Community-Based Management of Acute Malnutrition for Infants Under 6 Months of Age Is Safe and Effective: Analysis of Operational Data

Objective: To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. Design: Review of operational acute malnutrition treatment records. Setting: 21 outpatient therapeutic feeding clinics in rural Malawi. Participants: Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6-9 months of age who were being treated at the same time in the same location in the context of two different randomized clinical trials. Results: A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6-9 months old with acute malnutrition (74 severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75.4%) achieved nutritional recovery; in comparison, 56 (75.7%) of those with SAM 6-9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81.3%) recovered; in comparison 241 (85.2%) of those aged 6-9 months recovered. Conclusions: In a rural Malawian population of infants u6m who had generally already stopped exclusive breastfeeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.

Limited water access is associated with food insecurity and diarrheal episodes among children suffering from moderate acute malnutrition in Far-North Cameroon

To gain further understanding of the interlinkages between poor water access, household food insecurity, and undernutrition among children, this study used a cross-sectional design with 474 female caretakers of children suffering from moderate acute malnutrition (MAM) to explore the relationship between limited access to water and diarrheal diseases among children, aged <5 years, experiencing MAM. The mean age of the caretakers was 28.50±6.88 years and that of their MAM children (sex ratio=0.7) was 17.79±9.59 months. The participants reported spending an average of 19.29±15.69 min for one trip to fetch water. A negative correlation was found between mean time spent fetching drinking water and hygiene and handwashing score (r=−0.141, p=0.003). Furthermore, the more severe the food insecurity status of a household, the farther the family member likely had to go to fetch for drinking water [F(2, 444)=8.64, p≤0.001]. Results from binary logistic regression showed that children from households practicing open defecation (p=0.008) and/or having inadequate hygiene practices (p=0.004) had increased odds of developing diarrhea. Therefore, ameliorating water access in households with MAM children could contribute to improvements in hygiene and sanitation attitudes with a subsequent increase in the effectiveness of nutrition interventions aiming at reducing acute malnutrition among children.

Composite Flour from Indonesian Local Food Resources to Develop Cereal/Tuber Nut/Bean-Based Ready-to-Use Supplementary Foods for Prevention and Rehabilitation of Moderate Acute Malnutrition in Children

Undernourishment is a threat to human health. The prevalence of undernourishment remains alarming, especially among children under five years old in many countries, including Indonesia. Nowadays, the handling of undernourishment has shifted to treatment outside the hospital, utilizing local nutrient-rich foods. At the national level, the utilization of local food resources is a part of the promotion of dietary diversification and the bioeconomy. Ready-to-use supplementary food (RUSF) refers to supplementary foods aimed at improving the nutrition of moderate acute malnutrition (MAM) children under five years old. RUSF biscuit recipes were made using local food resources available in Banten province, Indonesia. To optimize the nutritional profile of the developed RUSF, taro/talas banten were mixed with ground-nut/peanut (Arachis hypogaea L.) and mungbean (Vigna radiata) as protein and lipid sources and red rice (Oryza longistaminata) and maize (Zea mays) as carbohydrate sources, and enriched by the local banana Nangka (Musa textilia). Two formulations were selected for the pilot testing, namely the taro-peanut and taro-peanut/mungbean RUSF biscuits, made from taro Banten, cereal, peanut and/or mungbean, and local banana. The RUSF biscuit showed promising results, presenting a high level of acceptance and a macronutrient composition that meets the standards for MAM children. However, the RUSF biscuits should be fortified with micronutrient premix to fulfill the dietary requirement for the MAM children. The results of this study provide further development opportunities.

Nutritive and Antinutritive Values of Ready-to-use Foods Based on Local Ingredients for the Recovery of Moderate Acute Malnourished Children in Cote d Ivoire

Moderate acute malnutrition is one of the most common nutritional disorders among young children in Côte d'Ivoire. For treating this condition, ready-to-use foods have been found to be the most effective. However, their high cost and the recurrent stock breaks lead to national unavailability whose local production can fill and ensure sustainable care. This study has been set to assess the nutritional and anti-nutrient value of ready-to-use foods formulated with locally available ingredients. For doing this, four formulae meeting the recommended nutritive needs for moderately acutely malnourished children aged 6 to 59 months have been produced using traditional methods and household equipment. The cocoa (LF-1 and LF-3) and cashew (LF-2 and LF-4) formulae contained rice, soy, sugar, oil, and egg. The latter has been added to FL-3 and FL-4. All formulae presented biochemical compositions (proteins, fats, carbohydrates, and energy except fiber and ash) close to Plumpy’Sup®.

