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Khadilkar AV, Oza C, Kajale N, Pulungan AB, Wacharasindhu S, Moelyo AG, Amalia G, Wejaphikul K, Julia M, Dejkhamron P, Khadilkar V. Local anthropometric parameters for assessing double burden of malnutrition in South Asian and Southeast Asian countries: a review and retrospective analysis. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 28:100473. [PMID: 39280018 PMCID: PMC11399708 DOI: 10.1016/j.lansea.2024.100473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 09/18/2024]
Abstract
The double burden of malnutrition (DBM) is a significant public health issue in South and Southeast Asia (SA and SEA). This study aimed to assess the impact of using local and regional ethnicity-specific anthropometric references versus international references on the prevalence of DBM in these regions.A narrative review of DBM prevalence using local versus international standards was conducted. Additionally, deidentified datasets from India and Indonesia were analyzed to evaluate the effectiveness of different growth standards in identifying DBM. Anthropometric Z-scores were compared, and sensitivity, specificity, and positive predictive value (PPV) were calculated.WHO standards had the lowest specificity for identifying short stature in India and Indonesia. BMI-for-age charts using WHO Growth Reference (2007) had lower sensitivity and higher specificity for metabolic risk. Local references showed lower stunting and higher overweight or obesity prevalence. International standards overestimated stunting and underestimated obesity, leading to misclassification and missed cases of metabolic risk. Funding None.
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Affiliation(s)
- Anuradha V Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Lower Ground Floor, Block V, Jehangir Hospital, 32 Sassoon Road, Pune, 411001, Maharashtra, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, 411007, Maharashtra, India
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Lower Ground Floor, Block V, Jehangir Hospital, 32 Sassoon Road, Pune, 411001, Maharashtra, India
| | - Neha Kajale
- Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Lower Ground Floor, Block V, Jehangir Hospital, 32 Sassoon Road, Pune, 411001, Maharashtra, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, 411007, Maharashtra, India
| | - Aman B Pulungan
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Indonesia
| | - Suttipong Wacharasindhu
- Department of Pediatrics and School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Annang Giri Moelyo
- Department of Child Health, Faculty of Medicine Universitas Sebelas Maret, Indonesia
| | | | - Karn Wejaphikul
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Madarina Julia
- Department of Child Health, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Indonesia
| | - Prapai Dejkhamron
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute (HCJMRI), Lower Ground Floor, Block V, Jehangir Hospital, 32 Sassoon Road, Pune, 411001, Maharashtra, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, 411007, Maharashtra, India
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Mondkar SA, Khadilkar V, Jahagirdar R, Kore V, Yewale S, Dange N, More C, Khadilkar A. Comparison of Nutritional Status of Healthy Under-Five Indian Children Using Composite Index of Anthropometric Failure on WHO 2006 versus 2019 Indian Synthetic Growth Charts. Indian J Pediatr 2024; 91:659-666. [PMID: 37880468 DOI: 10.1007/s12098-023-04865-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/01/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES To assess nutritional status of apparently-healthy under-five Indian children using Composite Index of Anthropometric Failure (CIAF) and to compare anthropometric failure prevalence using conventional indices and CIAF on World Health Organization (WHO) vs. synthetic Indian growth charts. METHODS This observational study was conducted over 2 y. The inclusion criteria was apparently-healthy children (0-60 mo) and the exclusion criteria were acute/chronic illness and small for gestational age. RESULTS A total of 1557 children (762 girls) were included in the study. The mean age of the subjects was 21 mo. The Z-scores for height, weight, body mass index (BMI) for age and weight for height in children were lower on WHO vs. synthetic charts (p = 0.0001). Significantly higher proportion of children were moderately and severely underweight, stunted and wasted on WHO charts. Synthetic charts identified significantly higher proportion as normal for weight, height, BMI for age, weight for height, overweight (overall), and a higher prevalence of severe stunting, and severe acute malnutrition (SAM) was noted among girls compared to boys. Using CIAF, 54.1% children were normal on WHO charts vs. 78.0% on synthetic (p = 0.0001). Larger proportion of girls (8.8%) were stunted+underweight (category-E) vs. boys (4.3%) on synthetic charts (p = 0.0003). Significantly higher proportion of children demonstrated failure (single/dual/multiple) on WHO charts except category-Y (higher proportion of underweight on synthetic charts). Maximum difference in CIAF (WHO vs. synthetic) was observed between 0-24 mo age. Of 1215 children normal on synthetic charts, 837 (68.9%) were normal on WHO charts. Of 116 underweight children (category-Y) on synthetic charts, 20 (17.2%) were underweight on WHO charts; remaining had compound failure (wasting+underweight = 49.1%, wasting+stunting+underweight = 14.7%, stunting+underweight = 12.1%) on WHO charts. Among those stunted+underweight (category-E) on synthetic charts, WHO charts classified 1/4th as wasted+stunted+underweight (category-D). CONCLUSIONS Synthetic references are more representative of Indian growth patterns, and seem more appropriate for monitoring growth of Indian children to avoid mislabelling as malnourished.
