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Sahu SK, Pradhan DD, Gudu RK, Tripathy SK, Jena P. Prevalence of Acute Bacterial Infections and Their Antibiotic Sensitivity Pattern in Children With Severe Acute Malnutrition From a Tertiary Care Hospital of Odisha. Cureus 2024; 16:e65280. [PMID: 39184695 PMCID: PMC11343070 DOI: 10.7759/cureus.65280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Background and objective Malnutrition remains a significant cause of childhood morbidity and mortality worldwide. Severe acute malnutrition (SAM) profoundly affects immune development, physiological functions, and metabolic processes, increasing susceptibility to infections. This study aimed to investigate the prevalence of acute bacterial infections and their antibiotic sensitivity patterns among SAM children admitted to a tertiary care hospital. Methodology This prospective observational study was conducted at the pediatric department of Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, from November 2020 to October 2023. The study included 95 children aged 6-59 months meeting WHO criteria for SAM. Participants underwent comprehensive demographic assessments, clinical evaluations, and relevant laboratory tests, including blood and urine cultures with sensitivity testing. Results The study found that 82.1% of children had weight-for-height below -3 standard deviations, and 84.21% had mid-upper arm circumference below 115 mm, confirming SAM diagnosis. The most prevalent infections were acute gastroenteritis (47.3%), respiratory tract infections (46.3%), bacteremia (27.4%), and urinary tract infections (26.3%). Positive urine cultures were observed in 25 cases (26.3%), predominantly among females (68%). Escherichia coli (40%) and Klebsiella pneumoniae (24%) were the most common organisms isolated from urine, with high sensitivity to gentamicin (76%) and meropenem (72%). Blood cultures were positive in 26 cases (27.36%), with Staphylococcus aureus (30.76%) and Klebsiella pneumoniae (23%) being predominant. Blood isolates showed significant sensitivity to vancomycin (73%), meropenem (69.2%), and linezolid (65.3%). Conclusion Acute gastroenteritis, respiratory tract infections, bacteremia, and urinary tract infections are prevalent among SAM children. Staphylococcus aureus was frequently isolated from blood cultures, while Escherichia coli were predominant in urine cultures. High sensitivity of urinary isolates to gentamicin and meropenem, and of blood isolates to vancomycin, meropenem, and linezolid, highlights effective antibiotic choices. These findings emphasize the importance of tailored antimicrobial therapy based on local sensitivity patterns to improve clinical outcomes in SAM children.
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Affiliation(s)
| | - Deepti D Pradhan
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Rama K Gudu
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Suresh K Tripathy
- Neonatology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Pravati Jena
- Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Jini P, Prasad A, Lomash A, Bhardwaj N, Singh R, Agrawal A, Kapoor S. Aminoacid Profiling of Children with Severe Acute Malnutrition Pre and Post Nutritional Rehabilitation. Indian J Clin Biochem 2022; 37:93-99. [PMID: 35125698 PMCID: PMC8799827 DOI: 10.1007/s12291-020-00926-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/12/2020] [Indexed: 01/03/2023]
Abstract
Malnutrition is a significant comorbidity in nearly one-third of the 8 million deaths in children under five years of age worldwide. Children with severe acute malnutrition have severely disturbed physiology and metabolism. Considering the vital importance of amino acids and the likely changes with the therapeutic diet, we aimed at evaluating these changes in children with SAM at baseline and after rehabilitation with a therapeutic diet at 14 days. Severe acute malnutrition defined as per WHO, for children between 6 months and 5 years with weight for height/length < -3SD of WHO charts, bilateral pitting edema, and mid-upper arm circumference (MUAC) < 1.5 cm. A total of 38 children were enrolled as cases, whereas the control group comprised of 37 children. Anthropometric measurement and estimation of amino acids in the blood were done at the baseline and after dietary rehabilitation. The individual levels of the essential and non-essential amino acids were significantly lower in the cases as compared to the controls, except for Aspartate and Threonine. The levels of amino acids increased significantly after dietary rehabilitation except for arginine, however not to the levels of those in controls. Most of the metabolites were reflective of maladaptation in SAM. Though nutritional rehabilitation of children with SAM improved the levels of amino acids, these levels were still low when compared to the controls, stipulating that complete metabolic recovery may take a longer duration of time. This necessitates the continuation of nutritional rehabilitation for a longer time and regular follow up of these children to ensure better compliance.