Host Fecal mRNAs Predicted Environmental Enteric Dysfunction among Children with Moderate Acute Malnutrition in Sierra Leone

Examining the role of environmental enteric dysfunction (EED) in child growth requires noninvasive, field-appropriate biomarkers. Alternatives to the traditionally used lactulose:mannitol (L:M) test have been explored, but few studies have compared the L:M test to host fecal mRNA transcripts. The objectives of this study were to examine whether 1) host fecal mRNA transcripts could predict presence and severity of EED, measured using the L:M test, and 2) EED modifies the effect of specialized nutritious foods (SNFs) on recovery from moderate acute malnutrition (MAM). This substudy was nested within a cluster randomized trial comparing four SNFs in the treatment of MAM among children 6 to 59 months in Sierra Leone. EED was assessed at enrollment using the L:M test and 15 host fecal mRNA transcripts on 522 children. Recovery from MAM was defined as achieving mid-upper arm circumference ≥ 12.5 cm within 12 weeks of supplementation. Random forest classification models were used to examine prediction of presence and severity of EED by host fecal mRNA transcripts. Logistic regression was used to test for effect modification by L:M test variables including % lactulose excreted (%L). Eight host fecal mRNA transcripts (AQP9, REG3A, IFI30, DECR1, BIRC3, SELL, PIK3AP1, DEFA6) identified EED (%L ≥ 0.2) and severe EED (%L ≥ 0.45) with high sensitivity and specificity. The L:M test variables did not modify the effect of SNFs on recovery from MAM. In this study, we found host fecal mRNA transcripts that could be biomarkers of EED but did not find EED to modify the effect of SNFs on MAM treatment.

Childhood malnutrition and bacteraemia at a tertiary hospital in Malawi

Background: Malnutrition increases risk of acquiring infections but clinical characteristics and hospital outcomes among children in low resource settings with high rates of antimicrobial resistance have not been clearly described. Aim: Our main aim was to ascertain prevalence of bacteraemia in hospitalised children at Queen Elizabeth Central Hospital, Malawi. Methods: We conducted a secondary analysis of a prospective study of children who had a blood culture collected during hospitalisation. Results: Out of 175 children who had blood cultures collected during hospitalisation, 75 had severe acute malnutrition (SAM), 31 moderate acute malnutrition (MAM), and 69 no acute malnutrition (NAM). Twelve (7%) had bacteraemia (8 SAM, 1 MAM, 3 NAM) and seventeen (10%) died (14 SAM, 2 MAM, 1 NAM). Fever, vomiting and convulsions were least common in SAM (69%, 37%, 1%) compared to MAM (90%, 81%, 10%) and NAM (99%, 46%, 29%; p<0.001) children. Mortality was significantly higher in those with than without bacteraemia (33% vs 8%, p=0.004). Most common isolates were Salmonella Typhimurium (31%) and Escherichia coli (23%). High rates of bacterial resistance were noted to gentamicin (58%), a first-line antibiotic, and ceftriaxone (33%), a second-line antibiotic. Conclusions: Mortality and bacteraemia rates are highest in hospitalised children with SAM. Despite this, SAM children do not present with typical clinical features, including fever, vomiting and convulsions. Given the high rate of antimicrobial resistance in this setting, a high index of infection clinical suspicion, awareness of local susceptibility patterns and evidence-based antibiotic guidelines are needed to optimise clinical care and antimicrobial stewardship.

Arriving at Age Specific MUAC Cutoffs for Screening of Moderate Acute Malnutrition and Severe Acute Malnutrition in Children (7–36 Months) From the Tribal Population of Dahod

Objectives To identify SAM and MAM children using WHZ and MUAC. To derive age-appropriate MUAC cut offs for identifying SAM and MAM in children. Assess the sensitivity of MUAC for screening of SAM and MAM in children 7–36 mos. Arriving at age specific MUAC cut offs for identification of acute malnutrition can facilitate early identification of SAM to bring about reduction in under nutrition related morbidity and mortality and promote effective community based management. Methods The study was conducted in Antela and Piplod villages. Limkheda-I was included in the study because of the lesser amount of children found in the above mentioned villages. The prevalence of various forms of undernutrition- stunting, wasting and underweight was found using WHZ, WAZ, HAZ and MUAC. The Prevalence of MAM by MUAC was mapped using the cut-off between the range of 11.5 cm to 12.5 cm and SAM using the cut-off of &lt;11.5 cm. Prevalence of MAM and SAM was mapped by WHZ. The age appropriate MUAC cut offs for identifying SAM and assessing Sensitivity and Specificity of MUAC vis-à-vis the gold standard WHZ were arrived at. Results The highest prevalence of undernutrition was in the form of stunting in the children, followed by underweight and wasting. Correlation between various anthropometric indices and factors likely to affect the same were established and WAZ and WHZ (0.62) were found to be highly correlated. The correlation of present body weight was highest with MUAC indicating that a little change in child's weight would cause change in MUAC thus making it an appropriate indicator of acute malnutrition. Sensitivity and Specificity of various MUAC cut offs were arrived at and Youden index was calculated by plotting ROC curves. MUAC cut off of &lt;11.1 cm had the highest Youden index and the optimal cut off for identifying SAM was &lt;11.1 cm (sen. of 99.9%, sp. 99.7%). Conclusions MUAC is age dependent and therefore age specific MUAC cut offs need to be derived for early detection of SAM. A single cut-off is not adequate to detect SAM. A higher prevalence of stunting, wasting and underweight was seen in males and hence MUAC and WHZ is affected by gender in the present study. Funding Sources The study was funded was UGC DSA SAP III.