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Affiliation(s)
- Shruti A Mondkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
| | | | - Vrushali Kore
- Bharati Vidyapeeth University Medical College, Pune, India
| | - Sushil Yewale
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India
| | - Nimisha Dange
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India
| | - Chidvilas More
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement, Jehangir Hospital, 32 Sassoon Road, Pune, Maharashtra, 411001, India.
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India.
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Prasad V, Sinha D, Joseph RJ. Global relevance of MGRS growth standards: the case of India. BMJ Paediatr Open 2024; 8:e002472. [PMID: 38490693 PMCID: PMC10946363 DOI: 10.1136/bmjpo-2023-002472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
The most common measures of childhood undernutrition are based on anthropometric measures such as height-for-age (stunting/chronic undernutrition) and weight-for-height (wasting/acute undernutrition). It is well recognised that the determinants of undernutrition are multiple, including food intake, dietary diversity, health, sanitation and women's status. Currently, most countries across the world including India use the globally accepted WHO-Multicentre Growth Reference Study (MGRS) growth standards (2006) for the purposes of measurement as well as for evaluating progress on these metrics. However, there is some discussion on the universal relevance of these standards, and in the Indian context, whether these standards overestimate the prevalence of stunting, considering differences in genetic potential for growth. This is especially relevant in the context of increasing burden of obesity and non-communicable diseases in India. Based on a detailed review of literature, policy documents and expert inputs, this review paper discusses the relevance of the WHO growth standards for height/stunting, in the context of India. Issues discussed related to the MGRS methodology include pooling of data and intersite and intrasite variability, opting for standards as opposed to references, and external validity. Other issues related to plasticity of stunting and the influence of maternal heights are also discussed, in the context of analysing the appropriateness of using universal growth standards. Based on the review, it is recommended that the current standards may continue to be used until a newer global standard is established through a similar study.
