scholarly journals The Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: A Prospective Empirical Study (Preprint)

2018 ◽  
Author(s):  
Sunhea Choi ◽  
Ho Ming Yuen ◽  
Reginald Annan ◽  
Trevor Pickup ◽  
Andrew Pulman ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Professionals ◽  
Severe Acute Malnutrition ◽  
Scale Up ◽  
Health Sector ◽  
Nutrition Intervention ◽  
Acute Malnutrition ◽  
World Health ◽  
Knowledge Gain ◽  
Prospective Longitudinal

BACKGROUND Scaling-up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive Malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to guidelines of the World Health Organization (WHO). OBJECTIVE The study aim was to test whether the Malnutrition eLearning course improves knowledge and skills of in-service and pre-service health professionals in managing children with severe acute malnutrition. METHODS This 2-year prospective, longitudinal, empirical research study took place in Ghana, Guatemala, El Salvador and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 pre-service trainees from 9 academic institutions, and 204 online users participated. Knowledge gain after training and retention over time were measured through pre- and post-assessments, comprising questions pertaining to screening, diagnosis, pathophysiology, and treatment and prevention of malnutrition. Comprehension, application and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. RESULTS Before the course, awareness of the WHO guidelines was 36.7% (389/1059) overall and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course of 606 participants who had pre-and post-assessment data was 11.8 (95% CI 10.8, 12.9 P<.001) – a relative increase of 41.5%. The proportion who achieved above the pass mark post-training was 58.7% (356/606), compared with 18.2% (110/606) pre-training. Of the in-service professionals, 86% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis and/or management. This group demonstrated significantly increased, retained knowledge 6-months after training (mean difference (SD) from pre-assessment:12.1 (11.8)), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional operational and policy changes were also found. CONCLUSIONS The Malnutrition eLearning course improved knowledge, understanding and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following completion of the course.

scholarly journals Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 681
Author(s):  
Ritu Rana ◽  
Marie McGrath ◽  
Ekta Sharma ◽  
Paridhi Gupta ◽  
Marko Kerac
Keyword(s):  
At Risk ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Cochrane Library ◽  
Breastfeeding Support ◽  
Middle Income ◽  
Middle Income Countries ◽  
Breastfeeding Practices ◽  
Low And Middle Income

Small and nutritionally at-risk infants under six months, defined as those with wasting, underweight, or other forms of growth failure, are at high-risk of mortality and morbidity. The World Health Organisation 2013 guidelines on severe acute malnutrition highlight the need to effectively manage this vulnerable group, but programmatic challenges are widely reported. This review aims to inform future management strategies for small and nutritionally at-risk infants under six months in low- and middle-income countries (LMICs) by synthesising evidence on existing breastfeeding support packages for all infants under six months. We searched PubMed, CINAHL, Cochrane Library, EMBASE, and Global Health databases from inception to 18 July 2018. Intervention of interest were breastfeeding support packages. Studies reporting breastfeeding practices and/or caregivers’/healthcare staffs’ knowledge/skills/practices for infants under six months from LMICs were included. Study quality was assessed using NICE quality appraisal checklist for intervention studies. A narrative data synthesis using the Synthesis Without Meta-analysis (SWiM) reporting guideline was conducted and key features of successful programmes identified. Of 15,256 studies initially identified, 41 were eligible for inclusion. They were geographically diverse, representing 22 LMICs. Interventions were mainly targeted at mother–infant pairs and only 7% (n = 3) studies included at-risk infants. Studies were rated to be of good or adequate quality. Twenty studies focused on hospital-based interventions, another 20 on community-based and one study compared both. Among all interventions, breastfeeding counselling (n = 6) and education (n = 6) support packages showed the most positive effect on breastfeeding practices followed by breastfeeding training (n = 4), promotion (n = 4) and peer support (n = 3). Breastfeeding education support (n = 3) also improved caregivers’ knowledge/skills/practices. Identified breastfeeding support packages can serve as "primary prevention" interventions for all infants under six months in LMICs. For at-risk infants, these packages need to be adapted and formally tested in future studies. Future work should also examine impacts of breastfeeding support on anthropometry and morbidity outcomes. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2018 CRD42018102795).

