protein digestibility adjusted to the chemical index PDCASS was 0.95.</p>Hence, the prepared RUSF is in accordance with the specification given by WHO which could be effective in the treatment of moderate acute malnourished children after the clinical trial.

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.

Community-Based Management of Acute Malnutrition for Infants Under 6 Months of Age Is Safe and Effective: Analysis of Operational Data

2021 ◽  
pp. 1-27
Author(s):  
Maeve M. Woeltje ◽  
Anastasia B. Evanoff ◽  
Beth A. Helmink ◽  
Diana L. Culbertson ◽  
Kenneth M. Maleta ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Community Based ◽  
Malnourished Children ◽  
Nutritional Recovery ◽  
Economic Barriers ◽  
Moderate Acute Malnutrition ◽  
Supplementary Foods ◽  
Operational Data

Abstract Objective: To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. Design: Review of operational acute malnutrition treatment records. Setting: 21 outpatient therapeutic feeding clinics in rural Malawi. Participants: Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6-9 months of age who were being treated at the same time in the same location in the context of two different randomized clinical trials. Results: A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6-9 months old with acute malnutrition (74 severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75.4%) achieved nutritional recovery; in comparison, 56 (75.7%) of those with SAM 6-9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81.3%) recovered; in comparison 241 (85.2%) of those aged 6-9 months recovered. Conclusions: In a rural Malawian population of infants u6m who had generally already stopped exclusive breastfeeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.

scholarly journals A Study of Serum Electrolytes in Malnourished Children

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.

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 Quality attributes of maize-based supplementary diets in the in vitro for the management of moderately acute malnourished children

2021 ◽  
Author(s):  
ADESANMI Raymond Ade ◽  
OKORIE Ijioma John ◽  
NWAMARAH Joy Ugu
Keyword(s):  
Severe Acute Malnutrition ◽  
Sub Saharan Africa ◽  
Acute Malnutrition ◽  
Mineral Contents ◽  
Supplementary Food ◽  
Malnourished Children ◽  
Sub Saharan ◽  
Child Mortality Rate ◽  
Moderate Malnutrition

Abstract Background and aimsModerate Acute Malnutrition (MAM) is a major global health problem threatening the life of approximately 33 million children and affects 15% of under- five children in sub-Saharan Africa. The efforts to reduce the burden of severe acute malnutrition and drop child mortality rate require appropriate dietary management of MAM through promotion of an affordable, readily available and locally produced supplementary food. The aim of this study was therefore to formulate and evaluate the quality of locally produced maize-peanut and maize-soybean supplementary food.ResultProximate composition was moisture (74.62%±0.02; 69.11%±0.01), crude protein (7.59%±0.02; 7.19%±0.02), crude fat (3.81%±0.02; 4.79%± 0.04), crude fiber (0.17%±0.02; 0.28%±0.03), ash (0.11%±0.02; 0.10%±0.02), carbohydrate (88.31%±0.02; 87.63%±0.06) and energy (417.96 ± 0.08; 424.05 ± 0.22) Kcal for MSB and MPN gruels, respectively. The mineral contents were calcium (14.15 ± 0.00; 11.81 ± 0.00) mg, iron (5.54 ± 0.00; 4.84 ± 0.00) mg, zinc (3.98 ± 0.00; 3.13 ± 0.00) mg, and iodine (297.33 ± 1.16; 293.00 ± 2.00) µg for MSB and MPN gruels, respectively. Vitamin contents of MSB and MPN gruels were B1 (2.30 ± 0.02; 2.22 ± 0.03) mg, B3(0.08 ± 0.02; 0.06 ± 0.03) mg, B9 (300.00 ± 26.46; 150.00 ± 17.32) mg, A (1.24 ± 0.05; 1.13 ± 0.04) RE, and K (0.86 ± 0.02; 1.98 ± 0.02) µg, respectively. Tannin (0.90 ± 0.03; 0.93 ± 0.02) %, saponin (0.30 ± 0.04; 0.34 ± 0.03) %, oxalate (0.24 ± 0.02; 0.11 ± 0.01) mg and alkaloid (0.12 ± 0.02; 0.10 ± 0.02) mg contents were not significantly different between MSB and MPN gruels.ConclusionThe formulation diets are suitable as supplementary food for the management of moderate malnutrition in children6-59 months, they provided all the required macro and micronutrients as recommended for children under this condition.

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 Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amare Kassaw ◽  
Desalegne Amare ◽  
Minyichil Birhanu ◽  
Aragaw Tesfaw ◽  
Shegaw Zeleke ◽  
...  
Keyword(s):  
Public Health ◽  
Oxygen Saturation ◽  
Retrospective Cohort ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Altered Consciousness ◽  
Time To Death ◽  
Under Five ◽  
Predictors Of Mortality ◽  
Malnourished Children

Abstract Background Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers. Methods A facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance. Results Out of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition. Conclusion The overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.

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).

scholarly journals Development and Acceptability of Locally Made Fish-Based, Ready-to-Use Products for the Prevention and Treatment of Malnutrition in Cambodia

2018 ◽  
Vol 39 (3) ◽  
pp. 420-434 ◽  
Author(s):  
Sanne Sigh ◽  
Nanna Roos ◽  
Daream Sok ◽  
Bindi Borg ◽  
Chhoun Chamnan ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Treatment Intervention ◽  
Intervention Trial ◽  
Overall Acceptability ◽  
High Prevalence ◽  
Prevention And Treatment ◽  
Moderate Acute Malnutrition ◽  
Hedonic Scale ◽  
Supplementary Foods

Background: Cambodia has a high prevalence of moderate acute malnutrition and severe acute malnutrition (SAM). The SAM treatment requires ready-to-use therapeutic foods (RUTFs), whereas ready-to-use supplementary foods (RUSFs) are used for prevention of acute malnutrition. Three locally produced fish-based products were developed: an RUTF paste (NumTrey-Paste) for treatment and 2 wafer versions, one for prevention (NumTrey-RUSF) and one for treatment (NumTrey-RUTF). Objective: To assess the acceptability of NumTrey-Paste and NumTrey-RUSF in comparison to a standard biscuit product (BP-100) used for the treatment of SAM. Methods: Acceptability of NumTrey-RUSF and NumTrey-Paste was tested in a nonblinded crossover taste trial among children (n = 52), aged ≥ 6 months to 18 years, and their caregivers. Eight organoleptic qualities were assessed on a 5-point hedonic scale, as well as a ranking test. A score of 1 to 3 was categorized as acceptable. The acceptability of NumTrey-RUTF was assessed using the caregivers’ perception during an SAM treatment intervention. Results: Taste trial: The proportion of children categorizing products as overall acceptable was lowest for NumTrey-Paste compared to for BP-100 and NumTrey-RUSF (21% vs 43% [BP-100] and 36% [NumTrey-RUSF]). No difference was found in the proportion of children who ranked BP-100 or NumTrey-RUSF as “liked most” ( P > .05). Acceptability of NumTrey-RUSF ranked highest in appearance and taste (caregiver), whereas acceptability of NumTrey-Paste was ranked lowest in appearance and smell among the products. Intervention trial: The acceptability of NumTrey-RUTF increased from 72% to 86%. Conclusions: The overall acceptability was ranked lowest for a pure paste product. However, filling the paste into a wafer made the product more acceptable.

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