scholarly journals Long term mortality after community and facility based treatment of severe acute malnutrition: Analysis of data from Bangladesh, Kenya, Malawi and Niger

2012 ◽  
Vol 4 (8) ◽  
pp. 215-225 ◽  
Author(s):  
Paluku Bahwere
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Long Term Mortality

scholarly journals Long-term outcomes for children with disability and severe acute malnutrition in Malawi

2020 ◽  
Vol 5 (10) ◽  
pp. e002613
Author(s):  
Natasha Lelijveld ◽  
Nora Groce ◽  
Seema Patel ◽  
Theresa Nnensa ◽  
Emmanuel Chimwezi ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
School Achievement ◽  
Acute Malnutrition ◽  
Health Issues ◽  
Physical Strength ◽  
Children With Disability ◽  
Increased Risk ◽  
Outcomes For Children

IntroductionSevere acute malnutrition (SAM) and disability are major global health issues. Although they can cause and influence each other, data on their co-existence are sparse. We aimed to describe the prevalence and patterns of disability among a cohort of children with SAM.MethodsA longitudinal cohort study in Malawi followed SAM survivors up to 7 years postdischarge. Clinical and anthropometric profiles were compared with sibling and community controls. Disability at original admission was identified clinically; at 7-year follow-up a standardised screening tool called ‘the Washington Group Questionnaire’ was used.Results60/938 (6.4%) of admissions to SAM treatment had clinically obvious disability at admission. Post-treatment mortality was high, with only 11/60 (18%) surviving till 7-year follow-up. SAM children with a disability at admission had 6.99 (95% CI 3.49 to 14.02; p<0.001) greater risk of dying compared with children without disability. They were also older, less likely to be HIV positive or have oedema and more severely malnourished. Long-term survivors were more stunted, had less catch-up growth, smaller head circumference, weaker hand grip strength and poorer school achievement than non-disabled survivors.The Washington Group Questionnaire confirmed disability in all who had been identified clinically, and identified many who had not been previously flagged.ConclusionDisability is common among children affected by SAM. Those with disability-associated SAM have greatly increased risk of dying even if they survive the initial episode of malnutrition. Survivors have poorer growth, physical strength and school achievement. To enable all children to survive and thrive post-SAM, it is vital to focus more on those with disabilities. SAM treatment programmes should consider using not just clinical assessment but structured assessments to better identify at-risk individuals as well as understand the population of children for which they are developing services.

scholarly journals Molecular Evidence for Differential Long-term Outcomes of Early Life Severe Acute Malnutrition

EBioMedicine ◽  
2017 ◽  
Vol 18 ◽  
pp. 274-280 ◽  
Author(s):  
Allan Sheppard ◽  
Sherry Ngo ◽  
Xiaoling Li ◽  
Michael Boyne ◽  
Debbie Thompson ◽  
...  
Keyword(s):  
Early Life ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Molecular Evidence ◽  
Long Term Outcomes

scholarly journals Long-term effects of severe acute malnutrition during childhood on adult cognitive, academic and behavioural development in African fragile countries: The Lwiro cohort study in Democratic Republic of the Congo

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244486
Author(s):  
Pacifique Mwene-Batu ◽  
Ghislain Bisimwa ◽  
Marius Baguma ◽  
Joelle Chabwine ◽  
Achille Bapolisi ◽  
...  
Keyword(s):  
Daily Living ◽  
Democratic Republic ◽  
Severe Acute Malnutrition ◽  
Self Esteem ◽  
Acute Malnutrition ◽  
Long Term Effects ◽  
Health Related ◽  
Republic Of The Congo ◽  
Community Controls

Introduction Little is known about the outcomes of subjects with a history of severe acute malnutrition (SAM). We therefore sought to explore the long-term effects of SAM during childhood on human capital in adulthood in terms of education, cognition, self-esteem and health-related disabilities in daily living. Methodology We traced 524 adults (median age of 22) in the eastern Democratic Republic of the Congo, who were treated for SAM during childhood at Lwiro hospital between 1988 and 2007 (median age 41 months). We compared them with 407 community controls of comparable age and sex. Our outcomes of interest were education, cognitive function [assessed using the Mini Mental State Examination (MMSE) for literate participants, or its modified version created by Ertan et al. (MMSE-I) for uneducated participants], self-esteem (measured using the Rosenberg Self-Esteem Scale) and health-related social and functional disabilities measured using the World Health Organization Disability Assessment Schedule (WHODAS). For comparison, we used the Chi-squared test along with the Student’s t-test for the proportions and means respectively. Results Compared with the community controls, malnutrition survivors had a lower probability of attaining a high level of education (p < 0.001), of reporting a high academic performance (p = 0.014) or of having high self-esteem (p = 0.003). In addition, malnutrition survivors had an overall mean score in the cognitive test that was lower compared with the community controls [25.6 compared with 27.8, p = 0.001 (MMSE) and 22.8 compared with 26.3, p < 0.001(MMSE-I)] and a lower proportion of subjects with a normal result in this test (78.0% compared with 90.1%, p < 0.001). Lastly, in terms of health-related disabilities, unlike the community controls, malnutrition survivors had less social disability (p = 0.034), but no difference was observed as regards activities of daily living (p = 0.322). Conclusion SAM during childhood exposes survivors to low human capital as regards education, cognition and behaviour in adulthood. Policy-deciders seeking to promote economic growth and to address various psychological and medico-social disorders must take into consideration the fact that appropriate investment in child health as regards SAM is an essential means to achieve this.