scholarly journals Brain MRI and cognitive function seven years after surviving an episode of severe acute malnutrition in a cohort of Malawian children

2018 ◽  
Vol 22 (8) ◽  
pp. 1406-1414 ◽  
Author(s):  
Natasha Lelijveld ◽  
Alhaji A Jalloh ◽  
Samuel D Kampondeni ◽  
Andrew Seal ◽  
Jonathan C Wells ◽  
...  
Keyword(s):  
Brain Structure ◽  
Severe Acute Malnutrition ◽  
School Achievement ◽  
Brain Mri ◽  
Well Being ◽  
Reference Population ◽  
Acute Malnutrition ◽  
Lower Grade ◽  
Economic Implications ◽  
Prospective Longitudinal

AbstractObjectiveTo assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children.DesignProspective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children.SettingBlantyre, Malawi.ParticipantsChildren discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children.ResultsSAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73).ConclusionsDespite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.

scholarly journals Performance and costing of nutrition intervention measures on admitted children in malnutrition treatment center: a case study from Jharkhand, India

2020 ◽  
Vol 7 (10) ◽  
pp. 4048
Author(s):  
Rajesh Kumar Sinha ◽  
Asha Kiran ◽  
Vivek Kashyap ◽  
Praveen Kumar
Keyword(s):  
Severe Acute Malnutrition ◽  
Average Length ◽  
Nutrition Intervention ◽  
Acute Malnutrition ◽  
Treatment Center ◽  
Medical Complication ◽  
Average Weight ◽  
Post Discharge ◽  
Target Weight ◽  
Intervention Measures

Background: Children with severe acute malnutrition (SAM) having medical complications require immediate care at malnutrition treatment centers (MTC). Thus, it becomes important to assess the effect and treatment cost of such children in these facilities. Hence, the present study was done with these aims in two MTCs in Jharkhand, India.Methods: A retrospective record review was done of the children admitted to these two MTCs between 1st April 2017 and 31st March 2018. A predesigned proforma was used to collect child related information. The data collected was entered in Microsoft excel sheet and analysed.Results: Majority of the admitted children (90.6%) were in 6-23 months age group. 358 (51.5%) children were females. Only, 194 (27.9%) children admitted were SAM had any medical complication. 690 (99.3%) children were discharged of whom 499 (72.3%) were discharged after achieving the target weight. The average weight gain during their stay was 8.1±2.4 g/kg/day and average length of stay was 16.7±3.2 days. Post discharge follow up rates were found to be low and only 130 (18.8%) children completed all three follow ups. Average cost per SAM child treated was Rs. 18,599 (US$ 272) and per SAM child cured was Rs. 25,904 (US$ 379).Conclusions: MTCs are effective in managing medically complicated SAM children. However, improvements are necessary to ensure that more such children should be treated at facility level, complimented with a community based programme for managing uncomplicated SAM children to improve coverage and ensure continuum of care.

scholarly journals Ethnic and age differences in prediction of mortality by mid-upper arm circumference in children below 3 years of age in Nepal

2018 ◽  
Vol 21 (12) ◽  
pp. 2230-2237 ◽  
Author(s):  
Avni Gupta ◽  
James M Tielsch ◽  
Subarna K Khatry ◽  
Steven C LeClerq ◽  
Luke C Mullany ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Sociodemographic Factors ◽  
Nutrition Intervention ◽  
Acute Malnutrition ◽  
Older Children ◽  
Upper Arm ◽  
Prediction Of Mortality ◽  
Arm Circumference ◽  
Increased Risk ◽  
Mid Upper Arm Circumference