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Affiliation(s)
- Pepu Jini
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Anupa Prasad
- Biochemistry Department, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand India
| | - Avinash Lomash
- Division of Genetics, Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Namita Bhardwaj
- Division of Genetics, Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Raghavendra Singh
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Anurag Agrawal
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Seema Kapoor
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Takele WW, Baraki AG, Wolde HF, Desyibelew HD, Derseh BT, Dadi AF, Mekonnen EG, Akalu TY. Anemia and Contributing Factors in Severely Malnourished Infants and Children Aged between 0 and 59 Months Admitted to the Treatment Centers of the Amhara Region, Ethiopia: A Multicenter Chart Review Study. Anemia 2021; 2021:6636043. [PMID: 33854799 PMCID: PMC8019621 DOI: 10.1155/2021/6636043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/25/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anemia among severely malnourished children is a double burden that could make the treatment outcome of severe acute malnutrition (SAM) more unfavorable. The burden and the factors are, however, uncovered among children in the Amhara region. Therefore, the study was aimed at determining the prevalence of anemia and identifying contributing factors in severely malnourished children aged between 0 and 59 months admitted to the treatment centers of the Amhara region referral hospitals. METHODS A facility-based cross-sectional study was conducted that included 1,301 infants and children, who developed SAM and were admitted to the three referral hospitals of the Amhara region. Data were extracted using a data extraction checklist. The binary logistic regression analysis was employed to show an association between the dependent and independent variables. Multicollinearity was assessed using the variance inflation factor (VIF) and no problem was detected (overall VIF = 1.67). The presence of association was declared based on the p-value (≤0.05), and the adjusted odds ratio with its respective 95% confidence interval was used to report the direction, as well as the strength of association. RESULTS About 41.43% (95% CI: 38.78%-44.13%) of severely malnourished infants and children have developed anemia, of which around half (47%) of them were under six months old. Rural residence (AOR = 1.56; 95% CI: 1.14-2.12) and HIV infection (AOR = 2.00; 95% CI: 1.04-3.86) were significantly associated with higher odds of anemia. Furthermore, being exclusively breastfed (AOR = 0.57; 95% CI 0.39-0.83) remarkably reduced the likelihood of anemia. CONCLUSIONS This data confirms that anemia among severely malnourished infants and children is a public health problem in the Amhara region. Infants younger than six months were at a higher risk of anemia. Being a rural resident and contracting HIV infection have elevated the occurrence of anemia, whereas being exclusively breastfed decreased the risk. Therefore, the study gives an insight to policymakers and planners to strengthen the existing exclusive breastfeeding practice. Strategies being practiced to prevent HIV transmission and early detection, as well as treatment, should also be strengthened. Furthermore, mothers/caretakers of infants and children residing in the rural areas deserve special attention through delivering nutrition education.
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Affiliation(s)
- Wubet Worku Takele
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adhanom Gebreegziabher Baraki
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hanna Demelash Desyibelew
- Department of Human Nutrition, College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Behailu Tariku Derseh
- Department of Public Health, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abel Fekadu Dadi
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Epidemiology and Biostatistics, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA 5001, Australia
| | - Eskedar Getie Mekonnen
- Departent of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Negussie AS, Tadesse AW. Predictors of undesirable treatment outcomes of severe acute malnutrition among inpatient children in Addis Ababa, Ethiopia: a retrospective cohort study. BMC Public Health 2020; 20:1532. [PMID: 33036594 PMCID: PMC7547421 DOI: 10.1186/s12889-020-09645-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background In 2018, malnutrition contributed to 45% of all global cause of child death. These early child deaths were due to conditions that could either be prevented or treated with basic interventions. Hence, this study intended to provide a quantitative estimate of factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM). Methods We studied a retrospective cohort of 304 children aged 6–59 months with complicated SAM admitted to Yekatit 12 Hospital Medical College from 2013 to 2016. We extracted data from hospital records on nutritional status, socio-demographic factors and medical conditions during admission. The analysis was carried out using SPSS version 20. The Kaplan-Meier estimator was employed to analyze the recovery rate of the children treated for SAM and multivariable Cox regression was used to determine factors that predict inpatient undesirable treatment outcomes. Result From a total of 304 children 6–59 months with SAM, 133 (51.4%) were boys. Marasmus was the most common type (132 (51%)) of severe acute malnutrition. The recovery, death and defaulter rate were 70.4, 12.2 and 8.2% respectively. The main predictors of undesirable treatment outcomes were found to be the presence of HIV antibody (AHR = 3.208; 95% CI: [1.045–9.846]) and sepsis (AHR = 7.677, 95% CI: [2.320–25.404]). Conclusion The study revealed that the overall treatment outcomes were below the SPHERE standard recommendation. The main predictors of undesirable treatment outcomes among inpatient children treated for SAM were HIV and sepsis. Intervention to reduce undesirable treatment outcomes should focus on comorbidities, especially HIV and sepsis.
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Adem F, Edessa D, Bayissa B, Mohammed Hassen M, Mohammed MA. Treatment Outcomes and Associated Factors in Hospitalised Children with Severe Acute Malnutrition: A Prospective Cohort Study. Pediatric Health Med Ther 2020; 11:235-243. [PMID: 32765158 PMCID: PMC7382579 DOI: 10.2147/phmt.s253396] [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: 03/11/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Malnutrition continues to be a public health challenge in sub-Saharan African countries. In Ethiopia, there is a paucity of data regarding factors affecting treatment outcomes in children with severe acute malnutrition (SAM). METHODS A prospective cohort study was conducted among children aged 6 to 59 months with SAM, receiving care at Jimma University Medical center, Ethiopia. Bivariate and multivariate analyses were computed to determine factors associated with treatment outcomes. Kaplan-Meier survival analysis, life-table analysis, and Log rank test were used to determine death rates, estimate the proportion of surviving, and compare time to recovery (nutritional cure). RESULTS A total of 133 children were included in this study and 79.7% had medical comorbidities. Overall, nutritional recovery, death, and default rates were 25.6%, 3.8%, and 7.6%, respectively. There was no significant difference in the nutritional recovery rate (26.1% versus 25.4%; p=0.4) and the median time to recovery between children who had diarrhea at admission (26 days; 95% CI: 24.0-28.7) and those who had not (26.0 days; 95% CI: 21.90-30.10). Likewise, the average daily weight gain was not significantly different between the two groups (6.34 g/kg/day versus 7.76g/kg/day, p=0.4). Having diagnosed with tuberculosis (Adjusted Hazard Ratio (AHR)=0.19, CI 0.06-0.62) and anemia (AHR =0.32, CI 0.14-0.74) and treatment failures (AHR=0.17, CI, 0.16-0.03) were predicting factors for time to recovery. CONCLUSION The recovery rate and average daily weight gain were found to be sub-optimal in the study population. However, the median time to recovery was within the national recommendation. There was no significant difference in the recovery rate and time to recovery between the two groups. Treatment failures and the presence of tuberculosis and anemia were indicators for prolonged stabilization phase and time to achieve nutritional cure. Optimal average daily weight gain and clinical management of comorbidities may enhance early recovery in hospitalised children with SAM.
