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Yadav CP, Hussain SSA, Pasi S, Sharma S, Bharti PK, Rahi M, Sharma A. Linkages between malaria and malnutrition in co-endemic regions of India. BMJ Glob Health 2023; 8:bmjgh-2022-010781. [PMID: 36653068 PMCID: PMC9853155 DOI: 10.1136/bmjgh-2022-010781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Malaria and malnutrition are key public health challenges in India. However, the relationship between them is poorly understood. Here, we aimed to elucidate the potential interactions between the two health conditions by identifying the areas of their spatial overlap. METHODS We have analysed the district-wise undernutrition and malaria data of 638 districts of India across 28 states and 8 union territories. Data on malnutrition parameters viz. stunting, wasting, underweight and anaemia, sourced from the fourth National Family Health Survey (2015-2016), and malaria Annual Parasite Index (API) data of the same year (i.e, 2015), sourced from National Center of Vector Borne Diseases Control were analysed using local Moran's I Index and logistic regression. RESULTS Among all the malnutrition parameters, we found underweight in children and anaemia in men to co-occur with malaria in the districts of Chhattisgarh, Jharkhand, Madhya Pradesh and Odisha. Further, districts with more than 36% underweight children (OR (95% CI): 2.31 (1.53 to 3.48)) and/or more than 23.6% male population with anaemia (OR (95% CI): 2.06 (1.37 to 3.11)) had higher odds of being malaria endemic districts (ie, Annual Parasite Index >1). CONCLUSION Malaria and malnutrition co-occur in the malaria-endemic parts of India. The high prevalence of undernutrition in children and anaemia among men may contribute to malaria endemicity in a particular region. Therefore, future research should be prioritised to generate data on the individual level. Further, malaria control interventions could be tailored to integrate nutrition programmes to disrupt indigenous malaria transmission in endemic districts.
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Affiliation(s)
- Chander Prakash Yadav
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India,Epidemiology and Biostatistics, ICMR-National Institute of Cancer Prevention & Reserch, Noida, Uttar Pradesh, India
| | - Syed Shah Areeb Hussain
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Shweta Pasi
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Shweta Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Praveen K Bharti
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India
| | - Manju Rahi
- ICMR-National Institute of Malaria Research, New Delhi, India,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India,Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Amit Sharma
- ICMR-National Institute of Malaria Research, New Delhi, India .,Academy of Scientific and Innovative Research, Ghaziabad, Uttar Pradesh, India.,Molecular Medicine Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Kirolos A, Blacow RM, Parajuli A, Welton NJ, Khanna A, Allen SJ, McAllister DA, Campbell H, Nair H. The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2021-007411. [PMID: 34848440 PMCID: PMC8634228 DOI: 10.1136/bmjgh-2021-007411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/09/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Childhood malnutrition is widespread in low-income and middle-income countries (LMICs) and increases the frequency and severity of infections such as pneumonia. We aimed to identify studies investigating pneumonia deaths in malnourished children and estimate mortality risk by malnutrition severity. METHODS We conducted a systematic review of MEDLINE, EMBASE and Global Health databases to identify relevant studies. We used a network meta-analysis to derive ORs of death from pneumonia for moderately and severely underweight children using low weight-for-age, the most reported measure of malnutrition. We compared meta-estimates of studies conducted before and after 2000 to assess changes in mortality risk over time. We estimated the prevalence of underweight hospitalised children from hospital-based cohort studies and calculated the population attributable fraction of in-hospital pneumonia deaths from being underweight using our results. RESULTS Our network meta-analysis included 33 544 underweight children from 23 studies. The estimated OR of death from pneumonia was 2.0 (95% CI 1.6 to 2.6) and 4.6 (95% CI 3.7 to 5.9) for children moderately and severely underweight, respectively. The OR of death from pneumonia for those severely underweight was 5.3 (95% CI 3.9 to 7.4) pre-2000 and remained high post-2000 at 4.1 (95% CI 3.0 to 6.0). Prevalence of underweight children hospitalised with pneumonia varied (median 40.2%, range 19.6-66.3) but was high across many LMIC settings. We estimated a median 18.3% (range 10.8-34.6) and 40.9% (range 14.7-69.9) of in-hospital pneumonia deaths were attributable to being moderately and severely underweight, respectively. CONCLUSIONS The risk of death from childhood pneumonia dramatically increases with malnutrition severity. This risk has remained high in recent years with an estimated over half of in-hospital pneumonia deaths attributable to child malnutrition. Prevention and treatment of all child malnutrition must be prioritised to maintain progress on reducing pneumonia deaths.
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Affiliation(s)
- Amir Kirolos
- University of Liverpool Department of Women's and Children's Health, Liverpool, UK .,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,The University of Edinburgh Usher Institute, Edinburgh, UK
| | | | - Arun Parajuli
- The University of Edinburgh Usher Institute, Edinburgh, UK
| | - Nicky J Welton
- University of Bristol Bristol Population Health Science Institute, Bristol, UK
| | - Alisha Khanna
- The University of Edinburgh Usher Institute, Edinburgh, UK
| | - Stephen J Allen
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Alder Hey Children's Hospital, Liverpool, Merseyside, UK
| | | | - Harry Campbell
- The University of Edinburgh Usher Institute, Edinburgh, UK
| | - Harish Nair
- The University of Edinburgh Usher Institute, Edinburgh, UK
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Which National Factors Are Most Influential in the Spread of COVID-19? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147592. [PMID: 34300044 PMCID: PMC8307075 DOI: 10.3390/ijerph18147592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 12/16/2022]
Abstract
The outbreak of the novel COVID-19, declared a global pandemic by WHO, is the most serious public health threat seen in terms of respiratory viruses since the 1918 H1N1 influenza pandemic. It is surprising that the total number of COVID-19 confirmed cases and the number of deaths has varied greatly across countries. Such great variations are caused by age population, health conditions, travel, economy, and environmental factors. Here, we investigated which national factors (life expectancy, aging index, human development index, percentage of malnourished people in the population, extreme poverty, economic ability, health policy, population, age distributions, etc.) influenced the spread of COVID-19 through systematic statistical analysis. First, we employed segmented growth curve models (GCMs) to model the cumulative confirmed cases for 134 countries from 1 January to 31 August 2020 (logistic and Gompertz). Thus, each country’s COVID-19 spread pattern was summarized into three growth-curve model parameters. Secondly, we investigated the relationship of selected 31 national factors (from KOSIS and Our World in Data) to these GCM parameters. Our analysis showed that with time, the parameters were influenced by different factors; for example, the parameter related to the maximum number of predicted cumulative confirmed cases was greatly influenced by the total population size, as expected. The other parameter related to the rate of spread of COVID-19 was influenced by aging index, cardiovascular death rate, extreme poverty, median age, percentage of population aged 65 or 70 and older, and so forth. We hope that with their consideration of a country’s resources and population dynamics that our results will help in making informed decisions with the most impact against similar infectious diseases.
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Mortality in relation to profiles of clinical features in Ghanaian severely undernourished children aged 0-59 months: an observational study. Br J Nutr 2021; 125:1157-1165. [PMID: 32873346 DOI: 10.1017/s0007114520003396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Severe acute malnutrition (SAM) is associated with a complex pattern of various clinical conditions. We investigated how risk factors cluster in children with SAM, the relationship between clusters of risk factors and mortality as well as length of stay in children with SAM. A prospective observational study design was used. Data were extracted from medical records of 601 infants and children aged 0-59 months admitted and treated for SAM in three Ghanaian referral hospital between June 2013 and June 2018. Among the 601 medical records extracted, ninety-nine died. Three clusters of medical features clearly emerged from data analyses. Firstly, an association was defined by eye signs, pallor, diarrhoea and vomiting with gastrointestinal infections and malaria. In this cluster, pallor and eye signs were related to 2- to 5-fold increased mortality risk. Secondly, HIV, oedema, fast pulse, respiratory infections and tuberculosis; among those features, HIV increased child mortality risk by 2-fold. Thirdly, shock, convulsions, dermatitis, cold hands and feet, weak pulse, urinary tract infections and irritability were clustered. Among those features, cold hands and feet, dermatitis, convulsions and shock increased child mortality risk in a range of 2- to 9-fold. Medical conditions and clinical signs in children diagnosed with SAM associate in patterns and are related to clinical outcomes.
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Türkmenoğlu C, Etaner Uyar AŞ, Kiraz B. Recommending healthy meal plans by optimising nature-inspired many-objective diet problem. Health Informatics J 2021; 27:1460458220976719. [PMID: 33438501 DOI: 10.1177/1460458220976719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Healthy eating is an important issue affecting a large part of the world population, so human diets are becoming increasingly popular, especially with the devastating consequences of Coronavirus Disease (Covid-19). A realistic and sustainable diet plan can help us to have a healthy eating habit since it considers most of the expectations from a diet without any restriction. In this study, the classical diet problem has been extended in terms of modelling, data sets and solution approach. Inspired by animals' hunting strategies, it was re-modelled as a many-objective optimisation problem. In order to have realistic and applicable diet plans, cooked dishes are used. A well-known many-objective evolutionary algorithm is used to solve the diet problem. Results show that our approach can optimise specialised daily menus for different user types, depending on their preferences, age, gender and body index. Our approach can be easily adapted for users with health issues by adding new constraints and objectives. Our approach can be used individually or by dietitians as a decision support mechanism.
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Affiliation(s)
| | | | - Berna Kiraz
- Fatih Sultan Mehmet Vakif University, Turkey
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6
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Effect of malnutrition on length of hospital stay in children. Turk Arch Pediatr 2021; 56:37-43. [PMID: 34013228 DOI: 10.14744/turkpediatriars.2020.46354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/20/2020] [Indexed: 11/20/2022]
Abstract
Objective To determine the prevalence of malnutrition in hospitalized pediatric patients, to provide a classification of patients with malnutrition, and to evaluate the effect of malnutrition on length of hospital stay. Material and Methods The study included patients aged 5 months to 18 years who were hospitalized in the Department of Pediatrics of the Adana City Training and Research Hospital between May 1st, 2018, and December 31st, 2018. Bodyweight, height, mid-upper arm circumference, and triceps skinfold thickness were measured at the time of hospitalization, and age, sex, diagnosis, comorbid conditions, and length of stay for treatment were recorded. Results Of 1009 patients, 44% were female and 56% were male, and the mean age was 59.9±58.6 (median age 32) months. The mean length of stay was 6.83±4.48 days. Malnutrition was determined in 46.9% of the patients according to the Gomez classification. The mean length of stay in patients without malnutrition was 6.31±3.86 days, compared with 7.39±5.04 days in patients with malnutrition (p<0.001). The length of stay increased with increasing degrees of malnutrition (p<0.001). Conclusion Malnutrition is often overlooked in hospitalized patients. Studies conducted in different years that reported similar malnutrition rates indicated that this condition still existed as a significant health problem. In the evaluation of nutritional status in hospitalized patients, paying attention to malnutrition while addressing the main reason of hospitalization and incorporating nutritional support into the treatment plan will decrease the length of stay and also reduce the rate of complications.
