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. 

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 Comorbidities and Factors Associated with Mortality among Children under Five Years Admitted with Severe Acute Malnutrition in the Nutritional Unit of Jinja Regional Referral Hospital, Eastern Uganda

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Desire Banga ◽  
Melvis Baren ◽  
Namale Vivian Ssonko ◽  
Franck Katembo Sikakulya ◽  
Yves Tibamwenda ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Referral Hospital ◽  
Acute Malnutrition ◽  
Health Concern ◽  
Regional Referral Hospital ◽  
Children Under Five ◽  
Under Five ◽  
Factors Associated ◽  
Eastern Uganda ◽  
Children Under 5

Background. Mortality among children with severe acute malnutrition remains an immense health concern in the hospitals in developing countries, but its attributes are not completely assessed in various hospital settings. The aim of this study was to determine the proportion of mortality, the comorbidities, and factors associated with in-hospital mortality among children under five years of age admitted with severe acute malnutrition at Jinja Regional Referral Hospital, Eastern Uganda. Methods. This was a hospital-based analytical and descriptive prospective cohort study conducted in the nutritional unit of Jinja Regional Referral Hospital. A total of 338 children and their caretakers who met the criteria were consecutively enrolled into the study. Descriptive statistics were used to each of the independent factors, and comorbidities were subjected to chi-squared test followed by logistic regression analysis to assess its association incidence of mortality among children. All independent variables with p values ≤ 0.05 were entered into a multivariate model for factors and comorbidities independently. Factors and comorbidities with p values ≤ 0.05 were considered as associates of mortality among children. Results. Of the 338 children under 5 years of age enrolled, 49 (14.5%) died, although the majority of children were diagnosed with dehydration, 128 (37.9%); pneumonia, 127(37.6%); and malaria, 87(25.7%). Anemia ( aRR = 2.9 , 95% CI: 1.23-6.62, p = 0.01 ), bacteremia ( aRR = 10.0 , 95% CI: 3.62-29.01, p = 0.01 ), HIV ( aRR = 4.8 , 95% CI: 1.42-16.30, p < 0.01 ), TB ( aRR = 4.3 , 95% CI: 1.28-14.49, p < 0.02 ), and shock ( aRR = 60.9 , 95% CI: 9.05-410.28, p < 0.01 ) were the comorbidities significantly associated with a likelihood of mortality. Conclusions. The mortality among children under 5 years of age admitted with severe acute malnutrition is still high (14.5% versus 5%). The comorbidities are significantly associated with mortality. The clinicians are recommended to follow-up closely patients with severe acute malnutrition and to focus on the critical comorbidities identified.

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.

scholarly journals An Integrated Micronutrient Powder Intervention Improved IYCF Practices Among Caregivers of Children 6–23 Months in Eastern Uganda (P10-131-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Nicole Ford ◽  
Laird Ruth ◽  
Sarah Ngalombi ◽  
Abdelrahman Lubowa ◽  
SIti Halati ◽  
...  
Keyword(s):  
Vitamin A ◽  
Complementary Feeding ◽  
Feeding Practices ◽  
Household Wealth ◽  
Bottle Feeding ◽  
World Health ◽  
Double Difference ◽  
Household Food Security ◽  
Micronutrient Powder ◽  
Eastern Uganda