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Affiliation(s)
- Fuad Adem
- Department of Clinical Pharmacy, School of Pharmacy, Haramaya University, Oromia, Ethiopia
| | - Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, Haramaya University, Oromia, Ethiopia
| | | | - Mesud Mohammed Hassen
- Madda-Walabu University, School of Medicine and Health Sciences, Madda-Walabu, Ethiopia
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Ahn E, Ouma C, Loha M, Dibaba A, Dyment W, Kim J, Beck NS, Park T. Do we need to reconsider the CMAM admission and discharge criteria?; an analysis of CMAM data in South Sudan. BMC Public Health 2020; 20:511. [PMID: 32299403 PMCID: PMC7164168 DOI: 10.1186/s12889-020-08657-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 04/05/2020] [Indexed: 11/20/2022] Open
Abstract
Background Weight-for-height Z-score (WHZ) and Mid Upper Arm Circumference (MUAC) are both commonly used as acute malnutrition screening criteria. However, there exists disparity between the groups identified as malnourished by them. Thus, here we aim to investigate the clinical features and linkage with chronicity of the acute malnutrition cases identified by either WHZ or MUAC. Besides, there exists evidence indicating that fat restoration is disproportionately rapid compared to that of muscle gain in hospitalized malnourished children but related research at community level is lacking. In this study we suggest proxy measure to inspect body composition restoration responding to malnutrition management among the malnourished children. Methods The data of this study is from World Vision South Sudan’s emergency nutrition program from 2006 to 2012 (4443 children) and the nutrition survey conducted in 2014 (3367 children). The study investigated clinical presentations of each type of severe acute malnutrition (SAM) by WHZ (SAM-WHZ) or MUAC (SAM-MUAC), and analysed correlation between each malnutrition and chronic malnutrition. Furthermore, we explored the pattern of body composition restoration during the recovery phase by comparing the relative velocity of MUAC3 with that of weight gain. Results As acutely malnourished children identified by MUAC more often share clinical features related to chronic malnutrition and minimal overlapping with malnourished children by WHZ, Therefore, MUAC only screening in the nutrition program would result in delayed identification of the malnourished children. Conclusions The relative velocity of MUAC3 gain was suggested as a proxy measure for volume increase, and it was more prominent than that of weight gain among the children with SAM by WHZ and MUAC over all the restoring period. Based on this we made a conjecture about dominant fat mass gain over the period of CMAM program. Also, considering initial weight gain could be ascribed to fat mass increase, the current discharge criteria would leave the malnourished children at risk of mortality even after treatment due to limited restoration of muscle mass. Given this, further research should be followed including assessment of body composition for evidence to recapitulate and reconsider the current admission and discharge criteria for CMAM program.
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Affiliation(s)
- Eunyong Ahn
- Korea Basic Science Institute, Seoul, Korea.,Research Institute of Basic Science, Seoul National University, Seoul, Korea
| | - Cyprian Ouma
- World Food Programme, Regional Bureau-Nairobi, Nairobi, Kenya
| | - Mesfin Loha
- East Africa Regional Office, World Vision, Nairobi, Kenya
| | - Asrat Dibaba
- East Africa Regional Office, World Vision, Nairobi, Kenya
| | | | - Jaekwang Kim
- Department of Statistics, Iowa State University, Ames, USA
| | | | - Taesung Park
- Department of Statistics, Seoul National University, Seoul, Korea. .,Interdisciplinary program in Bioinofrmatics, Seoul National University, Seoul, Korea.
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Prevalence, outcome and quality of care among children hospitalized with severe acute malnutrition in Kenyan hospitals: A multi-site observational study. PLoS One 2018; 13:e0197607. [PMID: 29771994 PMCID: PMC5957373 DOI: 10.1371/journal.pone.0197607] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 05/04/2018] [Indexed: 11/23/2022] Open
Abstract
Background Severe acute malnutrition (SAM) remains a major cause of admission and inpatient mortality worldwide in children aged less than 5 years. In this study, we explored SAM prevalence and outcomes in children admitted in 13 Kenyan hospitals participating in a Clinical Information Network (CIN). We also describe their immediate in-patient management. Methods We analyzed data for children aged 1–59 months collected retrospectively from medical records after discharge. Mean, median and ranges were used to summarize pooled and age-specific prevalence and mortality associated with SAM. Documentation of key signs and symptoms (S/S) and performance of indicators of quality of care for selected aspects of the WHO management steps were assessed. Logistic regression models were used to evaluate associations between documented S/S and mortality among SAM patients aged 6–59 months. Loess curves were used to explore performance change over time for indicators of selected SAM management steps. Results 5306/54140 (9.8%) children aged 1–59 months admitted with medical conditions in CIN hospitals between December 2013 and November 2016 had SAM. SAM prevalence identified by clinicians and case fatality varied widely across hospitals with median proportion (range) of 10.1% (4.6–18.2%) and 14.8% (6.0–28.6%) respectively. Seventeen variables were associated with increased mortality. Performance change over time of management steps varied across hospitals and across selected indicators but suggests some effect of regular audit and feedback. Conclusion Identification of SAM patients, their mortality and adherence to in-patient management recommendations varied across hospitals. An important group of SAM patients are aged less than 6 months. Continued efforts are required to improve management of SAM in routine settings as part of efforts to reduce inpatient mortality.
