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 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 Pathways between caregiver body mass index, the home environment, child nutritional status, and development in children with severe acute malnutrition in Malawi

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255967
Author(s):  
Allison I. Daniel ◽  
Mike Bwanali ◽  
Eric O. Ohuma ◽  
Celine Bourdon ◽  
Melissa Gladstone ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Child Development ◽  
Nutritional Status ◽  
Body Mass ◽  
Home Environment ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Nutritional Rehabilitation ◽  
Z Scores ◽  
Child Nutritional Status

Children with severe acute malnutrition (SAM) remain vulnerable after treatment at nutritional rehabilitation units (NRUs). The objective was to assess the concurrent pathways in a hypothesized model between caregiver body mass index (BMI), the home environment, and child nutritional status, and development (gross motor, fine motor, language, and social domains) in children with SAM following discharge from inpatient treatment. Structural equation modelling (SEM) was performed with data from a cluster-randomized controlled trial at the Moyo Nutritional Rehabilitation and Research Unit in Blantyre, Malawi. This approach was undertaken to explore simultaneous relationships between caregiver BMI, the home environment (Home Observation for Measurement of the Environment Inventory scores), child nutritional status (anthropometric indicators including weight-for-age z-scores [WAZ]), and child development (Malawi Developmental Assessment Tool (MDAT) z-scores as a latent variable) in children with SAM. These data were collected at participants’ homes six months after discharge from NRU treatment. This analysis included 85 children aged 6–59 months with SAM and their caregivers recruited to the trial at the NRU and followed up successfully six months after discharge. The model with WAZ as the nutritional indicator fit the data according to model fit indices (χ2 = 28.92, p = 0.42). Caregiver BMI was predictive of better home environment scores (β = 0.23, p = 0.03) and child WAZ (β = 0.30, p = 0.005). The home environment scores were positively correlated with MDAT z-scores (β = 0.32, p = 0.001). Child nutritional status based on WAZ was also correlated with MDAT z-scores (β = 0.37, p<0.001). This study demonstrates that caregiver BMI could ultimately relate to child development in children with SAM, through its links to the home environment and child nutritional status.

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% CI15.9-25.6%). 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 Anemia and Contributing Factors in Severely Malnourished Infants and Children Aged between 0 and 59 Months Admitted to the Treatment Centers of the Amhara Region, Ethiopia: A Multicenter Chart Review Study

Anemia ◽  
2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Wubet Worku Takele ◽  
Adhanom Gebreegziabher Baraki ◽  
Haileab Fekadu Wolde ◽  
Hanna Demelash Desyibelew ◽  
Behailu Tariku Derseh ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Severe Acute Malnutrition ◽  
Public Health Problem ◽  
Infants And Children ◽  
Acute Malnutrition ◽  
Binary Logistic Regression Analysis ◽  
Amhara Region ◽  
Contributing Factors ◽  
Malnourished Children ◽  
Referral Hospitals

Background. Anemia among severely malnourished children is a double burden that could make the treatment outcome of severe acute malnutrition (SAM) more unfavorable. The burden and the factors are, however, uncovered among children in the Amhara region. Therefore, the study was aimed at determining the prevalence of anemia and identifying contributing factors in severely malnourished children aged between 0 and 59 months admitted to the treatment centers of the Amhara region referral hospitals. Methods. A facility-based cross-sectional study was conducted that included 1,301 infants and children, who developed SAM and were admitted to the three referral hospitals of the Amhara region. Data were extracted using a data extraction checklist. The binary logistic regression analysis was employed to show an association between the dependent and independent variables. Multicollinearity was assessed using the variance inflation factor (VIF) and no problem was detected (overall VIF = 1.67). The presence of association was declared based on the p -value (≤0.05), and the adjusted odds ratio with its respective 95% confidence interval was used to report the direction, as well as the strength of association. Results. About 41.43% (95% CI: 38.78%–44.13%) of severely malnourished infants and children have developed anemia, of which around half (47%) of them were under six months old. Rural residence (AOR = 1.56; 95% CI: 1.14–2.12) and HIV infection (AOR = 2.00; 95% CI: 1.04–3.86) were significantly associated with higher odds of anemia. Furthermore, being exclusively breastfed (AOR = 0.57; 95% CI 0.39–0.83) remarkably reduced the likelihood of anemia. Conclusions. This data confirms that anemia among severely malnourished infants and children is a public health problem in the Amhara region. Infants younger than six months were at a higher risk of anemia. Being a rural resident and contracting HIV infection have elevated the occurrence of anemia, whereas being exclusively breastfed decreased the risk. Therefore, the study gives an insight to policymakers and planners to strengthen the existing exclusive breastfeeding practice. Strategies being practiced to prevent HIV transmission and early detection, as well as treatment, should also be strengthened. Furthermore, mothers/caretakers of infants and children residing in the rural areas deserve special attention through delivering nutrition education.

