scholarly journals Clinical Spectrum and Comorbidity Pattern of Severe Acute Malnutrition in Hospitalised Children Age between 6 Months to 59 Months

2021 ◽  
Author(s):  
Ashutosh Kumar Sharma ◽  
Ghanshyam Das ◽  
Durgesh Shukla
Keyword(s):  
Nutrition Education ◽  
Work Performance ◽  
Severe Acute Malnutrition ◽  
Public Health Problem ◽  
Sub Saharan Africa ◽  
Acute Malnutrition ◽  
Categorical Variables ◽  
Comprehensive Treatment ◽  
Treatment Unit ◽  
Co Morbidity

Abstract BACKGROUND The prevalence of underweight children in India is the highest in the world, and is nearly double that of Sub-Saharan Africa. Poor nutrition in the first 1000 days of a child’s life leads to stunted growth, impaired cognitive ability, reduced school and work performance. The mortality rate and duration of stay in hospital with oedematous SAM has remained unacceptably high. Such high mortality in inpatients has been attributed to co-morbidities.METHOD Descriptive hospital based study was done in the Department of Paediatrics, Kamla Raja Hospital, Gwalior from October 2018 to October 2020. Children 6-59 months of age with severe acute malnutrition admitted in severe acute malnutrition treatment unit were enrolled. WHO criteria were used to define severe acute malnutrition. The quantitative variables were described as mean ± standard deviation and categorical variables were in terms of proportion.RESULT Out of 29036 children, 1020 have severe acute malnutrition, constitute prevalence of 3.51%. A total of 400 cases met eligibility criteria and exploited. Sex ratio male and female 52.5%:47.5%. The peak prevalence was found in age group between 6-12 months (55%). Anaemia (68.25%) was found to be the commonest co morbidity, and then pneumonia (17.75%) dehydration (16.5%) followed by sepsis (13.5%). Most common chief complaint was fever (69%), followed by cough (38%) and watery loose motion (38%).CONCLUSION Severe acute malnutrition remains severe public health problem and mainly affects children under 24 months. Commonest causes are poor feeding practices, improper care of sick child at home, low maternal BMI. Maternal nutrition, education, media awareness, domestic decision, adequate nutrition of the girl child, early identification of anaemia, diarrhoea, pneumonia, sepsis and comprehensive treatment can reduces the morbidity and mortality.

scholarly journals Study of Anaemia in Children with Severe Acute Malnutrition

2018 ◽  
Vol 37 (3) ◽  
pp. 250-253 ◽  
Author(s):  
Deepak Dwivedi ◽  
Veerendra Singh ◽  
Jyoti Singh ◽  
Sangita Sharma
Keyword(s):  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Severe Anaemia ◽  
Acute Malnutrition ◽  
Folic Acid Deficiency ◽  
Care Hospital ◽  
Macrocytic Anaemia ◽  
Normal Children ◽  
Co Morbidity ◽  
Morphologic Type

Introduction: Severe anaemia is a leading cause of paediatric morbidity, hospitalization, and mortality and it is very important co morbidity in children with severe acute malnutrition. Severe Acute Malnutrition (SAM) with anaemia has been shown to have 2.62 times higher mortality as compared to SAM with no anaemia. So this study was done to evaluate this co-morbidity further. The aim of present study was to determine the prevalence and type of anaemia and to evaluate the possible aetiologies of anaemia in severe acute malnourished (SAM) children.Material and Methods: In tertiary care hospital a cross sectional study was conducted over a period of 8 month with 100 cases of SAM children and 101 cases of normal children. In both cases disorders of primary haematological problem were excluded. Auto analysers were used to measure blood counts. Blood smear was analysed by pathology consultant of institute and recorded for all patients with anaemia. Grade of anaemia and morphologic type of anaemia was analysed. Data were entered in Excel spreadsheets and analysed using SPSS 20.0.Results: Patient with SAM 42% had moderate anaemia and 19% had severe anaemia in contrast 41.6% and 16.8% in NON SAM child respectively. Predominant morphologic type in SAM patient was macrocytic anaemia (33%), while in controls microcytic anaemia (40.6%) was more prevalent.Conclusion: There was a high prevalence of anaemia in SAM children. Major morphologic type in SAM children was macrocytic anaemia which may indirectly show vitamin B12 or folic acid deficiency in these children.  