AbstractObjectiveTo assess ethnicity- and age-modified associations between mid-upper arm circumference (MUAC) and mortality in Nepalese children and whether sociodemographic factors explain these associations.DesignSecondary data analysis of children followed until 3 years of age. Estimated mortality hazard ratios (HR) for MUAC<11·5cm (recommended cut-off for identifying severe acute malnutrition among children ≥6 months old) compared with ≥11·5cm in younger (<6 months) and older children (≥6 months) of Pahadi and Madhesi ethnicity, adjusting for sex, socio-economic status (SES) and mother’s education using Cox proportional hazard models.SettingSarlahi, Nepal (21 October 2001–2 February 2006).SubjectsChildren (n 48 492) enrolled in the Nepal Nutrition Intervention Project, Sarlahi-4.ResultsAmong children aged ≥6 months, MUAC<11·5 cm was associated with increased risk of mortality in both Pahadis (HR=4·01; 95 % CI 1·42, 11·76) and Madhesis (HR=5·60; 95 % CI 3·87, 8·11) compared with those with MUAC≥11·5 cm, after adjusting for sex, SES and maternal literacy. Among children <6 months old, MUAC<11·5 cm was not associated with mortality in Pahadis with (HR=1·12; 95 % CI 0·72, 1·73) or without adjusting (HR=1·17; 95 % CI 0·75, 1·18) as compared with Madeshis (adjusted HR=1·76; 95 % CI 1·35, 2·28).ConclusionsAmong older children, MUAC<11·5 cm is associated with subsequent mortality in both ethnicities regardless of other characteristics. However, among children aged <6 months, it predicted mortality only among Madhesis, while sociodemographic factors were more strongly associated with mortality than MUAC<11·5cm among Pahadis.

scholarly journals Nutrient and Anti-nutrient Profile of a Local Formula from Sorghum, Peanut, Honey and Ghee (Metu2) for Treatment of Severe Acute Malnutrition

2018 ◽  
Vol 7 (2) ◽  
pp. 25
Author(s):  
Amegovu K. Andrew ◽  
Peter Yiga ◽  
Kuorwel K. Kuorwel ◽  
Timothy Chewere
Keyword(s):  
Vitamin A ◽  
Energy Content ◽  
Severe Acute Malnutrition ◽  
Essential Fatty Acids ◽  
High Energy ◽  
Acute Malnutrition ◽  
World Health ◽  
Home Based ◽  
North Eastern ◽  
Eastern Uganda

World over, we are still struggling with persistent acute malnutrition levels; an estimated 17 million preschool children suffer from SAM, roughly the same figures as reported in 2013, a trend depicting insufficient progress towards the 2025 World Health Assembly. One such affected area is Karamoja Region in North Eastern Uganda. Partly, the trend could be attributed to unsustainable interventions like RUTF. Formulas from locally available foods could provide not only an affordable but also a culturally acceptable and effective home based solution.   Locally available sorghum, peanut, honey and ghee in North Eastern Uganda, is such a potential local formula. The nutritional and anti-nutritional profile of this local formula(metu2) was compared to plumpy-nut. Standard official analytical methods were used. Proximate composition was comparable and within the WHO recommendations for therapeutic formulas. Local formula(metu2) had a comparatively high energy content, 528kcal/100g to 509kcal in plumpynut. Vitamin A and K contents were below the WHO recommendations in local formula while Na, Mg and essential fatty acids were comparable and within the contents needed for SAM recovery. Zn was comparatively higher in plumpy-nut but levels in both formulas were below the recommendations. Trypsin inhibitors, phytates and condensed tannins were higher in local formula while aflatoxins were within the limits but not for plumpynut. Though lacking in critical K, Zn and Vitamin A, local formula(metu2) was comparable to plumpy-nut and its efficacy to sustain recovery from SAM needs to be studied. 

Socio-demographic and Household-Level Risk Factors for Severe Acute Malnutrition in Pre-school Children in North-Western Nigeria

2020 ◽  
Vol 66 (6) ◽  
pp. 589-597 ◽  
Author(s):  
Abdulazeez Imam ◽  
Fatimah Hassan-Hanga ◽  
Azeezat Sallahdeen ◽  
Zubaida L Farouk
Keyword(s):  
Risk Factors ◽  
General Education ◽  
Parental Education ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Multivariable Logistic Regression Model ◽  
Household Level ◽  
The North ◽  
North Western

