A longitudinal assessment of the diet and growth of malnourished children participating in nutrition rehabilitation centres in Accra, Ghana

Can Sever Acute Malnourished children be effectively rehabilitated physically, biochemically and developmentally at nutritional rehabilitation centers: A follow up study from Ujjain

Background

Under-nutrition has got serious and lasting impact on health, development, society and economy. It may result in poor growth, development of child and can cause increase mortality, morbidity, health care cost, low productivity and economic growth. Nutritional rehabilitation is one of key intervention to address the under nutrition. It is questionable that nutritional intervention has potential to improve multiple domains.

Methods

Follow up study evaluated the multi-domain impact of nutritional interventions on 204 admitted Severe Acute Malnutrition (SAM) children. Data was analyzed with SPSS version 20.

Results

Significant positive changes were observed in physical, biochemical, developmental domains. Macnemar, paired t- test, co relation, z test were applied for data analysis.

Conclusion

Nutritional intervention was found to be effective in improving selected physical, biochemical and developmental parameters. After discharge rate of improvement in anthropometric parameters was less. Actual quantification of recovery especially in biochemical and developmental parameters due to nutritional intervention is difficult.

Comparative study of the nutritional composition of local brown rice, maize (obaatanpa), and millet-A baseline research for varietal complementary feeding

INTRODUCTION

Childhood malnutrition remains a major public health issue of concern particularly in sub-Saharan Africa, and inadequate complementary feeding is a common cause. Promoting dietary diversity is one way of tackling this problem. High dependence on maize has its limitations; modifying other local staples into complementary foods can be a feasible alternative to promote optimum nutrition.

OBJECTIVES

Comparing the nutritional composition of brown rice to millet and maize to determine its beneficial value as complementary food.

METHODS

Experimental study was carried out at the Department of Nutrition and Food Science of University of Ghana. Samples of maize, millet, and brown rice were obtained from the Ministry of Agriculture, Accra and nutritional contents analyzed. Statistical Package for Social Sciences version 20.0 and ANOVA were used to assess differences.

RESULTS

Results showed brown rice contained the highest content of carbohydrates (77.94 ± 0.32) % and zinc (12.15 ± 0.21) mg while millet had the highest protein (10.49 ± 0E-7) mg and fat (4.99 ± 0.46) % content. Maize contained highest amount of calcium (21.24 ± 0.14) mg. Iron was only found in millet (10.72 ± 0.15) mg. The zinc content per 100 g of all three (3) cereals was above RDA. All three (3) cereals contributed significantly <10% to the RDA of calcium. Iron content of millet contributed more than 90% to RDA.

CONCLUSIONS

Locally produced brown rice is rich in zinc and carbohydrates compared to millet and maize. Thus, can be used for complementary feed but, given the low protein and iron content, it may need to be fortified or diversified and used as a cereal blend.

A prospective observational study to evaluate the efficacy of facility-based management in malnourished children at NRC, district Meerut

BACKGROUND

Scarcity of suitable food, lack of purchasing power of the family as well as traditional beliefs and taboos about what the baby should eat, often lead to a sufficient balanced diet, resulting in malnutrition. In children, malnutrition is synonymous with growth failure. Malnourished children are shorter and weigh less than they should be for their age and height.

MATERIALS AND METHODS

The present study was conducted from September 2017 to November 2017.112 malnourish children, aged 6-60 months who were admitted to NRC during the study period at district hospital Meerut were assessed. Checklist based on operational guidelines on facility based management was used. Data was analyzed in Microsoft Excel and Epi info.

RESULT

In the studied population, there were 45 males and 67 females, out of which highest representation was from the age group of 13 to 24 months.67% of studied population belonged to schedule caste. The average weight gain during the stay at the center was 9.92±5.43g/kg/day. The average duration of stay at NRC was 12.01±1.61 days. Only 30% of mothers had appropriate knowledge regarding therapeutic diet and only 50% of the mothers know about the preparation of nutritious food from locally available foods.

CONCLUSION

Targeted supplementary nutrition and therapeutic nutrition with specific micronutrients when provided to malnourish children for 14 days by Nutrition Rehabilitation Center can be helpful to improve their nutritional status. There is need to scale up community awareness and community participation for NRCs.