Abstract Objectives We evaluated the impact of an integrated infant and young child feeding (IYCF) – micronutrient powder intervention on IYCF practices among caregivers of children 12–23 mo in Eastern Uganda. Methods We used pre-/post- data from two population-based, cross-sectional surveys representative of children aged 12–23 mo in Amuria (intervention) and Soroti (non-intervention) districts. Caregivers were interviewed in June/July at baseline 2015 (N = 1260) and 12 mo after implementation in 2016 (N = 1490) about their IYCF practices the day preceding the survey. Logistic regression estimated the double-difference effect of the intervention on core World Health Organization (WHO) IYCF indicators: child ever breastfed, current breastfeeding, bottle feeding, complementary foods introduced at age 6 mo, consumption of vitamin A-rich fruits or vegetables, consumption of animal-flesh foods, minimum meal frequency (MMF) (received food ≥3 times for breastfed children and ≥4 times for non-breastfed children), minimum dietary diversity (MDD) (received foods from ≥4 of 7 WHO food groups), and minimum acceptable diet (MAD) (MDD and MMF among breastfed children, and ≥2 milk feeds, MDD not including milk feeds, and MMF among non-breastfed children). Analyses were weighted and accounted for complex sampling design. Results After controlling for child age and sex, household wealth, household food security, and caregiver education, the intervention was positively associated with MMF (Adjusted Prevalence Difference-in-Difference [APDiD] 18.6%; 95% Confidence Interval [CI] 11.2, 26.0) and MAD (APDiD 5.6%; 95% CI 0.02, 11.2). The intervention was associated with 21.8% higher prevalence of timely introduction of complementary feeding (95% CI 13.4, 30.1) and with increased consumption of both vitamin A-rich fruits/vegetables (APDiD 23.5%; 95% CI 12.5, 34.5) and animal-flesh foods (APDiD 9.1%; 95% CI 1.5, 16.7). The intervention did not affect breastfeeding or bottle feeding practices. Despite program impact, prevalence of some IYCF practices were low in Amuria at endline including MAD (19%) and MMF (21%). Conclusions The integrated IYCF intervention had a positive impact on many core WHO IYCF practices; however, low endline prevalence of some indicators suggests a continued need to improve complementary feeding practices in Eastern Uganda. Funding Sources Funding or in kind technical support provided by the Ministry of Health Uganda, World Food Programme, and the U.S. Centers for Disease Control and Prevention (CDC).

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.

scholarly journals An Experience at a Tertiary Level Hospital NRC in Management of Severe Acute Malnutrition in Children Aged between 6-59 Months Adopting World Health Organization Recommendations

2016 ◽  
Vol 1 (1) ◽  
pp. 41 ◽  
Author(s):  
S. Bharathi ◽  
K. Anuradha ◽  
J. Venkateshwar Rao
Keyword(s):  
World Health Organization ◽  
Severe Acute Malnutrition ◽  
Case Fatality ◽  
Acute Malnutrition ◽  
World Health ◽  
Severe Malnutrition ◽  
Rehabilitation Center ◽  
Nutritional Rehabilitation ◽  
Retrospective Case ◽  
Health Organization

<p><em>Objectives:<strong> </strong></em><em>To study the outcome indicators of a nutritional rehabilitation center and to assess its performance.</em></p><p><em>Design: </em><em>Retrospective case study.</em></p><p><em>Period:</em><em> One year period from Jan 2014 to Dec 2014.</em></p><p><em>Methods:<strong> </strong></em><em>Data of 254 children aged between 6-59</em><em> </em><em>months with severe acute malnutrition admitted in nutritional rehabilitation center at department of pediatrics, Gandhi hospital, was</em><em> </em><em>analyzed retrospectively. Identification and treatment of severe acute malnutrition was done according to world health organization recommendations.</em></p><p><em>Results:<strong> </strong></em><em>The recovery rate, death rate, defaulter rate, mean (SD) weight gain &amp; mean (SD) duration of stay in the nutritional rehabilitation center were 51.42%, 3.54%, 28.57%, 8g/kg/day, 14.2 days respectively.</em></p><p><em>Conclusions:<strong> </strong></em><em>Nutritional rehabilitation centers are effective in management of severe malnutrition and also in decreasing the case fatality rates.</em></p>

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

2020 ◽  
Author(s):  
Damalie Nalwanga ◽  
Victor Musiime ◽  
Samuel Kizito ◽  
John Baptist Kiggundu ◽  
Anthony Batte ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hiv Infection ◽  
Treatment Guidelines ◽  
Severe Acute Malnutrition ◽  
Routine Care ◽  
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 (eGFR), 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 eGFR below 60 mL/min/1.73m 2 or have bacteraemia, are more likely to die. Further studies to explore the relationship between eGFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.

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