scholarly journals Invasive Fungal Infections in Under-Five Diarrheal Children: Experience from an Urban Diarrheal Disease Hospital

Life ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 94
Author(s):  
Nusrat Jahan Shaly ◽  
Mohammed Moshtaq Pervez ◽  
Sayeeda Huq ◽  
Dilruba Ahmed ◽  
Chowdhury Rafiqul Ahsan ◽  
...  
Keyword(s):  
Septic Shock ◽  
Early Diagnosis ◽  
Late Onset ◽  
Fungal Infections ◽  
Severe Acute Malnutrition ◽  
Fatal Outcome ◽  
Invasive Fungal Infections ◽  
Acute Malnutrition ◽  
Study Group ◽  
Co Morbidity

Invasive fungal infections (IFIs) are opportunistic, especially in immunocompromised and hospitalized patients. Children with IFIs are more vulnerable to a fatal outcome. For early diagnosis and treatment, knowledge of the spectrum and frequency of IFIs among children is prerequisite. In this prospective observational study, we enrolled 168 children of 2–59 months old of either sex from March 2018 to December 2019 admitted to the Dhaka hospital, icddr,b. Study participants with suspected IFIs were with or without severe acute malnutrition (SAM) along with sepsis/pneumonia and fulfilled any of the following criteria: (i) failure to respond to injectable antibiotics, (ii) development of a late-onset hospital-acquired infection, (iii) needed ICU care for >7 days, (iv) took steroids/antibiotics for >2 weeks before hospitalization, and (v) developed thrush after taking injectable antibiotics. The comparison group included non-SAM (weight-for-length Z score ≥ −2) children with diarrhea and fever <3 days in the absence of co-morbidity. We performed real-time PCR, ELISA, and blood culture for the detection of fungal pathogen. Study group children with SAM, positive ELISA and PCR considered to have a IFIs. In the study group, 15/138 (10.87%) children had IFIs. Among IFIs, invasive candidiasis, aspergillosis, histoplasmosis detected in 6 (4.53%), 11 (7.97%), and 1 (0.72%) children, respectively, and (3/15 [2.17%]) children had both candidiasis and aspergillosis. Children with IFIs more often encountered septic shock (26.7% vs. 4.9%; p = 0.013) and had a higher death rate (46.7% vs. 8.9%; p < 0.001) than those without IFIs. IFIs were independently associated with female sex (OR = 3.48; 95% CI = 1.05, 11.55; p = 0.042) after adjusting for potential confounders. Our findings thus implicate that, malnourished children with septic shock require targeted screening for the early diagnosis and prompt management of IFIs that may help to reduce IFIs related deaths.

scholarly journals An Overview on Acute Malnutrition and Food Insecurity among Children during the Conflict in Yemen

Children ◽  
2019 ◽  
Vol 6 (6) ◽  
pp. 77 ◽  
Author(s):  
Fekri Dureab ◽  
Eshraq Al-Falahi ◽  
Osan Ismail ◽  
Lina Al-Marhali ◽  
Ayoub Al Jawaldeh ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Severe Acute Malnutrition ◽  
Public Health Problem ◽  
Acute Malnutrition ◽  
Nutrition Status ◽  
Surveillance Program ◽  
Children Under Five ◽  
Under Five ◽  
Community Needs ◽  
Moderate Acute Malnutrition

Background: This study aims to describe malnutrition among children under five and to describe the food insecurity status during the current conflict in Yemen. Methods: Data were obtained from a Yemeni nutrition surveillance program (pilot phase) targeting 4142 households with 5276 children under five from two governorates (Ibb and Sana’a). Results: Global acute malnutrition was found in 13.3% of overall screened children, while 4.9% had severe acute malnutrition (SAM) and 8.4% had moderate acute malnutrition. One-fifth of the children under six months of age were acutely malnourished, followed by children under two years at 18.5% based on weight-for-height z scores. Significant associations between malnutrition and other diseases included suspected measles at three times higher rates (4.5%, p < 0.00) among SAM cases than other children. Diarrhea, fever, and cough were significantly higher among the SAM group (p < 0.05). Most households depended on market food purchases in the month preceding this survey (84.7%). Household coping mechanisms to secure daily meals included borrowing food to survive, changing types and quality of food, and decreasing the number of meals per day; some families sent their children to live with relatives. Conclusion: Malnutrition is a serious public health problem. The humanitarian community needs to adopt alternative strategies to improve food security and the nutrition status in Yemen.