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Affiliation(s)
| | - Dipa Sinha
- Dr BR Ambedkar University Delhi, New Delhi, India
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Dange NS, Khadilkar V, Kore V, Mondkar S, Yewale S, Gondhalekar K, Khadilkar AV. Comparison of WHO 2006 Growth Standards and Synthetic Indian References in Assessing Growth in Normal Children and Children with Growth-Related Disorders. Indian J Endocrinol Metab 2024; 28:220-226. [PMID: 38911119 PMCID: PMC11189285 DOI: 10.4103/ijem.ijem_380_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/16/2023] [Accepted: 01/20/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction A good screening tool, such as a growth chart, should distinguish between children with normal growth and those with perturbed growth. Suitability of synthetic Indian growth references for diagnosing growth-related disorders for under-five children has not been evaluated. To assess the validity of World Health Organization (WHO) 2006 standards vs synthetic Indian references (2019) (by comparing weight, height, body mass index (BMI), standard deviation scores (SDS) and the composite index of anthropometric failure (CIAF)) in differentiating normal children and children with growth-related disorders. Methods Records of 2188 children (0-60 months) attending a tertiary centre paediatric outpatient department (OPD) were retrospectively studied; 1854 children were healthy and 334 were diagnosed with growth-related disorders as per the European Society for Paediatric Endocrinology (ESPE) classification. The anthropometric parameters converted to Z-scores for weight-for-age (WAZ), height-for-age (HAZ), BMI-for-age (BAZ) and a CIAF were computed using WHO and synthetic charts; Student's t-test was used for assessing differences and Youden's index for validity. Results Disease status of children and anthropometric failure on WAZ, HAZ, BAZ and CIAF on both WHO and synthetic charts had a significant association (P-value <0.05). WAZ, HAZ on both charts and CIAF on synthetic chart had a fair to moderate agreement (Kappa statistics) with disease status as per diagnosis (P-value <0.05). The sensitivity and negative predictive value for all anthropometric parameters were higher for synthetic charts. Conclusion Indian charts were more sensitive for diagnosing growth-related disorders from birth to 60 months of age when compared to WHO growth standards.
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Affiliation(s)
- Nimisha Shankar Dange
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
- Department of Health Sciences, Savitribai Phule University, Pune, Maharashtra, India
| | - Vrushali Kore
- Department of Pediatrics, Bharati Hospital and Research Centre, Pune, Maharashtra, India
| | - Shruti Mondkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Sushil Yewale
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Ketan Gondhalekar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Anuradha V Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
- Department of Health Sciences, Savitribai Phule University, Pune, Maharashtra, India
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Aasim M, Chand S. Height-for-age and weight-for-age growth charts for Pakistani infants under six months: derived from a novel case selection method using multiple indicator cluster survey data. BMC Med Res Methodol 2023; 23:289. [PMID: 38066412 PMCID: PMC10709855 DOI: 10.1186/s12874-023-02116-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In the past two decades, there has been a growing recognition of the need to establish indigenous standards or reference growth charts, particularly following the WHO multicenter growth study in 2006. The availability of accurate and reliable growth charts is crucial for monitoring child health. The choice of an appropriate model for constructing growth charts depends on various data characteristics, including the distribution's tails and peak. While Pakistan has reported some reference growth charts, there is a notable absence of indigenous charts for children under two years of age, especially for infants aged 0-6 months who are exclusively breastfed. Additionally, acquiring data poses a significant challenge, particularly for low-income countries, as it demands substantial resources such as finances, time, and expertise. The Multiple Indicator Cluster Survey (MICS) constitutes a large-scale national survey conducted periodically in low-income countries under the auspices of UNICEF. In this study, we propose methods for generating selection variables utilizing the "Novel Case Selection Method," as previously published. Further our approach enables to select and fit appropriate model to the MICS data, selected, and to develop the standard growth charts. METHODS Out of the 11,478 children under 6 months of age included in MICS-6 (Pakistan), 3,655 children (1,831 males and 1,824 females) met the specified criteria and were selected using the "Novel Case Selection Method". The sample was distributed across provinces as follows: 841 (23.0%) from KPK, 1,464 (40.1%) from Punjab, 819 (22.4%) from Sindh, and 531 (14.5%) from Balochistan. This sample encompassed both rural (76.4%) and urban (23.6%) populations. Following data cleaning and outlier removal, a total of 3,540 records for weight (1,768 males and 1,772 females) and 3,515 records for height (1,759 males and 1,756 females) were ultimately available for the development of standard charts. The Bayesian Information Criterion (BIC) was employed to determine the optimal degrees of freedom for L, M, and S using RefCurv_0.4.2. Three families within the gamlss class-namely, Box Cox Cole and Green (BCCG), Box Cox T (BCT), and Box Cox Power Exponential (BCPE)-were applied, each with three smoothing techniques: penalized splines (ps), cubic splines (cs), and polynomial splines (poly). The best-fitted model was selected from these nine combinations based on the Akaike Information Criteria. RESULTS The Novel Case Selection Method yielded 3655 cases as per criteria. After cleaning the data, this method lead to selection of 3540 children for "weight for age" (W/A) and 3515 children for "height for age" (H/A). The "BCPE" family and "ps" as smoothing method proved to be best on AIC for all four curves, i.e. the W/A male, W/A female, H/A male, and H/A female. The optimum selected degrees of freedom for the curve "W/A", for both genders were (M = 1, L = 0, S = 0). The optimum degrees of freedom for H/A male were again (M = 1, L = 0, S = 0), but for females the selected degrees of freedom were (M = 1, L = 1, S = 1). The indigenous fitted standard curves for Pakistan were on lower trajectory in comparison to WHO standards. CONCLUSION This study uses the Novel Case Selection Method with introduced algorithms to construct tailored growth charts for lower and middle-income countries. Leveraging extensive MICS data, the methodology ensures representative national samples. The resulting charts hold practical value and await validation from established data sources, offering valuable tools for policy makers and clinicians in diverse global contexts.
