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Amat Camacho N, Husain F, Bahya-Batinda D, Aung E, Chara A, Tanko M, Ogundipe OF, Barbagallo M, Aung KH, von Schreeb J, Della Corte F, Kolokotroni O, Sunyoto T. Characteristics and treatment outcomes of malnutrition among infants aged less than 6 months in North-East Nigeria (2019-2022). MATERNAL & CHILD NUTRITION 2024:e13676. [PMID: 38837325 DOI: 10.1111/mcn.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/04/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
Recommendations for the management of malnutrition among infants aged less than 6 months (<6 m) are based on limited evidence. This study aimed to describe the characteristics, treatment outcomes and outcome-associated factors among malnourished infants <6 m admitted at Médecins Sans Frontières (MSF) inpatient and ambulatory therapeutic feeding centres (ITFC and ATFC) in North-East Nigeria, 2019-2022. We conducted a descriptive analysis of the cohorts and logistic regression to measure the association between two selected outcomes-inpatient mortality and defaulting from the ambulatory programme-and possible factors associated. In total, 940 infants <6 m were admitted at ITFC. Most of them presented severe acute malnutrition and comorbidities, with diarrhoea being the most frequent. On discharge, 13.3% (n = 125) of infants were cured, 72.9% (n = 684) stabilized (referred to ATFC), 6.5% (n = 61) left against medical advice and 4.2% (n = 39) died. The median length of hospital stay was 10 days [IQR 7-14]. A hospital stay shorter than 10 days was significantly associated with inpatient mortality (aOR = 12.51, 95% confidence interval [CI] = 3.72-42.11, p ≤ 0.01). Among 561 infants followed up at the ATFC, only 2.8% reported comorbidities. On discharge, 80.9% (n = 429) were cured, 16.2% (n = 86) defaulted and 1.1% (n = 6) died. Male sex (aOR = 1.94, 95% CI = 1.15-3.27, p = 0.01), internally displaced status (aOR = 1.70, 95% CI = 1.05-2.79, p = 0.03) and <-3 WLZ (aOR = 1.95, 95% CI = 1.05-3.63, p = 0.03) were significantly associated with programme defaulting. Stabilization and recovery rates among malnourished infants <6 m in the studied project align with acceptable standards in this humanitarian setting. Notable defaulting rates from outpatient care should be further explored.
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Affiliation(s)
- Nieves Amat Camacho
- Department of Global Public Health, Global Disaster Medicine-Health Needs and Response, Karolinska Institutet, Stockholm, Sweden
- Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Faisal Husain
- Médecins Sans Frontières, Operational Center Brussels, Abuja, Nigeria
| | - Dang Bahya-Batinda
- Médecins Sans Frontières, Operational Center Brussels, Luxembourg Operational Unit, Luxembourg, Luxembourg
| | - Eithandee Aung
- Médecins Sans Frontières, Operational Center Brussels, Abuja, Nigeria
| | - Abdullahi Chara
- Médecins Sans Frontières, Operational Center Brussels, Maiduguri, Nigeria
| | - Musa Tanko
- Médecins Sans Frontières, Operational Center Brussels, Maiduguri, Nigeria
| | | | - Mario Barbagallo
- Médecins Sans Frontières, Operational Center Brussels, Brussels, Belgium
| | - Kyi Htet Aung
- Médecins Sans Frontières, Operational Center Brussels, Abuja, Nigeria
| | - Johan von Schreeb
- Department of Global Public Health, Global Disaster Medicine-Health Needs and Response, Karolinska Institutet, Stockholm, Sweden
| | - Francesco Della Corte
- Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | - Ourania Kolokotroni
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Temmy Sunyoto
- Médecins Sans Frontières, Operational Center Brussels, Luxembourg Operational Unit, Luxembourg, Luxembourg
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Woeltje MM, Evanoff AB, Helmink BA, Culbertson DL, Maleta KM, Manary MJ, Trehan I. Community-based management of acute malnutrition for infants under 6 months of age is safe and effective: analysis of operational data. Public Health Nutr 2023; 26:246-255. [PMID: 34915944 PMCID: PMC11077441 DOI: 10.1017/s1368980021004894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. DESIGN Review of operational acute malnutrition treatment records. SETTING Twenty-one outpatient therapeutic feeding clinics in rural Malawi. PARTICIPANTS Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6-9 months of age who were being treated at the same time in the same location in the context of two different randomised clinical trials. RESULTS A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6-9 months old with acute malnutrition (seventy-four severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75·4 %) achieved nutritional recovery; in comparison, 56 (75·7 %) of those with severe acute malnutrition 6-9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81·3 %) recovered; in comparison, 241 (85·2 %) of those aged 6-9 months recovered. CONCLUSIONS In a rural Malawian population of infants u6m who had generally already stopped exclusive breast-feeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.