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Ndemwa M, Wanyua S, Kaneko S, Karama M, Anselimo M. Nutritional status and association of demographic characteristics with malnutrition among children less than 24 months in Kwale County, Kenya. Pan Afr Med J 2017; 28:265. [PMID: 29881508 PMCID: PMC5989189 DOI: 10.11604/pamj.2017.28.265.12703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 10/20/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction Malnutrition is an underlying cause of mortality in about half of the cases that occur among children less than five years in developing countries. In Africa including Kenya, this problem may be exacerbated by socio-demographic and socio-economic factors. This study aimed at determining nutritional status and association of demographic characteristics with malnutrition among children aged 1 day to 24 months in Kwale County, Kenya. Methods A cross-sectional study was done in Mwaluphamba Location, Kwale County, Kenya. Data was collected using a semi-structured questionnaire and administered to 380 randomly selected mothers who had children under the age of two years. Nutrition status was determined using anthropometric measurements. Data was analyzed using descriptive statistics and associations were determined by univariate logistic regression. Results Malnutrition prevalence for children in Kwale was high with 29.2% of the children being stunted and 13.4% being severely stunted. Underweight prevalence was at 20.8% of whom 9.5% were severely underweight. The global acute malnutrition rate was 18.9%. Stunting differed significantly between sex (males 35.1% compared to females 21.7%; p = 0.005). Significant differences were also observed in stunting and underweight due to age (p < 0.005). Conclusion The prevalence of stunting, underweight and global acute malnutrition rates was high among the children. Male children were associated with a significantly higher prevalence of stunting than the females. The prevalence of underweight and stunting significantly increased with increasing age.
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Affiliation(s)
- Morris Ndemwa
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.,Nagasaki University Institute of Tropical Medicine, Nairobi, Kenya
| | - Sheru Wanyua
- African Population Health Research Center, Nairobi, Kenya
| | - Satoshi Kaneko
- Nagasaki University Institute of Tropical Medicine, Nairobi, Kenya.,Department of Eco-Epidemiology, Institute of Tropical Medicine, Nagasaki University, Japan
| | - Mohammed Karama
- Nagasaki University Institute of Tropical Medicine, Nairobi, Kenya.,Center for Public Health Research, Kenya Medical Research Institute (KEMRI) Nairobi, Kenya
| | - Makokha Anselimo
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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Yohannes T, Laelago T, Ayele M, Tamrat T. Mortality and morbidity trends and predictors of mortality in under-five children with severe acute malnutrition in Hadiya zone, South Ethiopia: a four-year retrospective review of hospital-based records (2012-2015). BMC Nutr 2017; 3:18. [PMID: 32153800 PMCID: PMC7050820 DOI: 10.1186/s40795-017-0135-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/11/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Severe acute malnutrition remains one of the most common causes of morbidity and mortality in Sub-Saharan Africa. The objective of this study was to investigate morbidity and mortality trends and factors associated with mortality of under-five children admitted and managed for severe acute malnutrition in NEMMH. METHODS Four years retrospective cohort study was conducted on 500 under-five children admitted with the diagnosis of severe acute malnutrition. The study population was all under- five children admitted to the inpatient nutrition unit between 2012 and 2015. Data was entered using Epi-Data version 3.1 and exported to SPSS version 16 for analysis. A Kaplan- Meier curve was also used to estimate survival probability of different types of severe acute malnutrition. Cox proportional hazards regression was used to predict the risk of death among predictor while adjusting for other variables. A P-value less than 0.05 was considered as statistically significant. RESULT A total of 500 children were enrolled into the study. Kwashiorkor was the most frequently recorded morbidity accounting for 43.0%. Pneumonia was seen the commonest form of comorbid disease. It was the most common co-morbidity across all morbidity groups. (27.6% in kwashiorkor, 37.5% in marasmus and 37.7% in marasmic-kwashiorkor). The average length of stay in the hospital was 11 days.Children with new admission were 86% less likely to die than repeated admission given that the children were admitted to paediatric ward (HR: 0.14, 95% CI: (0.06, 0.35). Kaplan Meier survival curves also showed children with marasmus and those with repeated admission had reduced survival rates. The overall mortality rate was 7%. The mortality trends vary irregularly in each year but morbidity trend increased with admission from 2014 to 2015. CONCLUSION Mortality trends of SAM vary irregularly across the years but morbidity trends increased with admission from 2014 to 2015. An admission type was significantly associated with mortality. Morbidity and co-morbid diseases did not show significant effect on mortality of the children. Health extension workers and stakeholders should give due concern on promotion of proper nutrition in a community.