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Affiliation(s)
- Muhammad Aasim
- NHRC, NIH (HRI) Research Centre, Shaikh Zayed Medical Complex, Lahore, Pakistan.
- College of Statistical Sciences, University of the Punjab, Lahore, Pakistan.
| | - Sohail Chand
- College of Statistical Sciences, University of the Punjab, Lahore, Pakistan
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Chawla K, Burugina Nagaraja S, Siddalingaiah N, Sanju C, Kumar U, Shenoy VP, Shastri S, Singarajipur A. Tuberculosis screening for pediatric household contacts in India: Time to adapt newer strategies under the National TB Elimination Programme! PLoS One 2023; 18:e0292387. [PMID: 37796796 PMCID: PMC10553317 DOI: 10.1371/journal.pone.0292387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION The study aimed to evaluate the effectiveness of screening pediatric household contacts (under the age of 15 years) for tuberculosis (TB) in India through verbal screening, tuberculin skin testing, and chest radiography at intervals of 0, 3, 6, 9, and 12 months. The study also aimed to determine the proportion of contacts who tested positive for TB and to describe the challenges in implementing regular follow-up. Current National TB Elimination Programme (NTEP) guidelines only require verbal screening for contacts under 6 years old at TB treatment initiation. The study aimed to fill this knowledge gap and provide valuable insights for improving TB screening in pediatric household contacts in India. METHODS The study was conducted in two districts of Karnataka, India from 2021 to 2022, and utilized a cohort study design to enroll contacts of index tuberculosis (TB) cases diagnosed under the National TB Elimination Programme (NTEP). Participants were followed up at regular intervals for one year to evaluate the effectiveness of TB screening in pediatric household contacts. RESULTS In this study, 686 pediatric household contacts were enrolled and screened for tuberculosis (TB) using verbal symptom screening, tuberculin skin testing (TST), and chest radiography. Projected figures estimated that 0.8%, 42%, and 4% of contacts would test positive for symptomatic screening, TST, and chest radiography, respectively. TB cases were detected in 2.91% (1.84-4.38) of contacts, with females above 6 years of age having a 22% higher risk of contracting the infection than males above 6 to < 15 years. However, not all cases were subjected to TST and chest radiography. The primary reason for not investigating child contact for TB was their reported healthy or asymptomatic status. CONCLUSION The implementation of regular screening intervals for tuberculin skin test (TST) and chest radiography, along with verbal screening, among pediatric household contacts under the age of 15 years seems to be beneficial for the National TB Elimination Programme (NTEP), despite the challenges faced during implementation. Innovative strategies should be explored by NTEP to ensure effective implementation.