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

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

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

scholarly journals Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective study from Kampala, Uganda

2019 ◽  
Author(s):  
Damalie Nalwanga ◽  
Victor Musiime ◽  
Samuel Kizito ◽  
John Baptist Kiggundu ◽  
Philippa Musoke ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Treatment Guidelines ◽  
Severe Acute Malnutrition ◽  
Routine Care ◽  
Sub Saharan Africa ◽  
Acute Malnutrition ◽  
World Health ◽  
Children Under Five ◽  
Under Five ◽  
Factors Associated

Abstract Background: Mortality among children under five years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under five years of age admitted to the NRH for routine care of SAM. Methods: This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14. Results: Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2 % (95% CI 19.9-30.4%) died. In-hospital mortality was 20.7% (95% CI 15.9-25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2-4.2), p=0.014), bacteraemia (AHR 9 (95% CI 3.4-23.0), p<0.001, and low glomerular filtration rate (GFR), AHR 3.2; (95% CI 1.7-6.3), p=0.001). Conclusions: A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have GFR below 60 mL/min/1.73m2 or are bacteraemic, are more likely to die. Further studies to explore the relationship between GFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.

scholarly journals Children’s Nutritional Rehabilitation Program in Beira, Mozambique: A Retrospective Study

2021 ◽  
Author(s):  
Serena Calgaro ◽  
Valentina Isidoris ◽  
Cristian Girotto ◽  
Kajal Chhaganlal ◽  
Jorge Moiane ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Severe Acute Malnutrition ◽  
Rehabilitation Program ◽  
Sub Saharan Africa ◽  
Acute Malnutrition ◽  
Public Health Issue ◽  
Nutritional Rehabilitation ◽  
Outpatient Services ◽  
Malnourished Children ◽  
Z Scores

Malnutrition is still a major public health issue in sub-Saharan Africa and Mozambique. The main aim of this study was to evaluate the adherence to the nutritional rehabilitation program (NRP) and its impact on the growth of malnourished children in Beira, Mozambique. The secondary aim was to verify the prevalence of HIV infection in malnourished children at the time of admission to the NRP. A retrospective observational study in Beira Central Hospital and 10 health centers in Beira, Mozambique, was conducted. All children 0 to 5 years of age with acute malnutrition admitted to the outpatient services of the NRP from March 2016 until February 2017 were included in the study. A total of 1,231 children with the following characteristics have been enrolled: 58% female; 33% severely malnourished; and 16.5% HIV-positive. Of the 198 (21.7%) children who completed the program, 177 (89.4%) recovered from malnutrition and 21 (10.6%) did not. Ten (1.1%) were hospitalized and 706 (77.2%) dropped out of the program. Among children who completed the program, the median weight-for-length and weight-for-height z-scores at admission were ≥ −3 and < −2; at discharge, these median z-scores were ≥ −1 (P < 0.001). Children with HIV infection and who were male had a higher prevalence of severe acute malnutrition (P < 0.001). Weight gain was found to be significant after 23 days (P = 0.004) of consuming supplements (ready-to-use therapeutic food). A diagnosis of the degree of malnutrition was accurate at admission for 70.5%; at discharge, this diagnosis was accurate for 67.2%. The NRP seems to be successful if correctly followed, even if it is limited by adherence problems. However, its effectiveness requires further investigation.

scholarly journals STUDY TO EVALUATE THE SPECTRUM OF DIFFERENT CO-MORBIDITIES IN CHILDREN SUFFERING FROM SEVERE ACUTE MALNUTRITION WITH UNEXPECTED DYSELECTROLYTEMIA IN DIARRHEA

