Experience and Outcome of Children with Severe Acute Malnutrition Using Locally Prepared Therapeutic Diet

Effect of ready-to-use therapeutic foods on time to recovery among children with severe acute malnutrition in Ethiopia: a prospective cohort study

BACKGROUND

The therapeutic feeding unit (TFU) provides comprehensive inpatient clinical care for children suffering from severe acute malnutrition (SAM) in three stages: stabilization, transition, and rehabilitation. During the transitional and rehabilitation phases, children receive either F-100 or ready-to-use therapeutic food (RUTF). Although both promote weight gain, RUTF is more energy dense than F-100. There is limited and contrasting evidence regarding their effect on recovery time. Therefore, this study aimed to assess the effect of RUTF on time to recovery among SAM children aged 6-59 months admitted to the TFU in Ethiopia.

METHODS

Health Facility-based prospective cohort study was conducted among 476 children treated in three hospitals and four health centers in the Sidama region from September 2021 to January 2022. A structured questionnaire adopted from the Ethiopian national protocol for the management of SAM was used for data collection. Data were entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. The Kaplan-Meir curve and log-rank test were used to compare time to recovery between children who received RUTF and F-100. Multivariable Cox proportional hazard analysis was conducted to assess the association between time to recovery and the type of therapeutic food, controlling for the confounding variables.

RESULTS

The median recovery time was significantly shorter in children receiving RUTF (7 days; 95% CI: 6.62-7.38) compared to F-100 (10 days; 95% CI: 8.94-11.06). Children below 24 months (AHR = 0.54, 95% CI: 0.42-0.69), dehydrated (AHR = 1.34, 95% CI: 1.07-1.75), edematous malnutrition (AHR = 1.29, 95% CI: 1.03-1.61), and anemic (AHR = 2.57, 95% CI: 1.90-3.48) during admission were associated with time to recovery.

CONCLUSIONS

Children who received RUTF recovered faster than children who received F-100. Administering RUTF to children below 24 months, who present with anemia and dehydration can improve their recovery rate and shorten their stay in the health facility.

Treatment Outcomes and Associated Factors in Hospitalised Children with Severe Acute Malnutrition: A Prospective Cohort Study

BACKGROUND

Malnutrition continues to be a public health challenge in sub-Saharan African countries. In Ethiopia, there is a paucity of data regarding factors affecting treatment outcomes in children with severe acute malnutrition (SAM).

METHODS

A prospective cohort study was conducted among children aged 6 to 59 months with SAM, receiving care at Jimma University Medical center, Ethiopia. Bivariate and multivariate analyses were computed to determine factors associated with treatment outcomes. Kaplan-Meier survival analysis, life-table analysis, and Log rank test were used to determine death rates, estimate the proportion of surviving, and compare time to recovery (nutritional cure).

RESULTS

A total of 133 children were included in this study and 79.7% had medical comorbidities. Overall, nutritional recovery, death, and default rates were 25.6%, 3.8%, and 7.6%, respectively. There was no significant difference in the nutritional recovery rate (26.1% versus 25.4%; p=0.4) and the median time to recovery between children who had diarrhea at admission (26 days; 95% CI: 24.0-28.7) and those who had not (26.0 days; 95% CI: 21.90-30.10). Likewise, the average daily weight gain was not significantly different between the two groups (6.34 g/kg/day versus 7.76g/kg/day, p=0.4). Having diagnosed with tuberculosis (Adjusted Hazard Ratio (AHR)=0.19, CI 0.06-0.62) and anemia (AHR =0.32, CI 0.14-0.74) and treatment failures (AHR=0.17, CI, 0.16-0.03) were predicting factors for time to recovery.

CONCLUSION

The recovery rate and average daily weight gain were found to be sub-optimal in the study population. However, the median time to recovery was within the national recommendation. There was no significant difference in the recovery rate and time to recovery between the two groups. Treatment failures and the presence of tuberculosis and anemia were indicators for prolonged stabilization phase and time to achieve nutritional cure. Optimal average daily weight gain and clinical management of comorbidities may enhance early recovery in hospitalised children with SAM.

