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 Clinical spectrum of severe acute malnutrition among children admitted to nutritional rehabilitation centre of a tertiary care hospital with special reference to incidence of bilateral pitting pedal oedema in children with severe acute malnutrition

2018 ◽  
Vol 5 (5) ◽  
pp. 1928
Author(s):  
M. R. Prashanth ◽  
M. R. Savitha ◽  
H. N. Yashwanth Raju ◽  
M. Shanthi
Keyword(s):  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Clinical Spectrum ◽  
Acute Malnutrition ◽  
Care Hospital ◽  
Nutritional Rehabilitation ◽  
Rehabilitation Centre ◽  
Under Five ◽  
Under Five Children ◽  
Pedal Oedema

Background: Malnutrition is a major cause of morbidity and mortality in under five children globally, according to global nutrition report 2016, forty five percent of deaths in under five children are linked to malnutrition. The objective of this study was to study the clinical spectrum in children with Severe Acute Malnutrition (SAM) admitted to nutritional rehabilitation center of a tertiary care hospital.Methods: Children between the age group of 6 months to 5 years admitted in the nutritional rehabilitation centre during the period of 1 year (from April 2016 to March 2017) meeting our inclusion criteria were included in the study. We retrospectively reviewed the medical records of these children. Clinical spectrum of SAM was compared with comparison group.Results: A total of 100 cases were included in the study. Ninety five percent of children met the criteria of weight for height less than 3SD, 45% of children met the criteria of Mid Upper arm Circumference (MUAC) less than 11.5 cms and 5% of children met the criteria of bilateral pitting pedal oedema. Mean age of presentation of children in the present study was 15.8 months among which 45% were males and 55% were females. Major symptoms of the study group were fever, cough, hurried breathing, loss of appetite and loose stools with 79%, 45%, 27%, 26% and 23% as respective frequencies. Pneumonia (43%) was the major comorbidity among children admitted with severe acute malnutrition. Diarrhoea (21%), meningitis (8%), urinary tract infection (6%) were the other co-morbidities present in the study group.Conclusions: Pneumonia and diarrhoea are the major co-morbidities present in children with SAM. Majority of children fulfil the criteria of weight for height ≤3SD for diagnosis of SAM. There is a low incidence of oedematous malnutrition in the present study.

scholarly journals Aetiology and outcome of acute diarrhoea in children with severe acute malnutrition: a comparative study

2019 ◽  
Vol 23 (9) ◽  
pp. 1563-1568
Author(s):  
Abhishek Jain ◽  
Dheeraj Shah ◽  
Shukla Das ◽  
Rumpa Saha ◽  
Piyush Gupta
Keyword(s):  
Comparative Study ◽  
Urban Poor ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Total Duration ◽  
Acute Diarrhoea ◽  
Therapeutic Interventions ◽  
Acute Malnutrition ◽  
Care Hospital ◽  
Persistent Diarrhoea

AbstractObjective:To compare the microbiological profile, clinical course and outcome of acute diarrhoea in children aged <5 years having severe acute malnutrition (SAM) with those of children having normal nutritional status.Design:Cross-sectional comparative study.Setting:Tertiary-care hospital catering mainly to the urban poor of East Delhi, India.Participants:Children aged <5 years (n 140; seventy with SAM (cases) and seventy with normal anthropometry (controls)) with acute diarrhoea (duration < 14 d). Stool samples were collected for conventional culture, microscopy, acid-fast staining, rotavirus and Cryptosporidium antigen detection, and subtyping of diarrhoeagenic Escherichia coli (DEC). We followed-up these children for persistent diarrhoea and subsequent diarrhoeal episode in the next 3 months.Results:Rotavirus was detected in six (9 %) cases and in fifteen (21 %) controls (P = 0·03; OR = 0·34; 95 % CI 0·12, 0·94). DEC was isolated significantly more in cases compared with controls (93 v. 64 %; P < 0·001; OR = 7·25; 95 % CI 2·57, 20·4). Cryptosporidium was detected in seven (10 %) cases and five (7 %) controls. Total duration of diarrhoea and percentage change in weight after resolution of diarrhoea were comparable between cases and controls. At 3-month follow-up, number of subsequent episodes of diarrhoea and persistent diarrhoea were comparable between the two groups.Conclusions:Rotavirus was found significantly less frequently, whereas DEC was detected more frequently in children with SAM in comparison to non-malnourished children. To further reduce diarrhoea-related mortality, preventive and therapeutic interventions need to be designed against organisms causing diarrhoea in children with SAM.