scholarly journals Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM): rationale and methods of a longitudinal observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023077 ◽  
Author(s):  
Mutsa Bwakura-Dangarembizi ◽  
Beatrice Amadi ◽  
Claire D Bourke ◽  
Ruairi C Robertson ◽  
Benjamin Mwapenya ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Research Ethics ◽  
Severe Acute Malnutrition ◽  
Ethics Committee ◽  
Acute Malnutrition ◽  
Institutional Review Boards ◽  
Research Ethics Committee ◽  
Poor Outcomes ◽  
Discharge From Hospital

IntroductionMortality among children hospitalised for complicated severe acute malnutrition (SAM) remains high despite the implementation of WHO guidelines, particularly in settings of high HIV prevalence. Children continue to be at high risk of morbidity, mortality and relapse after discharge from hospital although long-term outcomes are not well documented. Better understanding the pathogenesis of SAM and the factors associated with poor outcomes may inform new therapeutic interventions.Methods and analysisThe Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM) study is a longitudinal observational cohort that aims to evaluate the short-term and long-term clinical outcomes of HIV-positive and HIV-negative children with complicated SAM, and to identify the risk factors at admission and discharge from hospital that independently predict poor outcomes. Children aged 0–59 months hospitalised for SAM are being enrolled at three tertiary hospitals in Harare, Zimbabwe and Lusaka, Zambia. Longitudinal mortality, morbidity and nutritional data are being collected at admission, discharge and for 48 weeks post discharge. Nested laboratory substudies are exploring the role of enteropathy, gut microbiota, metabolomics and cellular immune function in the pathogenesis of SAM using stool, urine and blood collected from participants and from well-nourished controls.Ethics and disseminationThe study is approved by the local and international institutional review boards in the participating countries (the Joint Research Ethics Committee of the University of Zimbabwe, Medical Research Council of Zimbabwe and University of Zambia Biomedical Research Ethics Committee) and the study sponsor (Queen Mary University of London). Caregivers provide written informed consent for each participant. Findings will be disseminated through peer-reviewed journals, conference presentations and to caregivers at face-to-face meetings.

scholarly journals Dysglycemia in Children with Severe Acute Malnutrition: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Elizabeth Ledger ◽  
Philliness Prisca Harawa ◽  
Allison I Daniel ◽  
Toby Candler ◽  
Andrew M Prentice ◽  
...  
Keyword(s):  
Systematic Review ◽  
Severe Acute Malnutrition ◽  
Meta Analysis ◽  
Clinical Importance ◽  
Acute Malnutrition ◽  
Assessment Development ◽  
Wide Range ◽  
Secondary Objective ◽  
Short And Long Term

ABSTRACT Dysglycemia is a common complication of severe acute malnutrition (SAM) in children. Its prevalence and impact on short- and long-term outcomes are not well described. This systematic review was undertaken to review the available evidence on dysglycemia (either hypo- or hyperglycemia) in hospitalized children with SAM. The 2 primary objectives of this systematic review were to understand the prevalence of hypoglycemia and hyperglycemia in children with SAM. A secondary objective was to understand the relation between dysglycemia and clinical outcomes like mortality in children with SAM. MEDLINE was searched with terms related to children, SAM, and dysglycemia. A meta-analysis of proportions was completed to determine the hypoglycemia prevalence and a standard meta-analysis was done to determine the relation between hypoglycemia and mortality. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 2148 articles were identified in the database search of which 16 met the inclusion criteria for the systematic review based on screening done by multiple reviewers. The overall prevalence of hypoglycemia in SAM across studies based on the meta-analysis of proportions was 9% (95% CI: 7%, 12%; I2 = 92%). Meta-analysis results showed that hypoglycemia was associated with a higher chance of mortality during hospitalization in children with SAM (OR: 4.29; 95% CI: 3.04, 6.05; I2 = 0%). According to the GRADE evaluation, the certainty of the evidence for the prevalence of hypoglycemia was low and for hyperglycemia was very low. For the relation between hypoglycemia and mortality, the certainty of the evidence was moderate. A meta-analysis was not carried out for the prevalence of hyperglycemia due to the wide range of definitions used for across studies, but the prevalence ranged from 2% to 38% in the literature. This systematic review highlights the need for further work in this area to include serial glucose measurements to understand the clinical importance of dysglycemia during hospitalization in children with SAM.

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