Recovery time from severe acute malnutrition and associated factors among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

OBJECTIVES

Recovery time from severe acute malnutrition (SAM) is often a neglected topic despite its clinical impact. Although a few studies have examined nutritional recovery time, the length of hospitalization in those studies varied greatly. Therefore, the aim of this study was to determine the recovery time from SAM and to identify predictors of length of hospitalization among under-5 children.

METHODS

A retrospective cohort study was conducted among 423 under-5 children with SAM who had been admitted to Yekatit 12 Hospital. Kaplan-Meier analysis was used to estimate time to nutritional recovery, and Cox proportional hazard regression analysis was performed to determine independent predictors.

RESULTS

The nutritional recovery rate was 81.3%, and the median recovery time was 15.00 days (95% confidence interval [CI], 13.61 to 16.39). Age, daily weight gain per kilogram of body weight, vaccination status, and the existence of at least 1 comorbidity (e.g., pneumonia, stunting, shock, and deworming) were found to be significant independent predictors of nutritional recovery time. The adjusted hazard ratio (aHR) for nutritional recovery decreased by 1.9% for every 1-month increase in child age (aHR, 0.98; 95% CI, 0.97 to 0.99).

CONCLUSIONS

The overall nutritional recovery time in this study was within the Sphere standards. However, approximately 13.0% of children stayed in the hospital for more than 28.00 days, which is an unacceptably large proportion. Daily weight gain of ≥8 g/kg, full vaccination, and deworming with albendazole or mebendazole reduced nutritional recovery time. Conversely, older age, pneumonia, stunting, and shock increased nutritional recovery time.

Outcome of Children with Severe Acute Malnutrition and Diarrhea: a Cohort Study

PURPOSE

Severe acute malnutrition (SAM) is an important public health problem which contributes to significant number of under five deaths. Protocol based management significantly decreases risk of deaths in children with medical complications.

METHODS

Outcome of children aged 2 months-5 years admitted and fulfilling definition of SAM having diarrhea (group A) was compared to children with SAM having medical complications other than diarrhea (group B). Both groups were managed according to standard recommended protocols and monitored and followed up for 12 weeks after discharge.

RESULTS

The average weight gain, defaulter rate, primary failure, secondary relapse rate and readmission rate were similar in both groups. Length of stay in group A was three days longer (p-value=0.039). Discharge rate was comparable with overall 68% of children successfully discharged and 50% of children reaching weight/height >-2 standard deviation at follow-up of 12 weeks.

CONCLUSION

The current management protocol is equally effective for managing children with SAM having diarrhea. Good adherence to management protocol of dehydration and timely modification of therapeutic feeds in children with persistent diarrhea results in satisfactory weight gain.

Performance of nutrition rehabilitation centers: A case study from Chhattisgarh, India

Background:

High prevalence of malnutrition across India poses a significant obstacle to achieving desirable child health outcomes. For addressing childhood malnutrition, the government of Chhattisgarh during 2010–2014 established Nutrition Rehabilitation Centers (NRCs) in selected health units for the timely, adequate, and appropriate feeding of children, and for improving skills of mothers and caregivers on age-appropriate caring, counseling, and growth monitoring. This study examined the functioning of NRCs in three districts; assessed perception of mothers and carers of children admitted in the NRC; and assessed the perspectives of service providers.

Methods:

Four out of 46 NRCs were purposively chosen. Monthly performance reports of 2012–2014 were reviewed. Fifty mothers/carers of under-five children were interviewed; and ten in-depth interviews were conducted with the service providers. Descriptive statistics, co-relational, and regression models were used for data analysis; qualitative data were analyzed thematically.

Results:

Vacancy of staff ranged from 7.4% to 70%. The mean age of children during admission was 23.8 ± 6.2 months. The mean percentage weight gain was 11.6%, whereas the mean duration of stay in the NRC was 10.7 ± 3.5 days. Weight gain was directly related to the weight during admission. Follow-up visit and follow-up card issuing, counseling to mothers, special diet preparation, timely receipt of incentives, and training on diet preparation needed immediate attention.

Conclusions:

Regular review and supportive supervision could play a crucial role in improving the quality of services. The awareness level and expectation of mothers could be improved through NRC-based education and outreach services.