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Wambui KM, Musenge E. A space-time analysis of recurrent malnutrition-related hospitalisations in Kilifi, Kenya for children under-5 years. BMC Nutr 2020; 5:32. [PMID: 32153945 PMCID: PMC7050923 DOI: 10.1186/s40795-019-0296-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background Globally, malnutrition underlies 45% of under-5 s mortality, mainly from potentiating common infections such as diarrhoea and pneumonia. Malnutrition as a public health problem is not evenly disbursed because of disparities in food insecurity and health, and children commonly suffer recurrent episodes of opportunistic infections. We aimed to understand better the spatial and temporal structure of multiple paediatric hospital admissions associated with malnutrition-related illnesses. This paper aimed to investigate the spatial-temporal variations in malnutrition-related recurrent morbidity of children under-5 years from the Kilifi County in Kenya between 2002 and 2015. Methods The study included data from children under-5 years old who had more than one admission to a rural district hospital in Kenya within the Kilifi Health and Demographic Surveillance System (KHDSS). The primary outcome was a malnutrition-related admission, based on wasting (WHZ < -2) or nutritional oedema. Individual, household and environmental level covariates were examined as exposures. We first fitted a SARIMA model for the temporality, and the Moran’s Index affirmed spatial clustering in malnutrition admissions. Kulldorf Statistics using SaTScan were applied to detect hotspots. Then, bivariate analysis was done using repeated values tabulation and analysis of covariance (ANCOVA). Inferential analysis was done using a mixed effect multivariable negative-binomial regression model, adjusting for spatiotemporal random effects. Results A total of 2821 children were admitted more than once, giving a total of 6375 admissions. Of these 6375 admissions, 1866 were malnutrition-related, and 3.9% (109/2821) of the children with repeat admissions died. There was a seasonal pattern of re-admissions, peaking from May to July over the years. Hotspots were found in both the Northern and Southern areas of the KHDSS, while the areas near Kilifi Town were least affected. We found that disease severity was most likely associated with a malnutrition re-admission to the hospital. Conclusion Disease severity was strongly associated with admission with malnutrition but its effect reduced after adjusting for the spatial and temporal random effects. Adjusting for clustering in space and in time (spatial-temporal) in models helps to improve the understanding of recurrent hospitalisations involving malnutrition. Electronic supplementary material The online version of this article (10.1186/s40795-019-0296-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kennedy Mwai Wambui
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hasegawa E, Kobayashi D, Kurosawa Y, Taniguchi S, Otani H, Abe A, Ito S, Nakazono K, Murasawa A, Narita I, Ishikawa H. Nutritional status as the risk factor of serious infection in patients with rheumatoid arthritis. Mod Rheumatol 2019; 30:982-989. [PMID: 31615317 DOI: 10.1080/14397595.2019.1681653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives: The aim of this study was to identify the risk factors associated with severe infection in RA patients, with a particular focus on the association of the nutritional status.Methods: We retrospectively analyzed data from 74 patients with RA (male, n = 21; female, n = 53; age 74.2 ± 12.4) admitted to our hospital between 2016 and 2017 for infection (infection group). We also recruited control RA patients (n = 222) who were matched for age, gender and disease duration, with a match ratio of 1:3 (non-infection group). The nutritional condition was assessed based on controlling nutrition status (CONUT) score, and prognostic nutritional index (PNI). The data of the infection group were obtained from the most recent visit prior to the present admission, and non-infection group from the last regular visit in 2017.Results: The respiratory tract was the most frequent site of infection. The BMI and PNI were significantly lower and the CONUT score significantly higher in the infection group than in the non-infection group. A logistic regression analysis revealed that the CONUT score, underlying lung disease and use of prednisolone and biological disease-modifying anti-rheumatic drugs were independent and significant risk factors for serious infection.Conclusion: Poor nutritional status increases the risk of serious infection.
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Affiliation(s)
- Eriko Hasegawa
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan.,Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Daisuke Kobayashi
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan.,Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoichi Kurosawa
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan.,Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shinji Taniguchi
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan.,Department of Orthopedic Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Hiroshi Otani
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Asami Abe
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Satoshi Ito
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Kiyoshi Nakazono
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Akira Murasawa
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hajime Ishikawa
- Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
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Mice chronically fed a high-fat diet are resistant to malaria induced by Plasmodium berghei ANKA. Parasitol Res 2019; 118:2969-2977. [DOI: 10.1007/s00436-019-06427-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/09/2019] [Indexed: 12/11/2022]
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Hassam I, Kisenge R, Aboud S, Manji K. Association of vitamin D and diarrhoea in children aged less than five years at Muhimbili national hospital, Dar es Salaam: an unmatched case control study. BMC Pediatr 2019; 19:237. [PMID: 31307425 PMCID: PMC6628469 DOI: 10.1186/s12887-019-1614-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 07/04/2019] [Indexed: 12/22/2022] Open
Abstract
Background There has been a growing interest in the non-skeletal roles of vitamin D particularly its immune-modulatory properties which has been shown to influence the susceptibility and severity to infections. There is insufficient data globally on the association between Vitamin D levels and Diarrhoea in children. The objective of the study was to determine the association between vitamin D levels and diarrhoea in children aged less than five years. Methods Hospital based unmatched case-control study was carried out at MNH between September 2015 and January 2016. Cases were defined as patients with diarrhoea, Sick controls were patients who did not have diarrhoea but were admitted for other illnesses and Healthy controls were children who had neither diarrhoea nor other co-morbid conditions. Structured questionnaires were used to capture the demographic data and anthropometric measurements. Blood samples of study participants were tested for serum vitamin D levels and grouped as vitamin D sufficient, insufficient or deficient (VDD). SPSSv.20 was used to carry out the Statistical analysis. Binary logistic regression, Mann-Whitney and Kruskal-Wallis tests were used, a p-value≤ 0.05 was considered to be statistically significant. Results A total of 188 children under five were recruited in the study at the ratio of 1 case: 3 controls, of these 47 were Cases, 94 were Sick controls and remaining 47 were Healthy controls. The mean age was 17.01 ± 14.8 months. The mean vitamin D level was 51.18 ± 21.97 nmol/l. Majority of the participants 101 (53.7%) were vitamin D deficient, 64 (34%) were insufficient and 23 (12.2%) had sufficient vitamin D levels. Sick controls were 3.2 times more likely to be VDD compared to cases [95% CI 0.14–0.69; p = 0.0015] and 5.03 times when compared to Healthy controls [95% CI 2.22–11.55; p = 0.000]. Severe acute malnutrition (SAM) was independently associated with diarrhoea (95% CI: 1.26–5.39, p 0.01). Conclusions High prevalence of vitamin D deficiency was found in the children under five years studied. Vitamin D levels was not found to be specifically associated with diarrhoea in children under five years of age.
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Affiliation(s)
- Imran Hassam
- Shree Hindu Mandal Hospital, P.O.Box 581, Sewa Street, Dar es Salaam, Tanzania.
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University College of Health and Allied Sciences, P. O. Box 65001, United Nations Road, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University College of Health and Allied Sciences, P. O. Box 65001, United Nations Road, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University College of Health and Allied Sciences, P. O. Box 65001, United Nations Road, Dar es Salaam, Tanzania
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Childhood Acute Illness and Nutrition (CHAIN) Network: a protocol for a multi-site prospective cohort study to identify modifiable risk factors for mortality among acutely ill children in Africa and Asia. BMJ Open 2019; 9:e028454. [PMID: 31061058 PMCID: PMC6502050 DOI: 10.1136/bmjopen-2018-028454] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Children admitted to hospitals in resource-poor settings remain at risk of both inpatient and post-discharge mortality. While known risk factors such as young age and nutritional status can identify children at risk, they do not provide clear mechanistic targets for intervention. The Childhood Acute Illness and Nutrition (CHAIN) cohort study aims to characterise the biomedical and social risk factors for mortality in acutely ill children in hospitals and after discharge to identify targeted interventions to reduce mortality. METHODS AND ANALYSIS The CHAIN network is currently undertaking a multi-site, prospective, observational cohort study, enrolling children aged 1 week to 2 years at admission to hospitals at nine sites located in four African and two South Asian countries. The CHAIN Network supports the sites to provide care according to national and international guidelines. Enrolment is stratified by anthropometric status and children are followed throughout hospitalisation and for 6 months after discharge. Detailed clinical, demographic, anthropometric, laboratory and social exposures are assessed. Scheduled visits are conducted at 45, 90 and 180 days after discharge. Blood, stool and rectal swabs are collected at enrolment, hospital discharge and follow-up. The primary outcome is inpatient or post-discharge death. Secondary outcomes include readmission to hospital and nutritional status after discharge. Cohort analysis will identify modifiable risks, children with distinct phenotypes, relationships between factors and mechanisms underlying poor outcomes that may be targets for intervention. A nested case-control study examining infectious, immunological, metabolic, nutritional and other biological factors will be undertaken. ETHICS AND DISSEMINATION This study protocol was reviewed and approved primarily by the Oxford Tropical Research Ethics Committee, and the institutional review boards of all partner sites. The study is being externally monitored. Results will be published in open access peer-reviewed scientific journals and presented to academic and policy stakeholders. TRIAL REGISTRATION NUMBER NCT03208725.
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Njunge JM, Gwela A, Kibinge NK, Ngari M, Nyamako L, Nyatichi E, Thitiri J, Gonzales GB, Bandsma RHJ, Walson JL, Gitau EN, Berkley JA. Biomarkers of post-discharge mortality among children with complicated severe acute malnutrition. Sci Rep 2019; 9:5981. [PMID: 30979939 PMCID: PMC6461700 DOI: 10.1038/s41598-019-42436-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 04/01/2019] [Indexed: 12/22/2022] Open
Abstract
High mortality after discharge from hospital following acute illness has been observed among children with Severe Acute Malnutrition (SAM). However, mechanisms that may be amenable to intervention to reduce risk are unknown. We performed a nested case-control study among HIV-uninfected children aged 2-59 months treated for complicated SAM according to WHO recommendations at four Kenyan hospitals. Blood was drawn from 1778 children when clinically judged stable before discharge from hospital. Cases were children who died within 60 days. Controls were randomly selected children who survived for one year without readmission to hospital. Untargeted proteomics, total protein, cytokines and chemokines, and leptin were assayed in plasma and corresponding biological processes determined. Among 121 cases and 120 controls, increased levels of calprotectin, von Willebrand factor, angiotensinogen, IL8, IL15, IP10, TNFα, and decreased levels of leptin, heparin cofactor 2, and serum paraoxonase were associated with mortality after adjusting for possible confounders. Acute phase responses, cellular responses to lipopolysaccharide, neutrophil responses to bacteria, and endothelial responses were enriched among cases. Among apparently clinically stable children with SAM, a sepsis-like profile is associated with subsequent death. This may be due to ongoing bacterial infection, translocated bacterial products or deranged immune response during nutritional recovery.