Prevalence and predictors of hypocalcaemia in severe acute malnutrition

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.

scholarly journals Evaluation of the performance of a nutrition rehabilitation centre in a tertiary care hospital in Eastern India

2019 ◽  
Vol 6 (4) ◽  
pp. 1728
Author(s):  
Mayadhar Panda ◽  
Sikata Nanda ◽  
Mangala Charan Murmu ◽  
Rama Chandra Giri ◽  
Lila Lalantika Debi
Keyword(s):  
Health Care Providers ◽  
Rural Areas ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Acute Malnutrition ◽  
Care Hospital ◽  
Care Providers ◽  
Rehabilitation Centre ◽  
Nutrition Rehabilitation ◽  
The Mean

Background: Severe acute malnutrition (SAM) places extraordinary challenges in the way of survival, growth and development of the child under five years of age. Our aim was to evaluate the functioning and performance of facility based management of SAM children admitted in the nutrition rehabilitation centre (NRC) and to identify the existing bottlenecks in the NRC.Methods: Children above 1 month and less than 5 years of age with severe acute malnutrition were included during the study period. Demographic details of the SAM children, clinical features during admission were recorded. Anthropometric measurements like MUAC, weight, height/length and WHZ scores were taken at admission and compared with the findings at discharge. Statistical analysis: the data after collection, compilation was analysed by SPSS.Results: Majority 277 (78.47%) of them belonged to rural areas. 300 (85%) SAM children were referred by medical officers. Bilateral oedema was recorded in 12 (17.9%) admitted children during 2014-2015, 22 (17.9%) children in 2015-2016 and in 37 (22.7%) children during 2016-2017. There was significant improvement in the mean weight (kg) and mean MUAC (cm) at discharge was in comparison to the weight and MUAC of the children at admission and this difference in increase in the mean weight and MUAC were found to be statistically significant.Conclusions: Implementation of WHO feeding guidelines resulted in adequate weight gain of inpatient malnourished children, however the frontline workers in the community and health care providers of PHCs should be trained and given hands on training for early identification and referral of SAM cases.

scholarly journals Prevalence of Severe Acute Malnutrition and Associated Mortality Rate in Infants in Tertiary Care Hospital of Hyderabad

2020 ◽  
pp. 40-44
Author(s):  
Asif Nadeem Jamali ◽  
Habibullah Siyal ◽  
Zamir Ahmed Qambrani ◽  
Naseer Ahmed Memon ◽  
Salman Baig ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Tertiary Care Hospital ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Study Participant ◽  
Acute Malnutrition ◽  
Outcome Variable ◽  
Severe Malnutrition ◽  
Care Hospital ◽  
Prompt Treatment

Aims: In developing countries malnutrition is characterized as one of the major risk factors for death in children, due to improper management of cases, lack of resources and escaping the guidelines provided by WHO. However, it is also highlighted that prompt treatment and proper management can reduce the mortality rate and improve the quality of life in children. Current study is designed to investigate the frequency of SAM and its outcomes at time of discharge in tertiary care hospital of Hyderabad. Study Design: A cross sectional study was performed. Place and Duration of Study: Study was performed at nutritional stabilization center of pediatric department of tertiary care hospital Hyderabad from July 2019 to Jan 2020. Methodology: Preformed proforma was designed to record the data of participants that included demographic and primary outcome variable. Hospital protocols using WHO guidelines 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-19, p-value <0.05 was considered as significant. Results: Mean age of the study participant was 13 ± 6.3 months while majority of them were male (72%). About 70% participants were below normal as per weight to height ratio. Out of recruited participants (N=273) admitted in nutritional center prevalence of severe acute malnutrition was found to be 32.6%. After admission and management protocols 91.6% recovered however, mortality was observed in 8.9% participants. Conclusion: We conclude that effective and prompt treatment measures and appropriate management of affected patients according provided guidelines shown decrease in mortality and increased the survival rate in admitted children.

scholarly journals Study of malaria and associated co-morbidity in children admitted with fever manifestation in a tertiary care centre

2020 ◽  
Vol 7 (8) ◽  
pp. 1705
Author(s):  
Pawan Ghanghoriya ◽  
Rahul Borkar ◽  
Monica Lazarus ◽  
Manish Ajmariya
Keyword(s):  
Severe Malaria ◽  
Severe Acute Malnutrition ◽  
Care Center ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Acute Malnutrition ◽  
Age Group ◽  
Tertiary Care Centre ◽  
Medical College ◽  
Co Morbidity

Background: Children under five year of age are highly vulnerable to malaria infection and often face dire consequences such as severe malaria if they are not promptly and adequately treated with anti-malarial medications. Authors set out to evaluate malaria and associated co-morbidity among children admitted with febrile illness in tertiary care center NSCB Medical college Jabalpur, India.Methods: This prospective and analytic study focused on children admitted with fever in pediatric unit of N.S.C.B. Medical College, Jabalpur, Madhya Pradesh, India. If any co-morbidity present with malaria their manifestation was noted. Association of co-morbidity with malaria was done, and effect of co-morbidity on severity of malaria and outcome of patients was noted.Results: A total number of 1950 of children suspected to have malaria who were tested by RDT and microscopy (PSMP), out of them 100 children were positive. Mean age calculated was 7.3±4.3 years. Maximum number of severe malaria cases (40.6%) were found in 6 months to <5 years age group. Most common co-morbidity associated with malaria was anemia (53%) followed by pneumonia (36%) hepatitis (26%), diarrhea (24%), enteric fever (15%), septicemia and meningoencephalitis (10%) each, UTI (4%), and AKI (6%), while dengue (3%) and severe acute malnutrition (2%). Out of 69 cases of severe malaria 46.3% cases had two and 34.7% cases had more than two co-morbidities while in 31 cases of uncomplicated malaria 38.7% cases had two co-morbidity and only 3% had more than two co-morbidity.Conclusions: All RDT positive cases have associated co-morbidity with malaria in our study, more is the co-morbidity is longer were the duration of stay and higher the complications and even mortality. 