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Affiliation(s)
- Maeve M Woeltje
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, M/S MB.7.520, Seattle, WA98105, USA
- Seattle Children’s Hospital, Seattle, USA
| | | | - Beth A Helmink
- Department of Surgery, Washington University in St. Louis, St Louis, USA
| | | | - Kenneth M Maleta
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mark J Manary
- School of Public Health and Family Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Pediatrics, Washington University in St. Louis, St Louis, USA
| | - Indi Trehan
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, M/S MB.7.520, Seattle, WA98105, USA
- Seattle Children’s Hospital, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
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Baazab MSM, Bilal JA, Ba-Saddik IA, Arabi AM. Supplementary suckling technique in infants less than 6 months of age with uncomplicated severe acute malnutrition: a prospective hospital-based study in armed conflict Yemen. BMC Pediatr 2022; 22:671. [PMID: 36414937 PMCID: PMC9680131 DOI: 10.1186/s12887-022-03745-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Globally 3.8 million of children under 6 month of age are severely wasted. In Yemen, around 20% of children under 6 months were affected by malnutrition during the armed conflict in the last 7 years. Supplementary suckling may reestablish exclusive breastfeeding in infant less than 6 months of age with Severe Acute Malnutrition (SAM). This study aimed to determine the outcomes of employing supplementary suckling technique in treatment of uncomplicated SAM infants in a conflict-affected community. METHODS A prospective hospital-based study was carried out between January to April 19th, 2020 among randomly selected infants less than 6 months of age with SAM following breastfeeding failure. Infants' anthropometric indices were daily measured and recorded. Supplementary sulking technique was used in management with high or low protein milk-based formula supplement. Outcome was recorded as cured, died, defaulter or in nonrecovery state. RESULTS In this study 108 infants were enrolled with a median (IQR) age of 4 (2.5-5) years and a male: female ratio of 1.4:1. After treatment, 80.6% recovered to cure, 12% defaulters, 6% died, and 2% did not respond to treatment Thirty-four infants (38.8%) gained weight with significantly increased median weight and median weight-for-age z score. The median (IQR) duration of treatment was 9 (7.5-14) days. The means of age and weight-for-length z score were correlated (r = - 0.22, p = 0.025). Duration of treatment was a predictor of outcome (OR = 1.71, 95% CI = 0.05-0.62, p < 0.001). CONCLUSION Supplementary suckling technique for feeding infant with SAM aged less than 6 months had a positive impact on anthropometric indices with high cure rate. The younger the infant and the longer the duration of treatment, the better the outcome.