Abstract Background Severe acute malnutrition (SAM) is associated with significant morbidity and mortality and is disproportionately distributed mainly in developing countries. In Nigeria, the prevalence of SAM in the North-Western region of the country is significantly higher than the national average. In this study, we identified risk factors for SAM in North-Western Nigeria. Identifying such risk factors would be helpful in developing local preventive strategies and providing insights for broader SAM control programs in other high-burden country settings. Methods We performed post hoc data analysis, comparing baseline socio-demographic and household-level risk factors in a cohort of 1011 children aged between 6 and 59 months who either had SAM or were well-nourished children. We defined nutritional status using the World Health Organization (WHO) reference standards and investigated the association between SAM and our identified risk factors using multivariable logistic regression model. Results Children aged between 12 and 23 months [adjusted odds ratio (AOR) 2.95, 95% confidence interval (CI) 1.99–4.38], household who reared domestic animals (AOR 1.94, 95% CI 1.40–2.69) and those from polygamous households (AOR 1.91, 95% CI 1.33–2.74) had significantly increased odds of developing SAM. Parental education and being on the household diet reduced the odds of having SAM. Conclusions Our findings suggest the need to develop optimal complementary feeding nutrition programs and promote adult and general education in our community. Cultural and feeding practices in local polygamous households also need further investigation to understand the association between polygamy with SAM.

Right diagnosis, right treatment: SAFER PRACTICES

2019 ◽  
Vol 1 (7) ◽  
pp. 356-360 ◽  
Author(s):  
Paul Silverston
Keyword(s):  
Clinical Practice ◽  
Health Professionals ◽  
Diagnostic Errors ◽  
Integrated Approach ◽  
Diagnostic Error ◽  
World Health ◽  
Formal Training ◽  
The World ◽  
Health Organization ◽  
The Right

Choosing the right treatment for the patient requires that the right diagnosis is made first. In primary and ambulatory care, however, diagnostic errors are both common and commonly preventable. The World Health Organization has recommended that all health professionals should receive formal training in the principles of diagnostic reasoning and the causes of diagnostic error, and that strategies and interventions to reduce the risk of diagnostic error should be used in clinical practice. This article describes a mnemonic checklist, SAFER PRACTICES, which can be used in an integrated approach to the prevention and detection of diagnostic errors that starts in the classroom and continues through to the consulting room.

scholarly journals Comparing azithromycin to amoxicillin in the management of uncomplicated severe acute malnutrition in Burkina Faso: a pilot randomized trial

2021 ◽  
Author(s):  
Kieran S O'Brien ◽  
Ali Sié ◽  
Clarisse Dah ◽  
Millogo Ourohire ◽  
Moussa Ouédraogo ◽  
...  
Keyword(s):  
Single Dose ◽  
Weight Gain ◽  
Adverse Events ◽  
Burkina Faso ◽  
Randomized Trial ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Promising Alternative

Introduction. Given the potential for asymptomatic infection in children with uncomplicated severe acute malnutrition (SAM), the World Health Organization recommends a broad-spectrum antibiotic like amoxicillin. Azithromycin is a promising alternative to amoxicillin as it can be administered as a single dose and has efficacy against several pathogens involved in the burden of infectious disease and mortality in this population. In this pilot study, we aimed to establish the feasibility of a larger randomized controlled trial and to provide preliminary evidence comparing the effect of azithromycin to amoxicillin on weight gain in children with uncomplicated SAM. Methods. This pilot randomized trial enrolled children 6-59 months old with uncomplicated SAM at 6 healthcare centers in Burkina Faso. Participants were randomized to a single dose of azithromycin or a 7-day course of amoxicillin. All participants received ready-to-use therapeutic food and were followed weekly until nutritional recovery and again at 8 weeks. The primary feasibility outcomes included enrollment potential, refusals, and loss to follow-up. The primary clinical outcome was weight gain (g/kg/day) over the 8-week period. Outcome assessors were masked. Results. Between June and October 2020, 312 children were screened, 301 were enrolled with 0 refusals, and 282 (93.6%) completed the 8-week visit. Average weight gain was 2.5 g/kg/day (SD 2.0) in the azithromycin group and 2.6 (SD) 1.7) in the amoxicillin group (Mean Difference -0.1, 95% CI -0.5 to 0.3, P = 0.63). Fewer adverse events were reported in the azithromycin group (Risk Ratio 0.50, 95% CI 0.31 to 0.82, P = 0.006). Conclusions. No differences were found in weight gain between groups. Given the ability to administer a single dose and the potential for fewer adverse events, azithromycin may be an alternative to amoxicillin for uncomplicated SAM. With strong enrollment and follow-up, a larger trial in this setting is feasible.

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