Impact of type of child growth intervention program on caregivers' child feeding knowledge and practices: a comparative study in Ga West Municipality, Ghana

Community-based growth promotion (CBGP) delivered by community volunteers aims at enhancing the traditional growth monitoring and promotion (GMP) program delivered by community health nurses through the promotion of optimum infant and young child feeding (IYCF) leading to improved child growth. This study compared IYCF knowledge and practices among caregiver-child pairs (0-24 months) receiving child welfare services from CBGP (n = 124) and GMP (n = 108) programs. Semistructured questionnaires were used to interview caregivers on IYCF knowledge/practices and validated food frequency questionnaire used to record infants' food intakes. Group differences were determined using Chi-square and independent samples t-tests (P < 0.05; 95% confidence interval [CI]). Mean IYCF knowledge scores were similar (CBGP: 10.84 ± 1.69 vs. GMP: 10.23 ± 1.38, P = 0.062). However, more CBGP caregivers (17%) were highly knowledgeable than their GMP counterparts (5%) (P = 0.011). Early breastfeeding initiation (CBGP: 54% vs. GMP: 28%, P < 0.0001), exclusive breastfeeding (CBGP: 73% vs. GMP: 56%, P = 0.001), and timely complementary feeding (CBGP: 72% vs. GMP: 49%, P = 0.014) were reportedly higher among CBGP caregivers. Underweight was 11% (CBGP: 8% vs. GMP: 14%, P = 0.154). Mean dietary diversity scores (10 food groups) were similar (CBGP: 4.49 ± 1.89 vs. GMP: 3.87 ± 1.89, P = 0.057) but more CBGP caregivers (77%) achieved minimum dietary diversity than their GMP counterparts (61%) (P = 0.035). Few caregivers achieved minimum meal frequency (CBGP: 31% vs. GMP: 29%, P = 0.486) and minimum acceptable diet (CBGP: 23% vs. GMP: 21%, P = 0.464) indicators. Number of children under 5 years owned by caregiver (adjusted odds ratio [AOR]: 0.405; 95% CI: 1.13-78.53, P = 0.038), her educational level (AOR: 0.112; 95% CI: 0.02-0.90, P = 0.040), and IYCF knowledge (AOR: 0.140; 95% CI: 0.03-0.79, P = 0.026) significantly predicted optimum child feeding. Nutrition education on optimum complementary feeding and birth spacing strategies should intensify.

Preferred delivery method and acceptability of Wheat-Soy Blend (WSB++) as a daily complementary food supplement in northwest Bangladesh

Fortified blended foods (FBFs) are widely used to prevent undernutrition in early childhood in food-insecure settings. We field tested enhanced Wheat Soy Blend (WSB++)-a FBF fortified with micronutrients, milk powder, sugar, and oil-in preparation for a complementary food supplement (CFS) trial in rural northwestern Bangladesh. Formative work was conducted to determine the optimal delivery method (cooked vs. not) for this CFS, to examine mothers' child feeding practices with and acceptance of the WSB++, and to identify potential barriers to adherence. Our results suggest WSB++ is an acceptable CFS in rural Bangladesh and the requirement for mothers to cook WSB++ at home is unlikely to be a barrier to its daily use as a CFS in this population.

Evaluation of a residential nutrition rehabilitation center in rural Bolivia: short-term effectiveness and follow-up results

BACKGROUND

Nutrition rehabilitation centers (NRCs) have shown mixed results in reducing morbidity and mortality among undernourished children in the developing world. Follow-up on children after leaving these programs remains undocumented.

OBJECTIVE

To assess the nutritional improvement of children attending the Centro de Rehabilitación Infantil Nutricional (CRIN), a residential NRC in rural Bolivia, from entrance to exit and to a household follow-up visit 1 month to 6 years later, and to identify factors associated with nutritional improvement.

METHODS

A retrospective analysis was conducted of clinical records collected by CRIN staff from 135 children under 3 years of age attending CRIN in rural Cochabamba, Bolivia, from 2003 to 2009, and of clinical records of household follow-up measurements on a subset of 26 children that were taken between 1 month and 6 years postexit. Nutritional status was evaluated by calculating z-scores for weight-for-height (WHZ), weight-for-age (WAZ), and height-for-age (HAZ). Children with z-scores < -2 were considered to be wasted, underweight, or stunted, respectively.