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Affiliation(s)
- James M Njunge
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Agnes Gwela
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Moses Ngari
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lydia Nyamako
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Emily Nyatichi
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnstone Thitiri
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gerard Bryan Gonzales
- Department of Gastroenterology, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Inflammation Research Centre, Flemish Institute for Biotechnology, Ghent, Belgium
| | - Robert H J Bandsma
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Judd L Walson
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Departments of Global Health, Medicine, Paediatrics and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Evelyn N Gitau
- African Population and Health Research Centre, Nairobi, Kenya
| | - James A Berkley
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Willis DW, Hamon N. Potential relationship between malaria elimination and reducing stunting in children in sub-Saharan Africa. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.12908.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The Sustainable Development Goals include goals to reduce malaria and stunting. Stunting is a result of childhood undernutrition. Our previous studies found that suppressing malaria could reduce poverty rates among agricultural households in Africa. The objective of this paper is to highlight how suppressing malaria could have the further effect of reducing stunting rates among children in agricultural households. Methods: We estimated the burden of stunting among children in agricultural households in malarious regions of sub-Saharan Africa on the basis of our previous research and data from UNICEF. We also used an evaluation of the impact of a nutrition program in Peru to assess the potential for poverty reduction to reduce stunting. Results: We estimated that there are approximately 21.5 million children suffering from stunting in agricultural households in malarious regions of sub-Saharan Africa. Poverty reduction was found to be a necessary condition to reduce stunting via a multisectoral nutrition program in Peru. The potential impact of suppressing malaria on the poverty rate of agricultural households could therefore play an important role in nutrition programs aiming to reduce stunting in Africa. Reducing the number of children with stunting in these households would improve their health and productivity as adults. Conclusion: We have developed the first estimates of the burden of stunting in agricultural households in malarious regions of sub-Saharan Africa. Understanding how suppressing malaria affects stunting in these households could affect funding for anti-malaria programs. Future research should use longitudinal data to examine this impact at a finer spatial scale.
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Seasonal malaria chemoprevention packaged with malnutrition prevention in northern Nigeria: A pragmatic trial (SMAMP study) with nested case-control. PLoS One 2019; 14:e0210692. [PMID: 30682069 PMCID: PMC6347255 DOI: 10.1371/journal.pone.0210692] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/25/2018] [Indexed: 11/19/2022] Open
Abstract
Integrating seasonal malaria chemoprevention (SMC), recommended by the WHO since 2012 to prevent malaria infection, with nutrition interventions may improve health outcomes and operational efficiencies. This study assessed the effects of co-packaging interventions on distribution coverage, nutrition, and clinical malaria outcomes in northern Nigeria. From August to November 2014, community volunteers delivered sulfadoxine-pyrimethamine and amodiaquine (SP-AQ) door-to-door each month to approximately 7,000 children aged 6–24 months in seven wards of Madobi, Kano State, Nigeria. In three of the wards children additionally received a lipid-based nutrient supplement (LNS–medium quantity), Plumpy Doz. Coverage, adherence, and anthropometric outcomes were assessed through baseline, midline, and endline household surveys. A facility-based case-control study was also conducted to estimate impact on clinical malaria outcomes. Coverage of SP-AQ was similar between arms at 89% (n = 2,409 child-months [88–90%]) in the SP-AQ only arm and 90% (n = 1,947 child-months [88–92%]) in the SP-AQ plus LNS arm (p = 0.52). Coverage of LNS was 83% (n = 2,409 child-months [81–84%]). Whilst there were marked changes in anthropometric status between baseline, midline and endline, these were largely accounted for by socioeconomic status and must be interpreted with care due to possible measurement issues, especially length-based indices. Overall nutritional status of our most robust measure, weight-for-age, does appear to have improved by endline, but was similar in the two study arms, suggesting no additional benefit of the LNS. While the odds of clinical malaria among those who received the intended intervention were lower in each study arm compared to children who did not receive interventions (SP-AQ only OR = 0.23 [0.09–0.6]; SP-AQ plus LNS OR = 0.22 [0.09–0.55]), LNS was not shown to have an additional impact. Coverage of SMC was high regardless of integrating LNS delivery into the SMC campaign. Supplementation with LNS did not appear to impact nutritional outcomes, but appeared to enhance the impact of SP-AQ on clinical odds of malaria. These results indicate that combining nutritional interventions with seasonal malaria chemoprevention in high-risk areas can be done successfully, warranting further exploration with other products or dosing. Trial Registration: ISRCTN 11413895
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15
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Das D, Grais RF, Okiro EA, Stepniewska K, Mansoor R, van der Kam S, Terlouw DJ, Tarning J, Barnes KI, Guerin PJ. Complex interactions between malaria and malnutrition: a systematic literature review. BMC Med 2018; 16:186. [PMID: 30371344 PMCID: PMC6205776 DOI: 10.1186/s12916-018-1177-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/20/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite substantial improvement in the control of malaria and decreased prevalence of malnutrition over the past two decades, both conditions remain heavy burdens that cause hundreds of thousands of deaths in children in resource-poor countries every year. Better understanding of the complex interactions between malaria and malnutrition is crucial for optimally targeting interventions where both conditions co-exist. This systematic review aimed to assess the evidence of the interplay between malaria and malnutrition. METHODS Database searches were conducted in PubMed, Global Health and Cochrane Libraries and articles published in English, French or Spanish between Jan 1980 and Feb 2018 were accessed and screened. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the risk of bias across studies was assessed using the GRADE approach. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline were followed. RESULTS Of 2945 articles screened from databases, a total of 33 articles were identified looking at the association between malnutrition and risk of malaria and/or the impact of malnutrition in antimalarial treatment efficacy. Large methodological heterogeneity of studies precluded conducting meaningful aggregated data meta-analysis. Divergent results were reported on the effect of malnutrition on malaria risk. While no consistent association between risk of malaria and acute malnutrition was found, chronic malnutrition was relatively consistently associated with severity of malaria such as high-density parasitemia and anaemia. Furthermore, there is little information on the effect of malnutrition on therapeutic responses to artemisinin combination therapies (ACTs) and their pharmacokinetic properties in malnourished children in published literature. CONCLUSIONS The evidence on the effect of malnutrition on malaria risk remains inconclusive. Further analyses using individual patient data could provide an important opportunity to better understand the variability observed in publications by standardising both malaria and nutritional metrics. Our findings highlight the need to improve our understanding of the pharmacodynamics and pharmacokinetics of ACTs in malnourished children. Further clarification on malaria-malnutrition interactions would also serve as a basis for designing future trials and provide an opportunity to optimise antimalarial treatment for this large, vulnerable and neglected population. TRIAL REGISTRATION PROSPERO CRD42017056934 .
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Affiliation(s)
- D Das
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - E A Okiro
- Kemri Wellcome Trust Research Programme, Kilifi, Kenya
| | - K Stepniewska
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - R Mansoor
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - D J Terlouw
- Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, University of Malawi, Blantyre, Malawi
| | - J Tarning
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - K I Barnes
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,WorldWide Antimalarial Resistance Network (WWARN) Pharmacology, University of Cape Town, Cape Town, South Africa
| | - P J Guerin
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
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16
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Haertel AJ, Prongay K, Gao L, Gottlieb DH, Park B. Standard growth and diarrhea-associated growth faltering in captive infant rhesus macaques (Macaca mulatta). Am J Primatol 2018; 80:e22923. [PMID: 30281825 PMCID: PMC6405262 DOI: 10.1002/ajp.22923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 08/26/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022]
Abstract
Reference growth studies of captive rhesus macaque infants have not accounted for diarrhea and the potential for growth stunting or growth faltering. Healthy infants without diarrhea could be used to build a standard growth chart and a tool used to detect growth faltering associated with diarrhea. We hypothesized infants who develop diarrhea during the first year of life would experience decreased linear weight gain compared to healthy infants, and we used healthy infants to establish standard growth of male and female infants. We hypothesized the lower 3rd percentile of standard growth would be cut-off criteria used in screening for diarrhea-associated growth faltering. Using a retrospective cohort of 6,510 infant weight records in a multiple linear regression, daily weight gain through the first year of life was determined by sex, housing type, and health status. Male standard growth was 4.1 g/day (95%CI: 4.0-4.2 g/day) in corrals and 4.7 g/day (95%CI: 4.5-4.8 g/day) in shelter housing. Female standard growth was 4.0 g/day (95%CI: 3.8-4.2 g/day) in corrals and 4.4 g/day (95%CI: 4.0-4.7 g/day) in shelter housing. Diarrhea was significantly associated with decreased linear weight gain by up to 34% during the first year of life. Odds of growth faltering of infants, defined as those falling below the 3rd percentile of standard growth, were at least 8.9 higher given a history of diarrhea compared to healthy. The growth faltering cut-off criteria had a sensitivity of at least 53% for males and females to screen for diarrhea in infants between 6 and 12 months in shelters housing. Interinstitutional collaborations of infant rhesus macaque weight records would refine the standard growth charts and cut-off criteria, and additional morphometric data would provide a more nuanced picture of growth stunting.
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Affiliation(s)
- Andrew J. Haertel
- Oregon National Primate Research Center, Oregon Health &
Science University, Beaverton, OR, USA,
| | - Kamm Prongay
- Oregon National Primate Research Center, Oregon Health &
Science University, Beaverton, OR, USA
| | - Lina Gao
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon
Health & Science University, Portland, OR, USA
- Biostatistics & Bioinformatics Core, Oregon National Primate
Research Center, Beaverton, OR, USA
| | - Daniel H. Gottlieb
- Oregon National Primate Research Center, Oregon Health &
Science University, Beaverton, OR, USA
| | - Byung Park
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon
Health & Science University, Portland, OR, USA
- Biostatistics & Bioinformatics Core, Oregon National Primate
Research Center, Oregon Health & Science University –Portland
State University School of Public Health, Beaverton, OR, USA
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17
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Wilson AL, Bradley J, Kandeh B, Salami K, D'Alessandro U, Pinder M, Lindsay SW. Is chronic malnutrition associated with an increase in malaria incidence? A cohort study in children aged under 5 years in rural Gambia. Parasit Vectors 2018; 11:451. [PMID: 30081945 PMCID: PMC6090805 DOI: 10.1186/s13071-018-3026-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition is common in children in sub-Saharan Africa and is thought to increase the risk of infectious diseases, including malaria. The relationship between malnutrition and malaria was examined in a cohort of 6–59 month-old children in rural Gambia, in an area of seasonal malaria transmission. The study used data from a clinical trial in which a cohort of children was established and followed for clinical malaria during the 2011 transmission season. A cross-sectional survey to determine the prevalence of malaria and anaemia, and measure the height and weight of these children was carried out at the beginning and end of the transmission season. Standard anthropometric indices (stunting, wasting and underweight) were calculated using z-scores. Results At the beginning of the transmission season, 31.7% of children were stunted, 10.8% wasted and 24.8% underweight. Stunting was more common in Fula children than other ethnicities and in children from traditionally constructed houses compared to more modern houses. Stunted children and underweight children were significantly more likely to have mild or moderate anaemia. During the transmission season, 13.7% of children had at least one episode of clinical malaria. There was no association between stunting and malaria incidence (odds ratio = 0.79, 95% CI: 0.60–1.05). Malaria was not associated with differences in weight or height gain. Conclusions Chronic malnutrition remains a problem in rural Gambia, particularly among the poor and Fula ethnic group, but it was not associated with an increased risk of malaria. Trial registration Trial registration: ISRCTN, ISRCTN01738840, registered: 27/08/2010 (Retrospectively registered).