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Affiliation(s)
| | | | - Menen Ayele
- Hossana College of Health Sciences, Hossana, Ethiopia
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Incidence of Refeeding Syndrome and Its Associated Factors in South African Children Hospitalized with Severe Acute Malnutrition. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.8297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Landi M, Swakin E, Minijihau C, Welch H, Tefuarani N, Duke T. Severe malnutrition in children in Papua New Guinea: effect of a multi-faceted intervention to improve quality of care and nutritional outcomes. Paediatr Int Child Health 2017; 37:21-28. [PMID: 26750043 DOI: 10.1080/20469047.2015.1106079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Severe malnutrition remains a major problem in Papua New Guinea; it is associated with 11% of paediatric hospital admissions and 33% of all child deaths, with a case fatality rate around 20%. This article aims to evaluate the effectiveness of a multi-faceted intervention for improving care for children with severe malnutrition. METHODS Severe malnutrition was defined as weight-for-age (WFA) <-3 Z-scores with severe wasting or mid upper arm circumference <115 mm or generalised oedema owing to malnutrition. The intervention included training for health-care workers on WHO guidelines for severe malnutrition, ward-round checklists, posters and support for nurses to provide better patient nutrition. Three point prevalence surveys were conducted; one before the intervention and two afterwards at 3-month intervals. The main outcomes were weight change since admission, energy intake and the proportion of the calculated required energy intake in the previous 24 hours. Each stage of the WHO guidelines for severe malnutrition management was assessed for adherence. RESULTS There were significant improvements in the WHO steps for the management of severe malnutrition. At pre-intervention baseline, children received a median of 356 ml/day (IQR 178-450): 31% (95% CI 21-48) of their estimated daily energy requirements for weight. In the first follow-up survey, children received a median of 820 (IQR 600-1110) ml/day: 98% (95% CI 67-100) of daily energy requirements; and in the second follow-up survey they received 780 (IQR 480-900) ml/day: 86% (95% CI 46-100%) of daily requirement (P<0.001 both for volume received and percentage of energy requirements). Median weight gain prior to the intervention was 1.55 g/kg/day (IQR -4.3-6.0) which increased to 5.56 g/kg/day (IQR -3.7-12.0) and 10.19 g/kg/day (IQR 0-16.0) in the first and second follow-up surveys, respectively (P=0.013). CONCLUSION Implementation of a multi-faceted intervention to improve the management of children with severe malnutrition was associated with improved quality of care and improved weight gain.
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Affiliation(s)
- Michael Landi
- a Paediatric Department , Port Moresby General Hospital , Papua New Guinea
| | - Evelyn Swakin
- a Paediatric Department , Port Moresby General Hospital , Papua New Guinea
| | - Cecilia Minijihau
- a Paediatric Department , Port Moresby General Hospital , Papua New Guinea
| | - Henry Welch
- b Baylor College of Medicine , Houston , Texas , USA
| | - Nakapi Tefuarani
- c School of Medicine & Health Sciences, Uzniversity of Papua New Guinea
| | - Trevor Duke
- d Centre for International Child Health, University of Melbourne , Australia and School of Medicine and Health Sciences, University of Papua New Guinea
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Bahwere P, Balaluka B, Wells JCK, Mbiribindi CN, Sadler K, Akomo P, Dramaix-Wilmet M, Collins S. Cereals and pulse-based ready-to-use therapeutic food as an alternative to the standard milk- and peanut paste-based formulation for treating severe acute malnutrition: a noninferiority, individually randomized controlled efficacy clinical trial. Am J Clin Nutr 2016; 103:1145-61. [PMID: 26984485 DOI: 10.3945/ajcn.115.119537] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 01/26/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The cost of current standard ready-to-use therapeutic food (RUTF) is among the major obstacles to scaling up community-based management of acute malnutrition (CMAM), an important child survival strategy. Identifying a cheaper alternative is a global public health priority. OBJECTIVE We sought to compare the efficacy of soya-maize-sorghum RUTF (SMS-RUTF) with that of standard peanut paste-based RUTF (P-RUTF). DESIGN We used a nonblinded, parallel-group, simple randomized controlled trial along with a day care approach that enrolled 2 groups of children aged 6-23 and 24-59 mo, respectively, with severe acute malnutrition (SAM). RESULTS Intention-to-treat (ITT) and per-protocol (PP) analyses showed noninferiority of SMS-RUTF compared with P-RUTF for the recovery rate [ITT: Δ = -2.0% (95% CI: -7.6%, 3.6%); PP: -1.9% (95% CI: -5.3%, 1.4%)], weight gain [Δ = -0.7 g · kg(-1)· d(-1)(95% CI: -1.3, 0.0 g · kg(-1)· d(-1))], and length of stay [Δ = 2.0 d (95% CI: -1.7, 5.8 d)] in children ≥24 mo of age. In children ≤23 mo of age, the recovery rate of SMS-RUTF was inferior to that of P-RUTF [ITT: Δ = -20.8% (95% CI: -29.9%, -11.7%); PP: -17.2% (95% CI: -25.6%, -8.7%)]. Treatment with SMS-RUTF resulted in a greater increase in hemoglobin [0.670 g/dL (95% CI: 0.420, 0.921 g/dL);P< 0.001]. Treatment with both RUTFs resulted in the replenishment of all of the amino acids tested except for methionine. There were no differences at discharge between RUTF groups in fat mass [Δ = 0.3 kg (95% CI: -0.6, 1.6 kg);P= 0.341] or fat mass index [Δ = 0.4 kg/m(2)(95% CI: -0.3, 1.1 kg/m(2));P= 0.262]. By contrast, comparisons of fat-free mass indicated lower concentrations than the community controls after treatment with either of the 2 RUTFs [Δ = -1.3 kg (95% CI: -2.4, -0.1 kg) andP= 0.034 for comparison between community controls and the SMS-RUTF group; Δ = -1.8 kg (95% CI: -2.9, -0.6 kg) andP= 0.003 for comparison between community controls and the P-RUTF group]. CONCLUSION SMS-RUTF can be used to treat SAM in children aged ≥24 mo to reduce the costs of CMAM programs. More research is required to optimize SMS-RUTF for younger children. This trial was registered in the Pan African Clinical Trial Registry as PACTR201303000475166.