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Affiliation(s)
| | - Jalal Ali Bilal
- grid.449644.f0000 0004 0441 5692Pediatrics Department, College of Medicine, Shaqra University of Shaqra, Shaqra, Saudi Arabia
| | - Iman Ali Ba-Saddik
- grid.411125.20000 0001 2181 7851Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Ali Mohammed Arabi
- grid.9763.b0000 0001 0674 6207Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Amat Camacho N, von Schreeb J, Della Corte F, Kolokotroni O. Interventions to support the re-establishment of breastfeeding and their application in humanitarian settings: A systematic review. MATERNAL & CHILD NUTRITION 2022; 19:e13440. [PMID: 36222214 PMCID: PMC9749597 DOI: 10.1111/mcn.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
In 1998, the World Health Organisation (WHO) published general guidelines proposing essential measures to achieve relactation. Yet, increased knowledge about the practical set-up of relactation support interventions in different contexts is needed, especially in humanitarian settings, where nonbreastfed infants are particularly at risk. This study aimed to compile and assess the characteristics, outcomes and factors influencing the implementation of relactation support interventions reported since the latest WHO recommendations. We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, undertaking a search from Medline, Embase, PubMed Central, Web of Science, Global Health and CINAHL electronic databases. Studies published in English and Spanish, reporting characteristics and outcomes of relactation support provided to non-(breastfeeding) BF mothers with infants aged less than 6 months were included. Data were analysed by narrative synthesis and the Johanna Briggs Institute Critical Appraisal Tools were used for quality assessment. Overall, 16 studies met the inclusion criteria. Most were observational and conducted in middle-income countries, only one focused on humanitarian settings. Studies reported inpatient and community-based interventions, which generally followed WHO recommendations for relactation. In 13 out of 16 studies, over 80% of mothers restarted BF after receiving relactation support. Enabling factors included younger infant age, shorter lactation gap, mother's strong motivation, family support, and continuous skilled support. Although current literature suggests that intensive relactation support can contribute to re-establish BF, its application and effectiveness in humanitarian settings remain uncertain. Further research is needed to explore the effectiveness, feasibility and acceptability of different approaches to relactation support, especially in humanitarian settings.
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Affiliation(s)
- Nieves Amat Camacho
- Department of Global Public Health, Center for Research on Health Care in DisastersKarolinska InstituteStockholmSweden,Centre for Research and Training in Disaster Medicine,Humanitarian Aid, and Global HealthUniversità del Piemonte OrientaleNovaraItaly
| | - Johan von Schreeb
- Department of Global Public Health, Center for Research on Health Care in DisastersKarolinska InstituteStockholmSweden
| | - Francesco Della Corte
- Centre for Research and Training in Disaster Medicine,Humanitarian Aid, and Global HealthUniversità del Piemonte OrientaleNovaraItaly
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van Immerzeel TD, Camara MD, Deme Ly I, de Jong RJ. Inpatient and outpatient treatment for acute malnutrition in infants under 6 months; a qualitative study from Senegal. BMC Health Serv Res 2019; 19:69. [PMID: 30683086 PMCID: PMC6347835 DOI: 10.1186/s12913-019-3903-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/14/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Treatment of acute malnutrition in infants under 6 months is a relevant topic regarding the global problem of maternal and child malnutrition. While treatment for older age groups has shifted more towards an outpatient, community based approach, young infants are mostly treated in hospital. This study aims to describe barriers and facilitators for outpatient and inpatient treatment of malnourished infants under 6 months in Senegal. METHODS This qualitative descriptive study uses in-depth interviews with health workers and focus group discussions with mothers of malnourished infants, conducted from June to September 2015 in two case clinics. In data analysis, Collins' 3 key factors for a successful nutrition program were used as a theoretical framework: access, quality of care and community engagement. RESULTS Within Collins' 3 key factors, 9 facilitators and barriers have emerged from the data. Key factor access: Outpatient care was perceived as more accessible than inpatient concerning distance and cost, given that there is a milk supplement available. Trust could be more easily generated in an outpatient setting. Key factor quality of care: The cup and spoon re-lactation technique was efficiently used in outpatient setting, but needed close supervision. Basic medical care could be offered to outpatients provided that referral of complicated cases was adequate. Health education was more intensive with inpatients, but could be done with outpatients. Key factor community engagement: The community appeared to play a key role in treating malnourished young infants because of its influence on health seeking behaviour, peer support and breastfeeding practices. CONCLUSIONS Outpatient care does facilitate access, provided that an affordable milk supplement is available. Quality of care can be guaranteed using an appropriate re-lactation technique and a referral system for complications. The community has the potential to be much engaged, though more attention is required for breastfeeding education. In view of the magnitude of the health problem of young infant malnutrition and its strong relationship with breastfeeding practices, an outpatient community-based treatment approach needs to be considered.
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Affiliation(s)
| | - Maty D. Camara
- Head of department Nutrition and Alimentation at the Ministry of Health, University Cheikh Anta Diop, Dakar, Senegal
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