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Arunabh Kumar ◽  
Ashok Kumar ◽  
Manish Ranjan
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
P Value ◽  
Medical College ◽  
Institutional Ethics ◽  
Co Morbidity ◽  
Significant Difference ◽  
Study Population ◽  
Hiv 1 ◽  
Morbid Conditions

Aim: to evaluate the spectrum of co-morbidities in severe acute malnutrition with unexpected dyselectrolytemia in diarrhea. Material and methods: The study was an observational study which was carried in the Department of pediatrics, Darbhanga Medical College and Hospital, Laheriasarai, Darbhanga Bihar, India for 2 years.  after taking the approval of the protocol review committee and institutional ethics committee. Total 200 Children below 5 year age were included in this study. Various co morbid conditions in study population were identified. All the laboratory examination was done with standard method. Results: Total 200 cases were included in study of which 96% were associated co-morbid conditions in SAM. Majority of children with SAM were having co-morbidity in the form of Anaemia (88%), Diarrhoea (60%) followed by pneumonia (32%), Rickets (31%), Tuberculosis (14%), Otitis    media    (12%),    UTI    (11%),    Celiac   (4%), Hypothyroidism (2%), & HIV (1%). Mean age (SD) of the diarrheal cases was 25(6) months (95% C.I. 24.1- 25.8) of which 70 were male (58.33%). Mean age (SD) of non-diarrheal cases was 19(6). (95% C.I. 16.6 – 19.4) of which 45 were male(75%). 120 (60%) SAM children presented with diarrhea of which 117 had dysnatremia in the form of Hyponatremia in 117 cases (58.5%) & Hypernatremia in 3 cases (1.5%) No statistically significant difference was found with hyponatremia in diarrheal or non-diarrheal cases of SAM (P value of 0.07). It was found that 20% SAM children were having hypokalemia. Hypokalemia was found in 15% of diarrheal cases & 5% in non- diarrheal cases. A statistically significant difference was found with hypokalemia in SAM (P value of 0.019) between Diarrheal & Non diarrheal cases. Conclusion: Dyselectrolytemia is high in complicated SAM and mainly sodium disturbances in form of hyponatremia are common in different co-morbid conditions. Keywords: Co-morbidities, Dyselectrolytemia, Potassium, Severe acute malnutrition, Sodium

scholarly journals Role of Brown Adipose Tissues / Beige Adipose Tissue (BAT/bAT) relevant genes expression and polymorphism in regulating human body weight

2020 ◽  
Vol 5 (10) ◽  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Tetralogy Of Fallot ◽  
Congenital Heart ◽  
Severe Acute Malnutrition ◽  
Sub Saharan Africa ◽  
Acute Malnutrition ◽  
Medical Progress ◽  
Brown Adipose ◽  
Sub Saharan

Introduction: Tetralogy of Fallot is the most common cyanogenic congenital heart disease. In sub-Saharan Africa, the incidence of the disease is unknown. Hospital studies show that it is the most common cyanogenic congenital heart disease. This heart disease, which varies in severity, has benefited from considerable medical progress over the last fifty years. The main objective of the work is to study management modalities of this heart disease in Senegal. Method: This retrospective study conducted from first January 2010 to thirty-one December 2015 in the pediatric cardiology department of the Albert Royer National Children Hospital of Dakar (CHNEAR), involves 125 children diagnosed with tetralogy of Fallot. Results: Tetralogy of Fallot accounted for 18.6% of congenital heart disease. Inbreeding and trisomy 21 were the main risk factors. Cyanosis was the main sign of disease discovery (33.2%) followed by anoxic malaise. Pulsed oxygen saturation averaged 70%. Severe acute malnutrition was detected in 21.8% of our patients. Ultrasound showed a regular pattern in 81 patients (64.8%) and an irregular pattern in 44 cases (35.2%). Modified Blalock surgery was performed in 16 patients (12.8%) and a surgical cure in 43 patients (34.4%). We reported 20 (16%) deaths in this series. Conclusion: The results of our series show an improvement in the management of Fallot tetralogy in Senegal, but the data is insufficient. Effort must be made in the context of disease screening and early surgical management.

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