RESULTS

The prevalence of wasting decreased significantly, while the prevalence of stunting did not change significantly between entrance and exit from the program. From entrance to exit, the mean changes in WHZ (0.79) and WAZ (1.08) were statistically significant, while the mean change in HAZ (-0.02) was not significant. Linear regression analysis suggested that nutritional status and diarrhea at entrance had the greatest effect on WHZ and HAZ changes between entrance and exit. Children maintained their nutritional gains from the program between exit and follow-up and showed statistically significant improvement in WAZ (but not HAZ).

CONCLUSIONS

CRIN is effective at rehabilitating nutritional deficits associated with wasting, but not those associated with stunting.

A study to evaluate the effect of nutritional intervention measures on admitted children in selected nutrition rehabilitation centers of indore and ujjain divisions of the state of madhya pradesh (India)

Background:

The state of Madhya Pradesh has 1.3 million severely malnourished children. Nutrition rehabilitation centers (NRCs) were started in the state to control severe malnutrition and decrease the prevalence of severe malnourished children to less than 1% among children aged 1–5 years.

Materials and Methods:

The present study was conducted from November 2008 to October 2009; 100 children admitted to seven different NRCs in Indore and Ujjain divisions of Madhya Pradesh were observed during their stay at NRCs and the follow-up period to analyze the effect of interventional measures on select anthropometric indicators. Mothers of the children were interviewed on health issues and therapeutic feeding practices at the NRCs using a predesigned and pretested interview schedule.

Results:

The study group consisted of 48 boys and 52 girls; 60% were between 13 and 36 months of age. 93 children were analyzed for anthropometric indicators following a dropout rate of 7%. A statistically significant difference was obtained between the weight of children at admission and discharge (t=14.552, P<0.001); difference of mid upper arm circumference (MUAC) at admission and discharge was statistically significant (t=9.548, P<0.001). The average weight gain during the stay at the centers was 9.25 ± 5.89 g/kg/day. Though the number of severe malnourished children decreased from 85 to 43 following the stay at NRCs (χ² = 44.195, P<0.001); 48.78% of the children lost weight within 15 days of discharge from the NRCs. Dropout rates of 9.89%, 23.07%, 42.65%, and 61.76% for the study group were obtained during the follow-up period of 6 months for the four follow-up visits conducted 15 days, 1, 3, and 6 months after discharge. The mothers of the children lacked adequate information on health issues and composition and preparation of therapeutic diets at the centers.

Conclusion:

The NRCs were effective in improving the condition of admitted children, but the effects were not sustained following discharge due to high drop-out rate and lack of adequate parental awareness. There is an urgent need to link these centers with community-based models for follow-up and improve health education measures to maintain the gains achieved.

An examination of environmental correlates with childhood height-for-age in Ghana

OBJECTIVE

The relationship between a child's environment and nutritional status is difficult to examine yet could offer an important guide to policy. The objective of the present work was to examine individual and environmental correlates with childhood height-for-age in Ghana.

DESIGN

Data were derived from the 2008 MEASURE Demographic and Health Survey in Ghana, the 2000 Ghana Population and Housing Census, and the World Wide Fund for Nature's eco-regions database. A generalized linear mixed regression model was used to estimate the effects of individual and environmental correlates on height-for-age.

SUBJECTS

The study examined 2225 Ghanaian children aged 0-59 months.

SETTING

The setting was all districts in Ghana for the year 2008.

RESULTS

After accounting for individual characteristics of children, mothers and households, height-for-age was significantly associated with population density. Other significantly associated variables in the final model were the age of the child, vaccination status, the size of the child at birth, months of breast-feeding, mother's BMI, whether the child's mother had health insurance and wealth quintile.

CONCLUSIONS

In addition to a number of characteristics of the children and their households, the social milieu is important to understanding differences in height-for-age among children in Ghana. The biophysical environment was not associated with height-for-age.

A 15-year study on the treatment of undernourished children at a nutrition rehabilitation centre (CREN), Brazil

Objective

To build a life table and determine the factors related to the time of treatment of undernourished children at a nutrition rehabilitation centre (CREN), São Paulo, Brazil.

Design

Nutritional status was assessed from weight-for-age, height-for-age and BMI-for-age Z-scores, while neuropsychomotor development was classified according to the milestones of childhood development. Life tables, Kaplan–Meier survival curves and Cox multiple regression models were employed in data analysis.

Setting

CREN (Centre of Nutritional Recovery and Education), São Paulo, Brazil.