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Affiliation(s)
- Anne L Wilson
- Department of Biosciences, Durham University, Stockton Road, Durham, DH1 3LE, UK.
| | - John Bradley
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Ballah Kandeh
- National Malaria Control Programme, Banjul, The Gambia
| | - Kolawole Salami
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Margaret Pinder
- Department of Biosciences, Durham University, Stockton Road, Durham, DH1 3LE, UK.,Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Steven W Lindsay
- Department of Biosciences, Durham University, Stockton Road, Durham, DH1 3LE, UK.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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18
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O'Brien KS, Amza A, Kadri B, Nassirou B, Cotter SY, Stoller NE, West SK, Bailey RL, Porco TC, Gaynor BD, Lietman TM, Oldenburg CE. Anthropometry and Malaria among Children in Niger: A Cross-Sectional Study. Am J Trop Med Hyg 2018; 99:665-669. [PMID: 30014814 DOI: 10.4269/ajtmh.18-0214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The complex relationship between malnutrition and malaria affects morbidity and mortality in children younger than 5 years, particularly in parts of sub-Saharan Africa where these conditions occur together seasonally. Previous research on this relationship has been inconclusive. Here, we examine the association between anthropometric indicators and malaria infection in a population-based sample of children younger than 5 years in Niger. This cross-sectional study is a secondary analysis of a cluster-randomized trial comparing treatment strategies for trachoma in Niger. We included children aged 6-60 months residing in the 48 communities enrolled in the trial who completed anthropometric and malaria infection assessments at the final study visit. We evaluated the association between anthropometric indicators, including height-for-age z-score (HAZ) and weight-for-age z-score (WAZ) and indicators of malaria infection, including malaria parasitemia and clinical malaria. In May 2013, we collected data from 1,649 children. Of these, 780 (47.3%) were positive for malaria parasitemia and 401 (24.3%) had clinical malaria. In models of malaria parasitemia, the adjusted odds ratio (aOR) was 1.05 (95% confidence interval [CI]: 1.00-1.10) for HAZ and 1.07 (95% CI: 0.99, 1.15) for WAZ. In models of clinical malaria, the aOR was 1.07 (95% CI: 1.02-1.11) for HAZ and 1.09 (95% CI: 1.01-1.19) for WAZ. Overall, we did not find evidence of an association between most anthropometric indicators and malaria infection. Greater height may be associated with an increased risk of clinical malaria.
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Affiliation(s)
- Kieran S O'Brien
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Abdou Amza
- Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger
| | - Boubacar Kadri
- Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger
| | - Baido Nassirou
- Programme FSS/Université Abdou Moumouni de Niamey, Programme National de Santé Oculaire, Niamey, Niger
| | - Sun Y Cotter
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Nicole E Stoller
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Robin L Bailey
- Department of Infectious and Tropical Diseases, Clinical Research Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Department of Ophthalmology, University of California San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Bruce D Gaynor
- Department of Ophthalmology, University of California San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Thomas M Lietman
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.,Department of Ophthalmology, University of California San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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19
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Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study. LANCET GLOBAL HEALTH 2017; 5:e208-e216. [PMID: 28104187 PMCID: PMC5340725 DOI: 10.1016/s2214-109x(16)30355-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/22/2016] [Accepted: 11/09/2016] [Indexed: 11/20/2022]
Abstract
Background Growth faltering remains common in children in sub-Saharan Africa and is associated with substantial morbidity and mortality. Due to a very slow decline in the prevalence of stunting, the total number of children with stunting continues to rise in sub-Saharan Africa. Identification of effective interventions remains a challenge. Methods We analysed the effect of 36 years of intensive health interventions on growth in infants and young children from three rural Gambian villages. Routine growth data from birth to age 2 years were available for 3659 children between 1976 and 2012. Z scores for weight-for-age, length-for-age, weight-for-length, mid-upper-arm circumference, and head circumference were calculated using the WHO 2006 growth standards. Seasonal patterns of mean Z scores were obtained by Fourier regression. We additionally defined growth faltering as fall in Z score between 3 months and 21 months of age. Findings We noted secular improvements in all postnatal growth parameters (except weight-for-length), accompanied by declines over time in seasonal variability. The proportion of children with underweight or stunting at 2 years of age halved during four decades of the study period, from 38·7% (95% CI 33·5–44·0) for underweight and 57·1% (51·9–62·4) for stunting. However, despite unprecedented levels of intervention, postnatal growth faltering persisted, leading to poor nutritional status at 24 months (length-for-age Z score −1·36, 95% CI −1·44 to −1·27, weight-for-age Z score −1·20, −1·28 to −1·11, and head circumference Z score −0·51, −0·59 to −0·43). The prevalence of stunting and underweight remained unacceptably high (30·0%, 95% CI 27·0–33·0, for stunting and 22·1%, 19·4 to 24·8, for underweight). Interpretation A combination of nutrition-sensitive and nutrition-specific interventions has achieved a halving of undernutrition rates, but despite these intensive interventions substantial growth faltering remains. We need to understand the missing contributors to growth faltering to guide development of new interventions. Funding UK Medical Research Council, UK Department for International Development.
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20
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Kinung'hi SM, Mazigo HD, Dunne DW, Kepha S, Kaatano G, Kishamawe C, Ndokeji S, Angelo T, Nuwaha F. Coinfection of intestinal schistosomiasis and malaria and association with haemoglobin levels and nutritional status in school children in Mara region, Northwestern Tanzania: a cross-sectional exploratory study. BMC Res Notes 2017; 10:583. [PMID: 29121978 PMCID: PMC5679344 DOI: 10.1186/s13104-017-2904-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/01/2017] [Indexed: 11/27/2022] Open
Abstract
Background Schistosomiasis represents a major public health problem in Tanzania despite ongoing national control efforts. This study examined whether intestinal schistosomiasis is associated with malaria and assessed the contribution of intestinal schistosomiasis and malaria on anaemia and undernutrition in school children in Mara region, North-western Tanzania. Methods Stool samples were collected from each of 928 school children randomly selected from 5 schools and examined for intestinal schistosomiasis using the Kato Katz method. Finger prick blood samples were collected and examined for malaria parasites and haemoglobin concentrations using the Giemsa stain and Haemocue methods, respectively. Nutritional status was assessed by taking anthropometric measurements. Results The overall prevalence and infection intensity of S. mansoni was 85.6% (794/928) and 192 (100–278), respectively. The prevalence of malaria was 27.4% (254/928) with significant differences among villages (χ2 = 96.11, p < 0.001). The prevalence of anaemia was 42.3% (392/928) with significant differences among villages (χ2 = 39.61, p < 0.001). The prevalence of stunting, thinness and underweight was 21, 6.8 and 1.3%, respectively. Stunting varied significantly by sex (χ2 = 267.8, p < 0.001), age group (χ2 = 96.4, p < 0.001) and by village (χ2 = 20.5, p < 0.001). Out of the 825 infected children, 217 (26.4%) had multiple parasite infections (two to three parasites). The prevalence of co-infections occurred more frequently in boys than in girls (χ2 = 21.65, p = 0.010). Mean haemoglobin concentrations for co-infected children was significantly lower than that of children not co-infected (115.2 vs 119.6; t = 0.01, p = 0.002). Co-infected children were more likely to be stunted than children who were not co-infected (χ2 = 11.6, p = 0.003). On multivariate analysis, age group, village of residence and severe anaemia were significant predictors of stunting after adjusting for sex and infection status. Conclusions Intestinal schistosomiasis and malaria are prevalent in Mara region. Coinfections of these parasites as well as chronic undernutrition were also common. We recommend Mara region to be included in national schistosomiasis control programmes.
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Affiliation(s)
- Safari M Kinung'hi
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania.
| | - Humphrey D Mazigo
- Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - David W Dunne
- Department of Pathology, Cambridge University, Tennis Court Road, Cambridge, UK
| | - Stella Kepha
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Godfrey Kaatano
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Samuel Ndokeji
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Teckla Angelo
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462, Mwanza, Tanzania
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P. O. Box 7072, Kampala, Uganda
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21
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Tosif S, Duke T. Evidence to Support Oxygen Guidelines for Children with Emergency Signs in Developing Countries: A Systematic Review and Physiological and Mechanistic Analysis. J Trop Pediatr 2017; 63:402-413. [PMID: 28158795 DOI: 10.1093/tropej/fmw100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There are currently no evidence-based oxygen saturation targets for treating children with life-threatening conditions. We reviewed evidence of SpO2 targets for oxygen therapy in children with emergency signs as per WHO Emergency Triage Assessment and Treatment guidelines. We systematically searched for physiological data and international guidelines that would inform a safe approach. Our findings suggest that in children with acute lung disease who do not require resuscitation, a threshold SpO2 for commencing oxygen of 90% will provide adequate oxygen delivery. Although there is no empirical evidence regarding oxygen saturation to target in children with emergency signs from developing countries, a SpO2 of ≥ 94% during resuscitation may help compensate for common situations of reduced oxygen delivery. In children who do not require resuscitation or are stable post resuscitation with only lung disease, a lower limit of SpO2 for commencing oxygen of 90% will provide adequate oxygen delivery and save resources.
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Affiliation(s)
- Shidan Tosif
- Centre for International Child Health, University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
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22
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Monteiro WM, Alexandre MA, Siqueira A, Melo G, Romero GAS, d'Ávila E, Benzecry SG, Leite HP, Lacerda MVG. Could Plasmodium vivax malaria trigger malnutrition? Revisiting the Bradford Hill criteria to assess a causal relationship between two neglected problems. Rev Soc Bras Med Trop 2016; 49:274-8. [PMID: 27384822 DOI: 10.1590/0037-8682-0397-2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/13/2016] [Indexed: 02/02/2023] Open
Abstract
The benign characteristics formerly attributed to Plasmodium vivax infections have recently changed owing to the increasing number of reports of severe vivax malaria resulting in a broad spectrum of clinical complications, probably including undernutrition. Causal inference is a complex process, and arriving at a tentative inference of the causal or non-causal nature of an association is a subjective process limited by the existing evidence. Applying classical epidemiology principles, such as the Bradford Hill criteria, may help foster an understanding of causality and lead to appropriate interventions being proposed that may improve quality of life and decrease morbidity in neglected populations. Here, we examined these criteria in the context of the available data suggesting that vivax malaria may substantially contribute to childhood malnutrition. We found the data supported a role for P. vivax in the etiology of undernutrition in endemic areas. Thus, the application of modern causal inference tools, in future studies, may be useful in determining causation.