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 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.

Increased risk of acquisition and transmission of ESBL-producing Enterobacteriaceae in malnourished children exposed to amoxicillin

2019 ◽  
Vol 75 (3) ◽  
pp. 709-717 ◽  
Author(s):  
Naouale Maataoui ◽  
Céline Langendorf ◽  
Fatou Berthe ◽  
Jumamurat R Bayjanov ◽  
Willem van Schaik ◽  
...  
Keyword(s):  
Placebo Group ◽  
Severe Acute Malnutrition ◽  
Controlled Trial ◽  
Acute Malnutrition ◽  
Double Blind ◽  
Adjusted Risk ◽  
Malnourished Children ◽  
Nutritional Recovery ◽  
Adjusted Risk Ratio ◽  
Increased Risk

Abstract Objectives Routine amoxicillin for children with uncomplicated severe acute malnutrition raises concerns of increasing antibiotic resistance. We performed an ancillary study nested within a double-blind, placebo-controlled trial in Niger testing the role of routine 7 day amoxicillin therapy in nutritional recovery of children 6 to 59 months of age with uncomplicated severe acute malnutrition. Methods We screened 472 children for rectal carriage of ESBL-producing Enterobacteriaceae (ESBL-E) as well as their household siblings under 5 years old, at baseline and Week 1 (W1) and Week 4 (W4) after start of therapy, and characterized strains by WGS. ClinicalTrials.gov: NCT01613547. Results Carriage in index children at baseline was similar in the amoxicillin and the placebo groups (33.8% versus 27.9%, P = 0.17). However, acquisition of ESBL-E in index children at W1 was higher in the amoxicillin group than in the placebo group (53.7% versus 32.2%, adjusted risk ratio = 2.29, P = 0.001). Among 209 index and sibling households possibly exposed to ESBL-E transmission, 16 (7.7%) had paired strains differing by ≤10 SNPs, suggesting a high probability of transmission. This was more frequent in households from the amoxicillin group than from the placebo group [11.5% (12/104) versus 3.8% (4/105), P = 0.04]. Conclusions Among children exposed to amoxicillin, ESBL-E colonization was more frequent and the risk of transmission to siblings higher. Routine amoxicillin should be carefully balanced with the risks associated with ESBL-E colonization.

scholarly journals The effects of malnutrition on cardiac function in African children

2015 ◽  
Vol 101 (2) ◽  
pp. 166-171 ◽  
Author(s):  
Jonathan A Silverman ◽  
Yamikani Chimalizeni ◽  
Stephen E Hawes ◽  
Elizabeth R Wolf ◽  
Maneesh Batra ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Function ◽  
Severe Acute Malnutrition ◽  
Resistance Index ◽  
Stroke Volume Index ◽  
Acute Malnutrition ◽  
Volume Index ◽  
Severe Malnutrition ◽  
Systemic Vascular Resistance Index ◽  
Malnourished Children