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Affiliation(s)
- Paluku Bahwere
- Valid International, Oxford, United Kingdom; Centre for Research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, University of Brussels, Brussels, Belgium;
| | - Bisimwa Balaluka
- Lwiro Natural Science Research Centre, South Kivu, Democratic Republic of Congo; College of Medicine, Catholic University of Bukavu, South Kivu, Democratic Republic of Congo
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, University College London Institute of Child Health, London, United Kingdom; and
| | | | | | | | - Michèle Dramaix-Wilmet
- Centre for Research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, University of Brussels, Brussels, Belgium
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Nguefack F, Adjahoung CA, Keugoung B, Kamgaing N, Dongmo R. [Hospital management of severe acute malnutrition in children with F-75 and F-100 alternative local preparations: results and challenges]. Pan Afr Med J 2015; 21:329. [PMID: 26587175 PMCID: PMC4633737 DOI: 10.11604/pamj.2015.21.329.6632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/09/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Méthodes Résultats Conclusion
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Affiliation(s)
- Félicitée Nguefack
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Cameroun ; Groupe Associatif pour la Recherche, l'Education et la Santé (GARES-Falaise), Dschang, Cameroun
| | | | - Basile Keugoung
- Groupe Associatif pour la Recherche, l'Education et la Santé (GARES-Falaise), Dschang, Cameroun
| | - Nelly Kamgaing
- Faculté de Médecine et des Sciences Biomédicales, Université de Yaoundé I, Cameroun ; Centre Hospitalier Universitaire de Yaoundé, Cameroun
| | - Roger Dongmo
- Groupe Associatif pour la Recherche, l'Education et la Santé (GARES-Falaise), Dschang, Cameroun ; Hôpital de District d'Efoulan, Yaoundé,Cameroun
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Jarso H, Workicho A, Alemseged F. Survival status and predictors of mortality in severely malnourished children admitted to Jimma University Specialized Hospital from 2010 to 2012, Jimma, Ethiopia: a retrospective longitudinal study. BMC Pediatr 2015; 15:76. [PMID: 26174805 PMCID: PMC4502938 DOI: 10.1186/s12887-015-0398-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Although community based treatment of severe acute malnutrition has been advocated for in recent years, facility based treatment of severe acute malnutrition is still required. Therefore, information on the treatment outcomes of malnutrition and potential predictors of mortality among severely malnourished children admitted to hospitals is critical for the improvement of quality care. Thus, the aim of this study was to assess survival status and predictors of mortality in severely malnourished children admitted to Jimma University Specialized Hospital from September 11, 2010 to September 10, 2012. Methods Retrospective longitudinal study was conducted at Jimma University Specialized Hospital. From September 11, 2010 to September 10, 2012 available data from severely malnourished children admitted to the hospital were reviewed. Data were analyzed using SPSS version 20 for windows. Bivariate and multivariable analyses were performed by Kaplan-Meier and Cox regression to identify clinical characteristics associated with mortality. Result A total of 947 children were enrolled into the study. An improvement, death and abscond rate were 77.8, 9.3 and 12.9 % respectively. The median duration from admission to death was 7 days. The average length of stay in the hospital and average weight gain were 17.4 days and 10.4 g/kg/day respectively. The main predictors of earlier hospital deaths were age less than 24 months (AHR = 1.9, 95 % CI [1.2–2.9]), hypothermia (AHR = 3.0, 95 % CI [1.4–6.6]), impaired consciousness level (AHR = 2.6, 95 % CI [1.5–4.5]), dehydration (AHR = 2.3, 95 % CI [1.3–4.0]), palmar pallor (AHR = 2.1, 95 % CI [1.3–3.3]) and co-morbidity/complication at admission (AHR = 3.7, 95 % CI [1.9–7.2]). Conclusion The treatment outcomes (improvement rate, death rate, average length of stay in the hospital and average weight gain) were better than most reports in the literatures and in agreement with minimum international standard set for management of severe acute malnutrition. Intervention to further reduce earlier deaths should focus on young children with hypothermia, altered mental status, dehydration, anemia and comorbidities.
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Affiliation(s)
- Habtemu Jarso
- Department of Epidemiology, College of Health Science, Jimma University, P.O.Box 378, Jimma, Ethiopia.
| | - Abdulhalik Workicho
- Department of Epidemiology, College of Health Science, Jimma University, P.O.Box 378, Jimma, Ethiopia.
| | - Fessahaye Alemseged
- Department of Epidemiology, College of Health Science, Jimma University, P.O.Box 378, Jimma, Ethiopia.