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Affiliation(s)
- Wuelton Marcelo Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brasil
| | - Márcia Araújo Alexandre
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brasil
| | - André Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Gisely Melo
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brasil
| | | | - Efrem d'Ávila
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.,Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brasil
| | - Silvana Gomes Benzecry
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brasil.,Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil
| | - Heitor Pons Leite
- Departamento de Pediatria, Universidade Federal de São Paulo, São Paulo, São Paulo, Brasil
| | - Marcus Vinícius Guimarães Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brasil.,Instituto de Pesquisa Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brasil
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Prentice AM, Nabwera H, Unger S, Moore SE. Growth monitoring and the prognosis of mortality in low-income settings. Am J Clin Nutr 2016; 103:681-2. [PMID: 26888709 DOI: 10.3945/ajcn.115.130013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew M Prentice
- Medical Research Council (MRC) Unit, Banjul, The Gambia; MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom;
| | - Helen Nabwera
- Medical Research Council (MRC) Unit, Banjul, The Gambia; MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stefan Unger
- Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom; and
| | - Sophie E Moore
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
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24
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Okebe J, Mwesigwa J, Agbla SC, Sanya-Isijola F, Abubakar I, D'Alessandro U, Jaye A, Bojang K. Seasonal variation in haematological and biochemical reference values for healthy young children in The Gambia. BMC Pediatr 2016; 16:5. [PMID: 26754650 PMCID: PMC4710011 DOI: 10.1186/s12887-016-0545-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 01/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background Haematological and biochemistry reference values for children are important for interpreting clinical and research results however, differences in demography and environment poses a challenge when comparing results. The study defines reference intervals for haematological and biochemistry parameters and examines the effect of seasonality in malaria transmission. Methods Blood samples collected from clinically healthy children, aged 12–59 months, in two surveys during the dry and wet season in the Upper River region of The Gambia were processed and the data analysed to generate reference intervals based on the 2.5th and 97.5th percentiles of the data. Results Analysis was based on data from 1141 children with median age of 32 months. The mean values for the total white cell count and differentials; lymphocyte, monocyte and neutrophil decreased with increasing age, were lower in males and higher in the wet season survey. However, platelet values declined with age (p < 0.0001). There was no evidence of effect of gender on mean values of AST, ALT, lymphocytes, monocytes, platelets and haemoglobin. Conclusion Mean estimates for haematological and biochemistry reference intervals are affected by age and seasonality in the first five years of life. This consistency is important for harmonisation of reference values for clinical care and interpretation of trial results. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0545-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Umberto D'Alessandro
- Medical Research Council Unit, Fajara, Gambia.,Institute of Tropical Medicine, Antwerp, Belgium.,London school of Hygiene and Tropical Medicine, London, UK
| | - Assan Jaye
- Medical Research Council Unit, Fajara, Gambia
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25
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Ferreira ED, Alexandre MA, Salinas JL, de Siqueira AM, Benzecry SG, de Lacerda MVG, Monteiro WM. Association between anthropometry-based nutritional status and malaria: a systematic review of observational studies. Malar J 2015; 14:346. [PMID: 26377094 PMCID: PMC4574180 DOI: 10.1186/s12936-015-0870-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/25/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple studies in various parts of the world have analysed the association of nutritional status on malaria using anthropometric measures, but results differ due to the heterogeneity of the study population, species of the parasite, and other factors involved in the host and parasite relationship. The aim of this study was to perform a systematic review on the inter-relationship of nutritional status based on anthropometry and malarial infection. METHODS Two independent reviewers accessed the MEDLINE and LILACS databases using the same search terms related to malaria and anthropometry. Prospective studies associating anthropometry and malaria (incidence or severity) were selected. References from the included studies and reviews were used to increase the review sensitivity. Data were extracted using a standardized form and the quality of the prospective studies was assessed. Selected articles were grouped based on exposures and outcomes. RESULTS The search identified a total of 1688 studies: 1629 from MEDLINE and 59 from LILACS. A total of 23 met the inclusion criteria. Five additional studies were detected by reading the references of the 23 included studies and reviews, totaling 28 studies included. The mean sample size was 662.1 people, ranging from 57 to 5620. The mean follow-up was 365.8 days, ranging from 14 days to 1 year and 9 months, and nine studies did not report the follow-up period. Prospective studies assessing the relationship between malaria and malnutrition were mostly carried out in Africa. Of the 20 studies with malarial outcomes, fifteen had high and five had average quality, with an average score of 80.5 %. Most anthropometric parameters had no association with malaria incidence (47/52; 90.4 %) or parasite density (20/25; 80 %). However, the impact of malnutrition was noted in malaria mortality and severity (7/17; 41.2 %). Regarding the effects of malaria on malnutrition, malaria was associated with very few anthropometric parameters (8/39; 20.6 %). CONCLUSIONS This systematic review found that most of the evidence associating malaria and malnutrition comes from P. falciparum endemic areas, with a significant heterogeneity in studies' design. Apparently malnutrition has not a great impact on malaria morbidity, but could have a negative impact on malaria mortality and severity. Most studies show no association between malaria and subsequent malnutrition in P. falciparum areas. In Plasmodium vivax endemic areas, malaria was associated with malnutrition in children. A discussion among experts in the field is needed to standardize future studies to increase external validity and accuracy.
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Affiliation(s)
- Efrem d'Avila Ferreira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
| | - Márcia A Alexandre
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
| | - Jorge L Salinas
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, 49 Jesse Hill Jr Drive, Atlanta, GA, 30303, USA.
| | - André M de Siqueira
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
| | - Silvana G Benzecry
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
| | - Marcus V G de Lacerda
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
- Instituto de Pesquisas Leônidas and Maria Deane, Fundação Oswaldo Cruz, Rua Terezina, 476, Adrianópolis, Manaus, AM, 69057-070, Brazil.
| | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
- Universidade do Estado do Amazonas, Av. Pedro Teixeira, 25, Dom Pedro, Manaus, AM, 69040-000, Brazil.
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26
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Padonou G, Le Port A, Cottrell G, Guerra J, Choudat I, Rachas A, Bouscaillou J, Massougbodji A, Garcia A, Martin-Prevel Y. Factors associated with growth patterns from birth to 18 months in a Beninese cohort of children. Acta Trop 2014; 135:1-9. [PMID: 24674879 DOI: 10.1016/j.actatropica.2014.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 02/26/2014] [Accepted: 03/12/2014] [Indexed: 11/18/2022]
Abstract
The aim of this study was to analyze factors influencing the growth pattern of children from birth to 18 months. A longitudinal prospective study was conducted in three maternity wards in Southern Benin. Inclusion took place between June 2007 and July 2008; children were followed-up until 18 months of age. Height-for-age and weight-for-height Z-scores were computed using the newborn's anthropometric measurements taken at delivery, every month up to 6 months and then quarterly. Infant and young child feeding (IYCF) practices and malarial morbidity were recorded. Gestational age was estimated using the Ballard method; William's sex-specific reference curve of birth weight-for-gestational-age was used to determine intrauterine growth retardation (IUGR). Analyses were performed on 520 children using a linear mixed model. Low birth weight (coef=-0.43; p=0.002), IUGR (coef=-0.49; p<0.001), maternal short stature (coef=-0.25; p=0.001) and maternal low weight status (coef=-0.19; p=0.006) were significantly associated with growth impairment. Only LBW (coef=-0.28; p=0.05) and maternal low weight status (coef=-0.23; p=0.004) were associated with wasting. A good IYCF score was positively associated with weight gain (coef=0.14; p<0.001) whereas we found a paradoxical association with length (coef=-0.18; p<0.001). Malaria morbidity was not associated with growth. LBW, IUGR and maternal low weight status and height were important determinants of children's growth. These results reinforce and justify continuing public health initiatives to fight IUGR and LBW and break the intergenerational cycle of malnutrition.
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Affiliation(s)
- Géraud Padonou
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole doctorale 393, Université Pierre et Marie Curie Paris 6, France; Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Faculté des Sciences de la Santé, Champs de Foire, Cotonou, Benin.
| | - Agnès Le Port
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Ecole doctorale 393, Université Pierre et Marie Curie Paris 6, France
| | - Gilles Cottrell
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France; Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Faculté des Sciences de la Santé, Champs de Foire, Cotonou, Benin
| | - José Guerra
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Isabelle Choudat
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Antoine Rachas
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Julie Bouscaillou
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Achille Massougbodji
- Centre d'Etudes et de Recherche sur le Paludisme Associé à la Grossesse et à l'Enfant (CERPAGE), Faculté des Sciences de la Santé, Champs de Foire, Cotonou, Benin; Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Benin
| | - André Garcia
- Institut de Recherche pour le Développement (IRD) UMR216, Mère et enfant face aux infections tropicales, Paris, France; Faculté de Pharmacie, Université Paris Descartes, Paris, France
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27
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Olofin I, McDonald CM, Ezzati M, Flaxman S, Black RE, Fawzi WW, Caulfield LE, Danaei G. Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies. PLoS One 2013; 8:e64636. [PMID: 23734210 PMCID: PMC3667136 DOI: 10.1371/journal.pone.0064636] [Citation(s) in RCA: 313] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/16/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies. METHODS Pooled analysis involving children 1 week to 59 months old in 10 prospective studies in Africa, Asia and South America. Utilizing most recent measurements, we calculated weight-for-age, height/length-for-age and weight-for-height/length Z scores, applying 2006 WHO Standards and the 1977 NCHS/WHO Reference. We estimated all-cause and cause-specific mortality hazard ratios (HR) using proportional hazards models comparing children with mild (-2≤Z<-1), moderate (-3≤Z<-2), or severe (Z<-3) anthropometric deficits with the reference category (Z≥-1). RESULTS 53 809 children were eligible for this re-analysis and contributed a total of 55 359 person-years, during which 1315 deaths were observed. All degrees of underweight, stunting and wasting were associated with significantly higher mortality. The strength of association increased monotonically as Z scores decreased. Pooled mortality HR was 1.52 (95% Confidence Interval 1.28, 1.81) for mild underweight; 2.63 (2.20, 3.14) for moderate underweight; and 9.40 (8.02, 11.03) for severe underweight. Wasting was a stronger determinant of mortality than stunting or underweight. Mortality HR for severe wasting was 11.63 (9.84, 13.76) compared with 5.48 (4.62, 6.50) for severe stunting. Using older NCHS standards resulted in larger HRs compared with WHO standards. In cause-specific analyses, all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases. The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality. CONCLUSIONS All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO Standards. Even mild deficits substantially increase mortality, especially from infectious diseases.