ObjectiveCardiac dysfunction may contribute to high mortality in severely malnourished children. Our objective was to assess the effect of malnutrition on cardiac function in hospitalised African children.DesignProspective cross-sectional study.SettingPublic referral hospital in Blantyre, Malawi.PatientsWe enrolled 272 stable, hospitalised children ages 6–59 months, with and without WHO-defined severe acute malnutrition.Main outcome measuresCardiac index, heart rate, mean arterial pressure, stroke volume index and systemic vascular resistance index were measured by the ultrasound cardiac output monitor (USCOM, New South Wales, Australia). We used linear regression with generalised estimating equations controlling for age, sex and anaemia.ResultsOur primary outcome, cardiac index, was similar between those with and without severe malnutrition: difference=0.22 L/min/m2 (95% CI −0.08 to 0.51). No difference was found in heart rate or stroke volume index. However, mean arterial pressure and systemic vascular resistance index were lower in children with severe malnutrition: difference=−8.6 mm Hg (95% CI −12.7 to −4.6) and difference=−200 dyne s/cm5/m2 (95% CI −320 to −80), respectively.ConclusionsIn this largest study to date, we found no significant difference in cardiac function between hospitalised children with and without severe acute malnutrition. Further study is needed to determine if cardiac function is diminished in unstable malnourished children.

scholarly journals Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis

2020 ◽  
Vol 112 (4) ◽  
pp. 1069-1079
Author(s):  
Radhini Karunaratne ◽  
Jonathan P Sturgeon ◽  
Rajvi Patel ◽  
Andrew J Prendergast
Keyword(s):  
Systematic Review ◽  
Hiv Infection ◽  
Severe Acute Malnutrition ◽  
Meta Analysis ◽  
Multivariable Analysis ◽  
Acute Malnutrition ◽  
Cochrane Library ◽  
Inpatient Mortality ◽  
Baseline Factors ◽  
The Cochrane Library

ABSTRACT Background Malnutrition underlies 45% of under-5 deaths globally. Severe acute malnutrition (SAM) is the most serious form of undernutrition, characterized by wasting with or without edema. Mortality remains high (10%–40%) among children requiring hospitalization for complicated SAM. Objectives We aimed to systematically document the factors independently associated with inpatient mortality in children with SAM. Methods Embase, Ovid MEDINE, the Cochrane Library, and clinicaltrials.gov were searched for articles published between January 2000 and January 2020, using a prespecified protocol. Eligible studies included children aged ≤59 mo hospitalized with SAM and used multivariable analysis to assess the baseline factors independently associated with inpatient mortality. Random-effects meta-analysis, stratified by the stated measure of effect, was used where &gt;20% of studies included the same factor in analyses. Results Twenty-eight of 1432 studies fulfilled inclusion criteria: 19 studies included all children with SAM and 9 included specific subgroups of children with SAM. All 19 main studies were from 8 countries across Africa, with a median of 400 children/study. The mean inpatient mortality was 15.7% (95% CI: 10.4%, 21.0%) and HIV prevalence ranged from 2.1% to 51%. Nine factors were included in the meta-analysis, stratified by HR and OR. HIV infection (HR: 4.32; 95% CI: 2.31, 8.08), weight-for-height z score (WHZ) (OR: 0.44; 95% CI: 0.24, 0.80), diarrhea (HR: 2.84; 95% CI: 1.40, 5.75), pneumonia (HR: 1.89; 95% CI: 1.19, 3.02), presence of shock (HR: 3.67; 95% CI: 2.24, 6.03), and lack of appetite (HR: 2.16; 95% CI: 1.48, 3.16) were associated with increased mortality, whereas child age and sex were not. The association between edema and mortality was difficult to ascertain from the available studies. Conclusions HIV infection, diarrhea, pneumonia, shock, lack of appetite, and lower WHZ are independent predictors of inpatient mortality in children with SAM. These factors may help to risk-stratify children being hospitalized with complicated SAM. This systematic review/meta-analysis protocol was registered at www.crd.york.ac.uk/prospero as CRD42019152267.

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