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Warfa O, Njai D, Ahmed L, Admani B, Were F, Wamalwa D, Osano B, Mburugu P, Mohamed M. Evaluating the level of adherence to Ministry of Health guidelines in the management of severe acute malnutrition at Garissa Provincial General Hospital, Garissa, Kenya. Pan Afr Med J 2014; 17:214. [PMID: 25237411 PMCID: PMC4163184 DOI: 10.11604/pamj.2014.17.214.3821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/09/2014] [Indexed: 11/15/2022] Open
Abstract
Introduction Half of Kenya's high infant and under five mortality rates is due to malnutrition. Proper implementation of World Health Organization's (WHO) Evidence Based Guidelines (EBG) in management of severe acute malnutrition can reduce mortality rates to less than 5%. The objectives were to establish the level of adherence to WHO guideline and the proportion of children appropriately managed for severe acute malnutrition (steps 1-8) as per the WHO protocol in the management of severe acute malnutrition. This was a short longitudinal study of 96 children, aged 6-59 months admitted to the pediatric ward with diagnosis of severe acute malnutrition. Methods Data was extracted from patients’ medical files and recorded into an audit tool to compare care provided in this hospital with WHO guidelines. Results Non-edematous malnutrition was the commonest presentation (93.8%). A higher proportion (63.5%) of patients was male. Most (85.4%) of patients were younger than 2 years. Patients with non-edematous malnutrition were younger (mean age for non-edematous malnutrition was 16 (± 10.6) months versus 25 (± 13.7) months in edematous malnutrition). The commonest co- morbid condition was diarrhea (52.1%). Overall, 13 children died giving an inpatient case fatality rate of 13.5%. Appropriate management was documented in only 14.6% for hypoglycemia (step1), 5.2% for hypothermia (step 2) and 31.3% for dehydration (step 3). Conclusion The level of adherence to MOH guidelines was documented in 5 out of the 8 steps. Appropriate management of children with severe acute malnutrition was inadequate at Garissa hospital.
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Affiliation(s)
- Osman Warfa
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
| | - Daniel Njai
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
| | - Laving Ahmed
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
| | - Bashir Admani
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
| | - Fred Were
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
| | - Boniface Osano
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
| | | | - Musa Mohamed
- Garissa Provincial General Hospital, Garissa, Kenya
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Heilskov S, Rytter MJH, Vestergaard C, Briend A, Babirekere E, Deleuran MS. Dermatosis in children with oedematous malnutrition (Kwashiorkor): a review of the literature. J Eur Acad Dermatol Venereol 2014; 28:995-1001. [PMID: 24661336 DOI: 10.1111/jdv.12452] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 02/12/2014] [Indexed: 11/27/2022]
Abstract
Children with oedematous malnutrition, known as kwashiorkor, may develop a characteristic skin lesion, named 'Dermatosis of Kwashiorkor' (DoK). Only a few studies have been concerned with this condition, and the reason for the development of DoK remains unexplained. This study review the existing studies concerning DoK, including its clinical manifestations, histopathology, suggested pathophysiology, current treatment and prognosis for children of the age of 6 months to 5 years. Standardized clinical studies are needed to further understand the implications of DoK. Such studies would suffer from the lack of consistency concerning the terminology and scoring of the lesions in DoK. We therefore stress the need for a standardized scoring of the degree of DoK. This would facilitate valid and comparable studies and the development of better treatment for this vulnerable group of patients.
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Affiliation(s)
- S Heilskov
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark; Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
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Co-morbidities in hospitalized children with severe acute malnutrition. Indian Pediatr 2013; 51:125-7. [PMID: 23999679 DOI: 10.1007/s13312-014-0343-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/19/2013] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To study the co morbidities in hospitalized children with severe acute malnourishment. METHODS 104 severe acute malnourished children were included. RESULTS 54% had diarrhea and 27.8% had acute respiratory tract infections. Tuberculosis was diagnosed in 22% of cases (60.8% cases in children 6-12 mo old). Malaria and Measles were diagnosed in 3.8% each, and HIV infection was seen in 2.9% cases. Signs of vitamin B and vitamin A deficiency were seen in 14.4% and 5.8% cases, respectively. Malaria and HIV were not found to be major co morbid conditions. CONCLUSIONS Timely identification and treatment of various co-morbidities is likely to break undernutrition-disease cycle, and to decrease mortality and improve outcome.
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de Fátima Costa Caminha M, da Figueira MAS, Falbo AR, de Araújo de Amorim RC, Gallindo TC, Filho MB. Co-existence of micronutrient deficiencies in hospitalized children with severe malnutrition treated according to the WHO protocol. Trop Doct 2011; 41:230-2. [DOI: 10.1258/td.2011.100140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assessed the involvement of vitamin A deficiency (VAD) and anaemia as co-morbidities associated with severe forms of protein-energy malnutrition in hospitalized children. In a descriptive case series study of 57 children, one clinical case of xerophthalmia was diagnosed: 44.0% had levels of serum retinol <20 µg/dL and 88.0% had Hb <11 g/dL, of whom 30.0% had haemoglobin levels below 7.0 g/dL.