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Affiliation(s)
- Ibironke Olofin
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Christine M. McDonald
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Majid Ezzati
- MRC-HPA Center for Environmental Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Seth Flaxman
- School of Computer Science and Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Robert E. Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wafaie W. Fawzi
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Laura E. Caulfield
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Goodarz Danaei
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
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28
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Mitangala PN, D'Alessandro U, Donnen P, Hennart P, Porignon D, Bisimwa Balaluka G, Zozo Nyarukweba D, Cobohwa Mbiribindi N, Dramaix Wilmet M. [Malaria infection and nutritional status: results from a cohort survey of children from 6-59 months old in the Kivu province, Democratic Republic of the Congo]. Rev Epidemiol Sante Publique 2013; 61:111-20. [PMID: 23489948 DOI: 10.1016/j.respe.2012.06.404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 06/16/2012] [Accepted: 06/21/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite a reduction in the magnitude of endemic malaria reported in recent years, malaria and protein-energy malnutrition (PEM) still remain major causes of morbidity and mortality in sub-Saharan Africa among children under five. The relationship between malaria and malnutrition remains a topic of controversy. We aimed to investigate malaria infection according to nutritional status in a community-based survey. METHODS A cohort of 790 children aged 6 to 59 months and residing in eastern Democratic Republic of the Congo was followed-up from April 2009 to March 2010 with monthly visits. Data on nutritional status, morbidity between visits, use of insecticide-treated nets and malaria parasitemia were collected at each visit. The Z scores height for age, weight for age and weight for height were computed using the reference population defined by the WHO in 2006. Thresholds for Z scores were defined at -3 and -2. A binary logistic model of the generalized estimating equation (GEE) was used to quantify the association between PEM indicators and malaria parasitemia. Odds ratio (OR) and their 95% confidence interval (95% CI) were computed. RESULTS After adjustment for season, children with severe stunting (height for age Z score<-3) were at lower risk of malaria parasitemia greater or equal to 5000 trophozoits/μL of blood as compared to those in with a better nutritional status (height for age Z score≥-2) (OR=0.48, 95% CI: 0.25-0.91). CONCLUSION Severely stunted children are at a lower risk of high-level malaria parasitemia.
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Affiliation(s)
- P N Mitangala
- École de santé publique, département de biostatistique, Université libre de Bruxelles, campus Erasme, route de Lennik 808, 1070 Brussels, Belgium.
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29
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Clifton DC, Ramadhani HO, Msuya LJ, Njau BN, Kinabo GD, Buchanan AM, Crump JA. Predicting mortality for paediatric inpatients where malaria is uncommon. Arch Dis Child 2012; 97:889-94. [PMID: 22872067 PMCID: PMC3508729 DOI: 10.1136/archdischild-2012-301812] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE As the proportion of children living low malaria transmission areas in sub-Saharan Africa increases, approaches for identifying non-malarial severe illness need to be evaluated to improve child outcomes. DESIGN As a prospective cohort study, we identified febrile paediatric inpatients, recorded data using Integrated Management of Childhood Illness (IMCI) criteria, and collected diagnostic specimens. SETTING Tertiary referral centre, northern Tanzania. RESULTS Of 466 participants with known outcome, median age was 1.4 years (range 2 months-13.0 years), 200 (42.9%) were female, 11 (2.4%) had malaria and 34 (7.3%) died. Inpatient death was associated with: Capillary refill >3 s (OR 9.0, 95% CI 3.0 to 26.7), inability to breastfeed or drink (OR 8.9, 95% CI 4.0 to 19.6), stiff neck (OR 7.0, 95% CI 2.8 to 17.6), lethargy (OR 5.2, 95% CI 2.5 to 10.6), skin pinch >2 s (OR 4.8, 95% CI 1.9 to 12.3), respiratory difficulty (OR 4.0, 95% CI 1.9 to 8.2), generalised lymphadenopathy (OR 3.6, 95% CI 1.6 to 8.3) and oral candidiasis (OR 3.4, 95% CI 1.4 to 8.3). BCS <5 (OR 27.2, p<0.001) and severe wasting (OR 6.9, p<0.001) were independently associated with inpatient death. CONCLUSIONS In a low malaria transmission setting, IMCI criteria performed well for predicting inpatient death from non-malarial illness. Laboratory results were not as useful in predicting death, underscoring the importance of clinical examination in assessing prognosis. Healthcare workers should consider local malaria epidemiology as malaria over-diagnosis in children may delay potentially life-saving interventions in areas where malaria is uncommon.
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Affiliation(s)
- Dana C Clifton
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Levina J Msuya
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Grace D Kinabo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Ann M Buchanan
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - John A Crump
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA
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30
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Ngirabega JDD, Munyanshongore C, Donnen P, Dramaix M. [Influence of malnutrition on childhood mortality in a rural hospital in Rwanda]. Rev Epidemiol Sante Publique 2011; 59:313-8. [PMID: 21889859 DOI: 10.1016/j.respe.2011.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 09/20/2010] [Accepted: 05/03/2011] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recent estimates of the role of malnutrition on childhood mortality have led to a call for action by decision makers in the fight against child malnutrition. Further evaluation is needed to assess the burden of malnutrition in terms of morbidity and mortality, as well as to assess the impact of various interventions. The objective of this study is to determine the effect of malnutrition on mortality in a pediatric service of a rural hospital in Rwanda. METHODS A prospective cohort study included children aged 6-59 months coming from the catchment area of the hospital and admitted to the pediatric ward between January 2008 and June 2009. Anthropometric, clinical and biological data were gathered at the time of admission. The effect of malnutrition at the time of admission on mortality during hospitalization was analyzed by using logistic regression. RESULTS At the time of admission, the prevalences of wasting, underweight and stunting among children was 14.2%, 37.5% and 57.3% respectively. Fifty-six children died during hospitalization. The period mortality rate was 6.9%. After adjustment for age, sex, malaria thick smear and breathing with chest retractions, death was associated with underweight and stunting with adjusted odds rations of 4.6 (IC95% 2.5-8.4) and 4.0 (IC95% 2.0-8.2) respectively. CONCLUSION The study confirmed the influence of malnutrition on child mortality in pediatrics wards. These results can be of great help for improving the awareness of the community decision-makers in the fight to prevent malnutrition.
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31
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Nankabirwa V, Tylleskar T, Nankunda J, Engebretsen IMS, Sommerfelt H, Tumwine JK. Malaria parasitaemia among infants and its association with breastfeeding peer counselling and vitamin A supplementation: a secondary analysis of a cluster randomized trial. PLoS One 2011; 6:e21862. [PMID: 21760916 PMCID: PMC3131393 DOI: 10.1371/journal.pone.0021862] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 06/08/2011] [Indexed: 11/18/2022] Open
Abstract
Background Malaria is the second highest contributor to the disease burden in Africa and there is a need to identify low cost prevention strategies. The objectives of this study were to estimate the prevalence of malaria parasitaemia among infants and to measure the association between peer counselling for exclusive breastfeeding (EBF), vitamin A supplementation, anthropometric status (weight and length) and malaria parasitaemia. Methods A cluster randomized intervention trial was conducted between 2006 and 2008 where 12 of 24 clusters, each comprising one or two villages, in Eastern Uganda were allocated to receive peer counselling for EBF. Women in their third trimester of pregnancy (based on the last normal menstrual period) were recruited in all 24 clusters and followed up until their children's first birthday. Blood was drawn from 483 infants between 3 and 12 months of age, to test for malaria parasitaemia. Results The prevalence of malaria parasitaemia was 11% in the intervention areas and 10% in the control areas. The intervention did not seem to decrease the prevalence of malaria (PR 1.7; 95% CI: 0.9, 3.3). After controlling for potential confounders, infants not supplemented with Vitamin A had a higher prevalence for malaria compared to those who had been supplemented (PR 6.1; 95% CI: 2.1, 17.6). Among children supplemented with vitamin A, every unit increase in length-for-age Z (LAZ) scores was associated with a reduced prevalence in malaria (PR 0.5; 95% CI:0.4, 0.6). There was no association between LAZ scores and malaria among children that had not been supplemented. Conclusion Peer counselling for exclusive breastfeeding did not decrease the prevalence of malaria parasitaemia. Children that had not received Vitamin A supplementation had a higher prevalence of malaria compared to children that had been supplemented. Trial registration Clinicaltrials.gov: NCT00397150.
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Affiliation(s)
- Victoria Nankabirwa
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
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Okoromah CAN, Ekure EN, Lesi FEA, Okunowo WO, Tijani BO, Okeiyi JC. Prevalence, profile and predictors of malnutrition in children with congenital heart defects: a case-control observational study. Arch Dis Child 2011; 96:354-60. [PMID: 21266339 PMCID: PMC3056291 DOI: 10.1136/adc.2009.176644] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2010] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the prevalence, profile and predictors of severe malnutrition in children with congenital heart defects (CHDs). DESIGN Case-control, observational study. SETTING Tertiary teaching hospital in Lagos, Nigeria (March 2006 to March 2008). PARTICIPANTS Children aged 3-192 months with uncorrected symptomatic CHD and healthy controls, frequency matched for age and sex. MAIN OUTCOME MEASURES Prevalence of malnutrition based on WHO/National Center for Health Statistics/Centers for Disease Control and Prevention z score ≤-2; weight for age, weight for height/length and height for age; proportions of underweight, wasting and stunting in cases and controls, and in acyanotic and cyanotic CHD; and predictors of malnutrition using multivariate logistic analysis. RESULTS 90.4% of cases and 21.1% of controls had malnutrition (p=0.0001), and 61.2% and 2.6%, respectively, had severe malnutrition (p=0.0001). Wasting, stunting and underweight were identified in 41.1%, 28.8% and 20.5%, and 2.6%, 3.9% and 14.5% of cases and controls, respectively. Wasting was significantly higher (58.3%) in acyanotic CHD (p=0.0001), and stunting (68.0%) in cyanotic CHD (p=0.0001). Age at weaning was significantly lower in cases than controls (3.24±0.88 and 7.04±3.04 months, respectively; p=0.0001) and in acyanotic than cyanotic CHD (2.14±0.33 and 5.33±1.22 months, respectively; p=0.004). Predictors of malnutrition in CHD were anaemia, moderate to severe congestive heart failure (CHF), poor dietary intake of fat and prolonged unoperated disease. CONCLUSION Severe malnutrition in association with anaemia and moderate to severe CHF is highly prevalent in CHD preoperatively in these children. Early weaning may be a marker of feeding difficulties in heart failure.
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Affiliation(s)
- Christy A N Okoromah
- Associate Professor and Consultant, Cardiology and Infectious Disease Unit, Department of Paediatrics, College of Medicine, University of Lagos, Surulere, Idi-Araba, Lagos, Nigeria.