scholarly journals Urinary tract infections in children aged 6 months to 5 years presenting with severe acute malnutrition in a tertiary care hospital

2021 ◽  
Vol 8 (3) ◽  
pp. 474
Author(s):  
Naveen Dangayach ◽  
Hemant Jain
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Acute Malnutrition ◽  
World Health ◽  
Care Hospital ◽  
Asymptomatic Children ◽  
Sensitivity Pattern ◽  
Tract Infections

Background: Urinary tract infections (UTI) is more common in malnourished children than in well-nourished children. Malnutrition is associated with immune deficiency which makes affected children more vulnerable to various severe infections. World Health Organization (WHO) defined severe acute malnutrition (SAM) as weight-for-height below -3 standard deviations (or Z-scores) or mid upper arm circumference <11.5 cm or visible severe wasting or bilateral pedal edema.Methods: All eligible children were consecutively enrolled in the study. Detailed anthropometry measurements were taken and physical examination was done. Two urine specimens for routine microscopy and culture and sensitivity were sent. Antibiotic therapy was given as per standard protocol/sensitivity pattern. Statistical analysis was performed using the statistical packages for social sciences (SPSS) version 20 IBM Corporation.Results: Prevalence of UTI in our study was 21.54% in children with SAM. UTI was more common in females than males in SAM children with maximum prevalence in less than 24 months of age. MUAC was the most prevalent diagnostic criteria. Fever was the most common presenting symptom, but 36.84% asymptomatic children with SAM had UTI. Increased frequency of micturition had 100% association with UTI. E. coli was the most common isolated bacteria. Most sensitive antibiotic was imipenem. Routinely used antibiotic like ceftriaxone showed significant percentage of resistance.Conclusions: Given the high prevalence of UTI among children with SAM, it is suggested that urine culture should be performed in all children with SAM to diagnose UTI and to treat it on basis of antibiotic sensitivity pattern. 

Outcome and Incidence of Hypomagnesemia in Children Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital

2021 ◽  
Vol 15 (5) ◽  
pp. 1169-1173
Author(s):  
R. Farrukh ◽  
S. Masood ◽  
I. Shakoor ◽  
A. Naseer ◽  
S. Sultana ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Magnesium Level ◽  
Acute Malnutrition ◽  
Care Hospital

Background: Magnesium deficiency is common in serious diseases and is often associated with mechanical ventilation, mortality, and long-term intensive care. Awareness of hypomagnesaemia is essential because little data is available and may have prognostic and therapeutic implications. Aim: This study was conducted to calculate the incidence of hypomagnesaemia at PICU admission and to relate it to length of PICU stay, duration of mechanical ventilation, and outcome of hospital stay or discharge. Place and Duration: In the Pediatric Intensive Care Unit (PICU), Abbasi Shaheed Hospital, Karachi for one-year duration from April 2020 to April 2021. Methods: This is a prospective observational study involving 200 children aged 1 month to 12 years admitted to the PICU. All qualified children underwent an interview and clinical examination. Blood was collected during admission to calculate serum magnesium level. The patients were grouped into three groups: normomagnesemia, hypomagnesaemia and hypermagnesemia, and the data were analyzed. Results: 200 children were included in the inclusion study. Males constituted 57.0%and females 43.0%. The ratio of men to women was 1.2: 1. Most of the respondents were 5 years old. Most of the respondents were in the ICU with neurological symptoms (36.5%), followed by respiratory diseases (27%). Of the 200 patients, 138 (69%) had a mean magnesium level of 1.9 mg / dL. 51(25.5%) patients had hypomagnesaemia. The average magnesium level was 1.3 mg / dL. 11 (5.5%) patients had hypermagnesemia with a mean magnesium content of 2.7 mg / dl. The lowest measured magnesium level was 1 mg / dl and the highest was 4.2 mg / dl. There was no statistically significant association between hypomagnesaemia and gender, age, disease acceptance category, and sepsis. ≤ 27.4% of children under 5 years of age had severe acute malnutrition in the hypomagnesaemia group. Among those with normal magnesium levels, 24% had severe acute malnutrition and 27.3% had severe acute malnutrition among those with hypermagnesemia. In the study, overall mortality was 25% (50 out of 200). Mortality among people with hypomagnesaemia was 29.40%. Among those with normal magnesium levels, 21.2% died and 18.2% in the hypermagnesemia group. Conclusion: Patients with hypomagnesaemia have prolonged PICU stay, other related electrolyte disturbances and increased mortality. Therefore, in severe ill patients, magnesium levels are monitored. Keywords: Children, Hypomagnesaemia, Intensive Care Unit, Mortality, Outcome, ICU

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