Subjects

Undernourished children (n 228) from the southern slums of São Paulo who had received treatment at CREN under a day-hospital regime between the years 1994 and 2009.

Results

The Kaplan–Meier curves of survival analysis showed statistically significant differences in the periods of treatment at CREN between children presenting different degrees of neuropsychomotor development (log-rank = 6·621; P = 0·037). Estimates based on the multivariate Cox model revealed that children aged ≥24 months at the time of admission exhibited a lower probability of nutritional rehabilitation (hazard ratio (HR) = 0·49; P = 0·046) at the end of the period compared with infants aged up 12 months. Children presenting slow development were better rehabilitated in comparison with those exhibiting adequate evolution (HR = 4·48; P = 0·023). No significant effects of sex, degree of undernutrition or birth weight on the probability of nutritional rehabilitation were found.

Conclusions

Age and neuropsychomotor developmental status at the time of admission to CREN are critical factors in determining the duration of treatment.

Height and weight gains in a nutrition rehabilitation day-care service

OBJECTIVE

To evaluate nutritional recovery patterns in 106 undernourished children assisted by the Center of Nutritional Recovery and Education (CREN, in Portuguese) between January 1995 and December 1999.

DESIGN

CREN assists undernourished children aged 0 to 72 months living in the southern regions of Sao Paulo, in an outpatient setting. Nutritional status was assessed by Z-scores of weight-for-age, height-for-age and weight-for-height. Nutritional recovery evaluation considered Z-score gains in weight-for-age and height-for-age, grouping into four categories (Z-score increment of 0.50 between groups). Children with birth weight less than 2500 g were classified as low birth weight (LBW), while those born at term and with LBW were classified as small for gestational age.

SETTING

CREN (Center of Nutritional Recovery and Education in Portuguese), Sao Paulo, Brazil.

SUBJECTS

One hundred and six children from CREN.

RESULTS

Among the 106 evaluated children, ninety-eight (92.5 %) recovered their weight or height and seventy-two (67.9 %) recovered both. Nearly half of studied children presented a nutritional recovery (increase in Z-score) of more than 0.50 in height-for-age (46.2 %) and about 40 % in weight-for-age (38.7 %). Multivariate analysis showed that treatment duration and initial weight-for-age contributed to weight-for-age Z-score increment, explaining 25 % of the variation; and treatment duration, initial height-for-age and weight-for-age Z-score increment contributed to height-for-age Z-score increment, explaining 62 % of the variation.

CONCLUSIONS

Our findings show that nutritional recovery among children who attended CREN was influenced primarily by the degree of nutritional deficit at admission. It has also been shown that biological variables are more important than socio-economic status in determining the rate of nutritional recovery.

Efficacy and effectiveness of community-based treatment of severe malnutrition

BACKGROUND

There is a long tradition of community-based rehabilitation for treatment of severe malnutrition: the question is whether it is effective and whether it should be advised for routine health systems.

OBJECTIVE

To examine the effectiveness of rehabilitating severely malnourished children in the community in nonemergency situations.

METHODS

A literature search was conducted of community-based rehabilitation programs delivered by day-care nutrition centers, residential nutrition centers, primary health clinics, and domiciliary care with or without provision of food, for the period 1980-2005. Effectiveness was defined as mortality of less than 5% and an average weight gain of at least 5 g/kg/day.

RESULTS

Thirty-three studies of community-based rehabilitation were examined and summarized. Eleven (33%) programs were considered effective. Of the sub-sample of programs reported since 1995, 8 of 13 (62%) were effective. None of the programs operating within routine health systems without external assistance was effective.

CONCLUSIONS

With careful planning and resources, all four delivery systems can be effective. It is unlikely that a single delivery system would suit all situations worldwide. The choice of a system depends on local factors. High energy intakes (> 150 kcal/kg/day), high protein intakes (4-6 g/kg/day), and provision of micronutrients are essential for success. When done well, rehabilitation at home with family foods is more cost-effective than inpatient care, but the cost effectiveness of ready-to-use therapeutic foods (RUTF) versus family foods has not been studied. Where children have access to a functioning primary health-care system and can be monitored, the rehabilitation phase of treatment of severe malnutrition should take place in the community rather than in the hospital but only if caregivers can make energy- and protein-dense food mixtures or are given RUTF. For routine health services, the cost of RUTF, logistics of procurement and distribution, and sustainability need to be carefully considered.