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Ponka R, Fokou E. Dietary intake, zincemia and cupremia of Cameroonian schoolchildren of Ngali II. Int J Food Sci Nutr 2011; 62:377-84. [PMID: 21355749 DOI: 10.3109/09637486.2010.550274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The present study is aimed at investigating the dietary intake, zincemia and cupremia of Cameroonian schoolchildren of Ngali II. A total of 211 and 200 schoolchildren aged between 7 and 18 years were recruited during the rainy season and dry season, respectively. Information on dietary intake was collected using 7-day measured food diaries. The zincemia and cupremia of the subjects were determined by atomic absorption spectrophotometry. The energy, nutrient intakes, zincemia and cupremia obtained were compared with reference values. The energy and most nutrient intakes of these schoolchildren were higher in the rainy season than in the dry season. Energy and nutrient intakes were generally insufficient, when compared with reference values in children except zinc, iron, magnesium and vitamin E intakes and in adolescents (except magnesium and vitamin E intakes). The zincemia and cupremia of the subjects were low when compared with standard values.
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Affiliation(s)
- Roger Ponka
- Department of Agriculture, Animal Husbandry and By-Products, The Higher Institute of the Sahel, University of Maroua, Cameroon.
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Lima AMD, Gamallo SMM, Oliveira FLC. Desnutrição energético-proteica grave durante a hospitalização: aspectos fisiopatológicos e terapêuticos. REVISTA PAULISTA DE PEDIATRIA 2010. [DOI: 10.1590/s0103-05822010000300015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVOS: Apresentar a conduta para o tratamento da desnutrição energético-proteica grave e os principais aspectos fisiopatológicos da doença. FONTES DE DADOS: Tomando como base o Manual da Organização Mundial da Saúde (OMS, 1999), realizou-se uma busca por trabalhos publicados em inglês, espanhol e português sobre o tratamento hospitalar de crianças com desnutrição grave, nas bases de dados Lilacs, Medline e SciELO, publicados nos últimos dez anos, utilizando-se as palavras-chave: desnutrição, criança, hospitalização, terapia nutricional, diretrizes, OMS. SÍNTESE DE DADOS: Foram abordadas as principais características fisiopatológicas da desnutrição grave e a conduta recomendada para o tratamento. Identificaram-se as principais complicações clínico-metabólicas, como a hipotermia, a hipoglicemia, a desidratação e as infecções recorrentes, além da má absorção e a fase de estabilização ou de recuperação do desnutrido grave. A compreensão de todos esses conceitos relacionados à fisiopatologia da desnutrição energético-proteica, associada ao adequado planejamento e execução da terapia nutricional, pode reduzir o risco de morbimortalidade em crianças com idade inferior a cinco anos. CONCLUSÕES: As diretrizes da OMS devem ser implantadas levando-se em consideração a realidade de cada região e a capacitação do profissional da saúde quanto ao conhecimento da complexidade e fisiopatologia da desnutrição energético-proteica grave, para adequado diagnóstico e tratamento. O sucesso do tratamento está associado ao cuidado e à atenção ao paciente.
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Chisti MJ, Tebruegge M, La Vincente S, Graham SM, Duke T. Pneumonia in severely malnourished children in developing countries - mortality risk, aetiology and validity of WHO clinical signs: a systematic review. Trop Med Int Health 2009; 14:1173-89. [PMID: 19772545 DOI: 10.1111/j.1365-3156.2009.02364.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To quantify the degree by which moderate and severe degrees of malnutrition increase the mortality risk in pneumonia, to identify potential differences in the aetiology of pneumonia between children with and without severe malnutrition, and to evaluate the validity of WHO-recommended clinical signs (age-specific fast breathing and chest wall indrawing) for the diagnosis of pneumonia in severely malnourished children. METHODS Systematic search of the existing literature using a variety of databases (Medline, EMBASE, the Web of Science, Scopus and CINAHL). RESULTS Mortality risk: Sixteen relevant studies were identified, which universally showed that children with pneumonia and moderate or severe malnutrition are at higher risk of death. For severe malnutrition, reported relative risks ranged from 2.9 to 121.2; odds ratios ranged from 2.5 to 15.1. For moderate malnutrition, relative risks ranged from 1.2 to 36.5. Aetiology: Eleven studies evaluated the aetiology of pneumonia in severely malnourished children. Commonly isolated bacterial pathogens were Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, and Haemophilus influenzae. The spectrum and frequency of organisms differed from those reported in children without severe malnutrition. There are very few data on the role of respiratory viruses and tuberculosis. Clinical signs: Four studies investigating the validity of clinical signs showed that WHO-recommended clinical signs were less sensitive as predictors of radiographic pneumonia in severely malnourished children. CONCLUSIONS Pneumonia and malnutrition are two of the biggest killers in childhood. Guidelines for the care of children with pneumonia and malnutrition need to take into account this strong and often lethal association if they are to contribute to the UN Millennium Development Goal 4, aiming for substantial reductions in childhood mortality. Additional data regarding the optimal diagnostic approach to and management of pneumonia and malnutrition are required from regions where death from these two diseases is common.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Clinical Science Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Savy M, Edmond K, Fine PEM, Hall A, Hennig BJ, Moore SE, Mulholland K, Schaible U, Prentice AM. Landscape analysis of interactions between nutrition and vaccine responses in children. J Nutr 2009; 139:2154S-218S. [PMID: 19793845 DOI: 10.3945/jn.109.105312] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The world's poorest children are likely to be malnourished when receiving their childhood vaccines. It is uncertain whether this affects vaccine efficacy and whether the coadministration of nutrient supplements with vaccines has beneficial or detrimental effects. More recently, a detrimental interaction between vitamin A (VA) supplementation (VAS) and the killed diphtheria-tetanus-pertussis vaccine given in early childhood has been suggested. This report provides a critical review of the published interactions between nutritional status and/or supplementation and vaccine responses in children. Due to an absence of evidence for most nutrients, this analysis focused on protein-energy, vitamins A and D, and iron and zinc. All vaccines were considered. Both observational studies and clinical trials that led to peer-reviewed publications in English or French were included. These criteria led to a pool of 58 studies for protein-energy malnutrition, 43 for VA, 4 for vitamin D, 10 for iron, and 22 for zinc. Our analysis indicates that malnutrition has surprisingly little or no effect on vaccine responses. Evidence for definitive adjunctive effects of micronutrient supplementation at the time of vaccination is also weak. Overall, the paucity, poor quality, and heterogeneity of data make it difficult to draw firm conclusions. The use of simple endpoints that may not correlate strongly with disease protection adds uncertainty. A detailed examination of the immunological mechanisms involved in potential interactions, employing modern methodologies, is therefore required. This would also help us understand the proposed, but still unproven, negative interactions between VAS and vaccine safety, a resolution of which is urgently required.
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Affiliation(s)
- Mathilde Savy
- Medical Research Council International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.
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Fokou E, Ponka R. Étude de relation entre infection à Plasmodium falciparum chez les élèves camerounais de Ngali II et leurs apports nutritionnels. NUTR CLIN METAB 2009. [DOI: 10.1016/j.nupar.2009.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Prentice AM, Gershwin ME, Schaible UE, Keusch GT, Victora CG, Gordon JI. New challenges in studying nutrition-disease interactions in the developing world. J Clin Invest 2008; 118:1322-9. [PMID: 18382744 DOI: 10.1172/jci34034] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Latest estimates indicate that nutritional deficiencies account for 3 million child deaths each year in less-developed countries. Targeted nutritional interventions could therefore save millions of lives. However, such interventions require careful optimization to maximize benefit and avoid harm. Progress toward designing effective life-saving interventions is currently hampered by some serious gaps in our understanding of nutrient metabolism in humans. In this Personal Perspective, we highlight some of these gaps and make some proposals as to how improved research methods and technologies can be brought to bear on the problems of undernourished children in the developing world.
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Affiliation(s)
- Andrew M Prentice
- MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Acute Lower Respiratory Infections. NUTRITION AND HEALTH IN DEVELOPING COUNTRIES 2008. [PMCID: PMC7122747 DOI: 10.1007/978-1-59745-464-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sowunmi A, Gbotosho GO, Adedeji AA, Fateye BA, Sabitu MF, Happi CT, Fehintola FA. Effects of acute Plasmodium falciparum malaria on body weight in children in an endemic area. Parasitol Res 2007; 101:343-9. [PMID: 17323138 DOI: 10.1007/s00436-007-0494-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 02/05/2007] [Indexed: 10/23/2022]
Abstract
The impacts of acute falciparum malaria on body weight and the host and parasite factors predictive of change in body weight were characterized in 465 prospectively studied children in an endemic area of southwest Nigeria. Pre-treatment weights were significantly lower than the 14 to 28-day post-treatment weights (P = 0.0001). In 187 children, fractional fall in body weight (FFBW) exceeded 4.9%. FFBW correlated negatively with age and body weight (P = 0.014 and 0.0001, respectively), but not with enrollment parasitaemia. In a multiple regression model, an age < or =5 years (AOR = 2.03, 95% CI 1.2-3.2, P = 0.003), a hematocrit < or =29% (AOR = 1.6, 95% CI 1.0-2.3, P = 0.037), and a body weight < or =9.6 kg (AOR = 5.4, 95% CI 1.7-20, P = 0.003) were independent predictors of FFBW > or =5% at presentation. Children who, after initial clearance, had recurrence of their parasitaemia within 28 days had a significantly higher propensity not to gain weight than children who were aparasitaemic after treatment (log-rank statistic 6.76, df = 1, P = 0.009). These results indicate that acute malaria contribute to sub-optimal growth in young children and may have implications for malaria control efforts in sub-Saharan Africa.
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Affiliation(s)
- Akintunde Sowunmi
- Department of Pharmacology & Therapeutics and Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.
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Alphonse M, Hankard R. Évaluation de l'état nutritionnel et des besoins de l'enfant et de l'adolescent. NUTR CLIN METAB 2005. [DOI: 10.1016/j.nupar.2005.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Malnutrition, with its 2 constituents of protein-energy malnutrition and micronutrient deficiencies, continues to be a major health burden in developing countries. It is globally the most important risk factor for illness and death, with hundreds of millions of pregnant women and young children particularly affected. Apart from marasmus and kwashiorkor (the 2 forms of protein- energy malnutrition), deficiencies in iron, iodine, vitamin A and zinc are the main manifestations of malnutrition in developing countries. In these communities, a high prevalence of poor diet and infectious disease regularly unites into a vicious circle. Although treatment protocols for severe malnutrition have in recent years become more efficient, most patients (especially in rural areas) have little or no access to formal health services and are never seen in such settings. Interventions to prevent protein- energy malnutrition range from promoting breast-feeding to food supplementation schemes, whereas micronutrient deficiencies would best be addressed through food-based strategies such as dietary diversification through home gardens and small livestock. The fortification of salt with iodine has been a global success story, but other micronutrient supplementation schemes have yet to reach vulnerable populations sufficiently. To be effective, all such interventions require accompanying nutrition-education campaigns and health interventions. To achieve the hunger- and malnutrition-related Millennium Development Goals, we need to address poverty, which is clearly associated with the insecure supply of food and nutrition.