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Affiliation(s)
- Maria de Fátima Costa Caminha
- Research Department, Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Rua dos Coelhos, 300 Boa Vista, Recife-PE, CEP 50070-550
| | - Manoela Almeida Santos da Figueira
- Mother and Child Health, Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Rua dos Coelhos, 300 Boa Vista, Recife-PE, CEP 50070-550
| | - Ana Rodrigues Falbo
- Research Department, Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Rua dos Coelhos, 300 Boa Vista, Recife-PE, CEP 50070-550
| | | | | | - Malaquias Batista Filho
- Research Department, Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Rua dos Coelhos, 300 Boa Vista, Recife-PE, CEP 50070-550
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Rodríguez L, Cervantes E, Ortiz R. Malnutrition and gastrointestinal and respiratory infections in children: a public health problem. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:1174-205. [PMID: 21695035 PMCID: PMC3118884 DOI: 10.3390/ijerph8041174] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 04/07/2011] [Accepted: 04/11/2011] [Indexed: 12/27/2022]
Abstract
Infectious disease is the major cause of morbidity and mortality in developing countries, particularly in children. Increasing evidence suggests that protein-calorie malnutrition is the underlying reason for the increased susceptibility to infections observed in these areas. Moreover, certain infectious diseases also cause malnutrition, which can result in a vicious cycle. Malnutrition and bacterial gastrointestinal and respiratory infections represent a serious public health problem. The increased incidence and severity of infections in malnourished children is largely due to the deterioration of immune function; limited production and/or diminished functional capacity of all cellular components of the immune system have been reported in malnutrition. In this review, we analyze the cyclical relationship between malnutrition, immune response dysfunction, increased susceptibility to infectious disease, and metabolic responses that further alter nutritional status. The consequences of malnutrition are diverse and included: increased susceptibility to infection, impaired child development, increased mortality rate and individuals who come to function in suboptimal ways.
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Affiliation(s)
- Leonor Rodríguez
- Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana-Iztapalapa, Avenida San Rafael Atlixco 186, CP 09340, México, DF, México.
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Jensen GL, Bistrian B, Roubenoff R, Heimburger DC. Malnutrition Syndromes: A Conundrum vs Continuum. JPEN J Parenter Enteral Nutr 2009; 33:710-6. [DOI: 10.1177/0148607109344724] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gordon L. Jensen
- From the Department of Nutritional Sciences, the Pennsylvania State University, University Park, PA; Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA; Immunology Medical Research, Biogen Idec, Inc, Cambridge, MA; and Departments of Nutrition Sciences and Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Bruce Bistrian
- From the Department of Nutritional Sciences, the Pennsylvania State University, University Park, PA; Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA; Immunology Medical Research, Biogen Idec, Inc, Cambridge, MA; and Departments of Nutrition Sciences and Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Ronenn Roubenoff
- From the Department of Nutritional Sciences, the Pennsylvania State University, University Park, PA; Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA; Immunology Medical Research, Biogen Idec, Inc, Cambridge, MA; and Departments of Nutrition Sciences and Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Douglas C. Heimburger
- From the Department of Nutritional Sciences, the Pennsylvania State University, University Park, PA; Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA; Immunology Medical Research, Biogen Idec, Inc, Cambridge, MA; and Departments of Nutrition Sciences and Medicine, University of Alabama at Birmingham, Birmingham, AL
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Abstract
Protein energy malnutrition (PEM) is a common problem worldwide and occurs in both developing and industrialized nations. In the developing world, it is frequently a result of socioeconomic, political, or environmental factors. In contrast, protein energy malnutrition in the developed world usually occurs in the context of chronic disease. There remains much variation in the criteria used to define malnutrition, with each method having its own limitations. Early recognition, prompt management, and robust follow up are critical for best outcomes in preventing and treating PEM.
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Affiliation(s)
- Zubin Grover
- Department of Gastroenterology, Royal Children's Hospital, Herston Road, Brisbane, Queensland 4029, Australia.
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Nzioki C, Irimu G, Musoke R, English M. Audit of care for children aged 6 to 59 months admitted with severe malnutrition at kenyatta national hospital, kenya. Int Health 2009; 1:91-6. [PMID: 20396608 PMCID: PMC2854808 DOI: 10.1016/j.inhe.2009.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We conducted a prospective audit of 101 children with severe malnutrition aged 6 to 59 months admitted to Kenyatta National Hospital, Kenya's largest tertiary level health facility, from February-April 2008. A structured tool was prepared to capture data to allow assessment of implementation of the WHO guidelines steps 1-8. Overall, 58% of children had marasmus and 47% of children were younger than one year old. Common co-morbidities at admission were diarrhoea (70.3%) and pneumonia (51.4%). The highest degree of implementation was observed for Step 5, treatment of potentially severe infections (90%, (95% CI 85.1-96.9)). Only 55% of the patients had F75 prescribed although this starter formula was available in this hospital. There was a delay in initiating feeds with a median time of 14.7 hours from the time of admission. There was modest implementation of Step 2, ensuring warmth (46.5%, 36.8-56.2), Step 3, treat dehydration (54.9%, 43.3-66.5) and Step 4, correct electrolyte imbalance, (45.5%, 35.6-55.8%). There was least implementation of Step 8, transition to catch-up feeding (23.8%, 13.6-34.0). We conclude that quality of care for children admitted with severe malnutrition at KNH is inadequate and often does not follow the WHO guidelines. Improving care will require a holistic and not simply medical approach.
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Affiliation(s)
| | - Grace Irimu
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
- Centre for Geographic Medicine Research – Coast, KEMRI / Wellcome Trust Research Programme, P.O. Box 230 Kilifi and P.O. Box 43640, Nairobi
| | - Rachel Musoke
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
| | - Mike English
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
- Centre for Geographic Medicine Research – Coast, KEMRI / Wellcome Trust Research Programme, P.O. Box 230 Kilifi and P.O. Box 43640, Nairobi
- Department of Paediatrics, University of Oxford, Oxford, UK
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Robinson AL, Razafindralambo M, Ratsitohaina H, Desjeux JF, Ravelomanana N. Nutrient composition vs food ingredients in the treatment of hospitalized and severely malnourished children. J Pediatr Gastroenterol Nutr 2009; 49:372-3. [PMID: 19458551 DOI: 10.1097/mpg.0b013e3181816fbc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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