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Affiliation(s)
- Olaf Müller
- Department of Tropical Hygiene and Public Health, Ruprecht-Karls-University, Heidelberg, Germany.
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Bahwere P, De Mol P, Donnen P, Dramaix-Wilmet M, Butzler JP, Hennart P, Levy J. Improvements in nutritional management as a determinant of reduced mortality from community-acquired lower respiratory tract infection in hospitalized children from rural central Africa. Pediatr Infect Dis J 2004; 23:739-47. [PMID: 15295224 DOI: 10.1097/01.inf.0000135663.17018.51] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In-hospital mortality from lower respiratory tract infections (LTRI) is unacceptably high in developing countries where LTRI are still a leading cause of death. OBJECTIVE To identify new approaches to reduce in-hospital mortality of LRTI through the improvement of its management. METHODS The prospectively collected database of children admitted during an 11-year period with LRTI in a pediatric rural hospital in Central Africa was reviewed to determine the predictors of death and to evaluate the impact on mortality of 4 different protocols for the management of malnutrition. RESULTS During the study period, 859 children were admitted with a nonmeasles severe LRTI. In the 3-year period during which blood cultures were obtained, 29.0% of the children with LRTI were bacteremic, and multiresistant Enterobacteriaceae were recovered in 81.4% of positive blood cultures. Independent predictors of death in children without edema were age <24 months, dehydration and hepatomegaly with adjusted odds ratios (numbers in parentheses, 95% confidence interval) of 3.47 (1.70-7.08), 4.24 (2.11-8.50) and 2.90 (1.43-5.85), respectively. In those with edema, a significantly increased risk of death was noted for girls [4.31 (1.71-10.90)], in children with z-score of weight to height < or = -3 [5.45 (1.67-17.79)] and when the serum albumin was <16 g/l [2.58 (1.01-6.58)]. The improvement in the management of malnutrition was followed by a reduction of LRTI-related mortality in children with edema from 32.4 to 8.9% (P < 0.001). In children without edema, the LRTI-related mortality decreased from approximately 12% to 3.5% when their diet was supplemented with micronutrients. CONCLUSION This study indicates that the improvement of the management of underlying nutritional deficiencies is crucial for the reduction of the high in-hospital case fatality rate associated with severe nonmeasles LRTI. The empiric antibiotic regimen should be modified to cover for multiresistant Enterobacteriaceae.
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Affiliation(s)
- Paluku Bahwere
- Centre de Recherche en Sciences Naturelles (CRSN), Lwiro, Democratic Republic of Congo.
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Fuller DG, Duke T, Shann F, Curtis N. Antibiotic treatment for bacterial meningitis in children in developing countries. ACTA ACUST UNITED AC 2004; 23:233-53. [PMID: 14738571 DOI: 10.1179/027249303225007752] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Bacterial meningitis causes 125,000 deaths each year in infants and young children and 96% of these occur in less developed countries where up to 50% of children with this disease die and 25-50% of survivors have neurological sequelae. Although 3rd-generation cephalosporins are optimal empirical therapy for bacterial meningitis, they are unaffordable in many developing countries. The majority of children worldwide are currently treated with cheaper alternatives. This paper reviews the challenges facing clinicians treating bacterial meningitis in developing countries, highlighting the problem of changing patterns of antibiotic resistance. In particular, it details the evidence for the use of chloramphenicol and 3rd-generation cephalosporins.
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Affiliation(s)
- David G Fuller
- Department of General Medicine, Royal Children's Hospital, Melbourne, Australia.
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Abstract
AIM To test whether nurses can use the WHO integrated management of childhood illness (IMCI) nutrition algorithm to identify reliably severe protein-energy malnutrition in children. METHODS Nurses were trained to identify severe protein-energy malnutrition using IMCI training materials. They identified visible severe wasting and bipedal oedema, and categorised weight-for-age using a growth chart, in consecutive children attending outpatient clinics. Their findings were compared with weight for height Z (WHZ) score, bipedal oedema assessed by a trained observer, and weight-for-age Z score. RESULTS A total of 352 children were recruited, of whom 34 (9.7%) were severely wasted (WHZ score <-3) and 18 (5.1%) had bipedal oedema. In the detection of severe wasting, the nurses' assessments showed 56% sensitivity, 95% specificity, and 56% positive predictive value (PPV), and for bipedal oedema 22%, 99%, and 57% respectively. Overall, the nurses identified only half of 50 children with severe wasting and/or bipedal oedema and wrongly identified a further 13 children as severely malnourished. Plotting weight for age by the nurses showed 62% sensitivity, 99% specificity, and 89% PPV for the detection of children with very low weight. CONCLUSIONS Severe malnutrition was both under-diagnosed and wrongly diagnosed by nurses trained in the use of the IMCI nutrition algorithm in a clinic setting in The Gambia. These guidelines for health workers and the training materials, particularly with respect to calculation of age, need further development to improve the detection of malnourished children.
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Affiliation(s)
- C Hamer
- Royal Victoria Hospital, Banjul, The Gambia.
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de Onis M, Blössner M. The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications. Int J Epidemiol 2003; 32:518-26. [PMID: 12913022 DOI: 10.1093/ije/dyg099] [Citation(s) in RCA: 255] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND For decades nutritional surveys have been conducted using various definitions, indicators and reference populations to classify child malnutrition. The World Health Organization (WHO) Global Database on Child Growth and Malnutrition was initiated in 1986 with the objective to collect, standardize, and disseminate child anthropometric data using a standard format. METHODS The database includes population-based surveys that fulfil a set of criteria. Data are checked for validity and consistency and raw data sets are analysed following a standard procedure to obtain comparable results. Prevalences of wasting, stunting, under- and overweight in preschool children are presented using z-scores based on the National Center for Health Statistics (NCHS)/WHO international reference population. New surveys are included on a continuous basis and updates are published bimonthly on the database's web site. RESULTS To date, the database contains child anthropometric information derived from 846 surveys. With 412 national surveys from 138 countries and 434 sub-national surveys from 155 countries, the database covers 99% and 64% of the under 5 year olds in developing and developed countries, respectively. This wealth of information enables international comparison of nutritional data, helps identifying populations in need, evaluating nutritional and other public health interventions, monitoring trends in child growth, and raising political awareness of nutritional problems. CONCLUSIONS The 15 years experience of the database can be regarded as a success story of international collaboration in standardizing child growth data. We recommend this model for monitoring other nutritional health conditions that as yet lack comparable data.
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Affiliation(s)
- Mercedes de Onis
- Department of Nutrition for Health and Development, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
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Berkley JA, Ross A, Mwangi I, Osier FHA, Mohammed M, Shebbe M, Lowe BS, Marsh K, Newton CRJC. Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. BMJ 2003; 326:361. [PMID: 12586667 PMCID: PMC148891 DOI: 10.1136/bmj.326.7385.361] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To identify clinical indicators of immediate, early, and late mortality in children at admission to a sub-Saharan district hospital and to develop prognostic scores. DESIGN Prospective cohort study. SETTING One district hospital in Kenya. PARTICIPANTS Children aged over 90 days admitted to hospital from 1 July 1998 to 30 June 2001. MAIN OUTCOME MEASURES Prognostic indicators of mortality. RESULTS Of 8091 children admitted up to 1 June 2000, 436 (5%) died. Sixty (14%) died within four hours after admission (immediate), 193 (44%) after 4-48 hours (early), and 183 (42%) after 48 hours (late). There were marked differences in the clinical features associated with immediate, early, and late death. Seven indicators (neurological status, respiratory distress (subcostal indrawing or deep breathing), nutritional status (wasting or kwashiorkor), severe anaemia, jaundice, axillary temperature, and length of history) were included in simplified prognostic scores. Data from 4802 children admitted from 1 July 2000 to 30 June 2001 were used to validate the scores. For simplified prognostic scores the areas under the receiver operating characteristic curves were 0.93 (95% confidence interval 0.92 to 0.94), 0.82 (0.80 to 0.83), and 0.82 (0.81 to 0.84) for immediate, early, and late death, respectively. CONCLUSION In children admitted to a sub-Saharan hospital, the prognostic indicators of early and late deaths differ but a small number of simple clinical signs predict outcome well.
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Affiliation(s)
- J A Berkley
- KEMRI Centre for Geographic Medicine Research (Coast), PO Box 230, Kilifi, Kenya.
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Hankard R, Bloch J, Martin P, Randrianasolo H, Bannier MF, Machinot S, Cézard JP. [Nutritional status and risk in hospitalized children]. Arch Pediatr 2001; 8:1203-8. [PMID: 11760671 DOI: 10.1016/s0929-693x(01)00635-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND A few studies report malnutrition in hospitalized patients. MATERIAL AND METHODS This one-day cross-sectional survey performed in January 1999 assessed nutritional status and protein-energy intake in a pediatric population hospitalized in medicine or surgery units. Every child older than six months, hospitalized for more than 48 h and free of nutritional support (parenteral, enteral, or special regimens for metabolic diseases) was included. RESULTS Fifty-eight children among the 183 present the day of the study met the inclusion criteria and were included in the statistical analysis. They were hospitalized in medicine (48%), psychiatry (31%) and surgery (21%). The body mass index (BMI) was below -2 standard deviations (DS) in 21% of them. Excluding patients with anorexia nervosa, BMI was < -2 SD, > +2 SD, or in between these limits in respectively 12, 14 and 74%. Energy intake measured at the hospital was below 75% of the recommended dietary allowances in two-thirds of the children whether malnourished or not. Fifty percent of the malnourished children had been referred to a dietician the day of the study. CONCLUSIONS Malnutrition is frequent in a population of hospitalized children. Energy intake and referral to a dietician are insufficient.
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Affiliation(s)
- R Hankard
- Comité de liaison alimentation nutrition, hôpital Robert-Debré, 48, boulevard Serurier, 75019 Paris, France.
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Abstract
This review critically examines the relationship between nutritional status and malaria. The data indicate that protein-energy malnutrition is associated with greater malaria morbidity and mortality in humans. In addition, controlled trials of either vitamin A or zinc supplementation show that these nutrients can substantially reduce clinical malaria attacks. Data for iron indicate that supplementation may minimally aggravate certain malariometric indices in some settings and also strongly improve hematologic status. Withholding of iron supplements from deficient population is, therefore, not currently indicated. Available evidence for other nutrients describe varied effects, with some deficiencies being exacerbative (e.g., thiamine), protective (e.g., vitamin E), or both exacerbative and protective in different settings (e.g., riboflavin, vitamin C). The roles of folate, other B vitamins, unsaturated fatty acids, amino acids, and selenium are also examined. Study of the interactions between nutrition and malaria may provide insight to protective mechanisms and result in nutrient-based interventions as low-cost and effective adjuncts to current methods of malaria prevention and treatment.
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Affiliation(s)
- A H Shankar
- Departments of International Health and of Molecular Microbiology and Immunology, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland, USA.
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