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Affiliation(s)
- Kiran Chawla
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education Manipal, Manipal, Karnataka, India
| | - Sharath Burugina Nagaraja
- Employees State Insurance Corporation Medical College and Post Graduate Institute of Medical Sciences and Research, Bengaluru, Karnataka, India
| | - Nayana Siddalingaiah
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education Manipal, Manipal, Karnataka, India
| | | | - Uday Kumar
- Employees State Insurance Corporation Medical College and Post Graduate Institute of Medical Sciences and Research, Bengaluru, Karnataka, India
| | - Vishnu Prasad Shenoy
- Department of Microbiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education Manipal, Manipal, Karnataka, India
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Kumar N, Gadgade BD, Shivapur AA, Radhakrishna V, Vasudev RB. Evaluation and Management of Achalasia Cardia in Children: A Retrospective Observational Study. J Indian Assoc Pediatr Surg 2023; 28:369-374. [PMID: 37842218 PMCID: PMC10569275 DOI: 10.4103/jiaps.jiaps_175_22] [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] [Received: 12/08/2022] [Revised: 01/24/2023] [Accepted: 03/06/2023] [Indexed: 10/17/2023] Open
Abstract
Background Achalasia cardia is a neuromuscular disorder of unknown etiology characterized by aperistalsis of the body of the esophagus and failure of relaxation of the lower esophageal sphincter. The diagnosis of achalasia cardia is delayed due to the rarity and the ability to mimic other common conditions in children. Hence, a study was conducted to evaluate the clinical presentation and the management of achalasia cardia in children. Materials and Methods A retrospective observational study was conducted in the department of pediatric surgery at a tertiary center. The children with achalasia cardia who presented between January 2014 and December 2021 were included. Results A total of 12 patients were treated for achalasia cardia during the study period. All children presented with recurrent episodes of vomiting, whereas dysphagia was seen in six (50%) children. Eighty-three percent of the children presented with a history of weight loss, whereas failure to thrive was seen in nine (75%) children. Five (42%) children were managed as gastroesophageal reflux disease (GERD) for more than a year before presenting to us. Three (25%) children underwent open cardiomyotomy with Thal fundoplication and the rest nine (75%) underwent laparoscopic cardiomyotomy. All are thriving well. Conclusion Achalasia is an important differential diagnosis in children with suspected GERD. The most common symptom of achalasia cardia is vomiting followed by dysphagia. Weight loss and failure to thrive are important presenting features in children with achalasia which are uncommon in adults. Cardiomyotomy without fundoplication is safe and effective to treat achalasia cardia in children without having any extra complications.
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Affiliation(s)
- Nitin Kumar
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Bahubali Deepak Gadgade
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Achyuth Ananth Shivapur
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Veerabhadra Radhakrishna
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Raghunath Bangalore Vasudev
- Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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Royal A, John D, Bharti O, Dhupar D, Diksha, Padmawati RS, Utarini A. Cost analysis of implementation of a population level rabies control programme for children in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Royal A, John D, Bharti O, Tanwar R, Bhagat DK, Padmawati RS, Chaudhary V, Umapathi R, Bhadola P, Utarini A. A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India. Vaccines (Basel) 2022; 11:88. [PMID: 36679933 PMCID: PMC9866950 DOI: 10.3390/vaccines11010088] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
Children contribute to one-half of the total painful rabies mortalities in India. The state-of-the-art rabies mortality averting strategies need exploration for the effective implementation of pre-exposure prophylaxis (PrEP) in India. This study reports on the economic evaluation of various PrEP and post-exposure prophylaxis (PEP) strategies to avert rabies mortalities in school-aged children in India. A decision tree model has been developed for children in the age group of 5-15 years to evaluate various PrEP + PEP and PEP only regimens. The 2-site intradermal regimen administered on day zero and seven was chosen as the intervention [PrEP (I)]. ICER was calculated from the quasi-societal and quasi-health systems' perspectives for the base case analysis, along with one-way sensitivity, and scenario analyses for each regimen. The incremental DALYs averted per million population with the implementation of PrEP (I) ranged between 451 and 85,069 in 2020. The ICER was reported in the range of USD 384-352/DALY averted (non-dominant) in comparison to PEP regimens from a quasi-societal perspective. PrEP (I) is reported to be 'very cost effective' in comparison with PEP regimens from the quasi-societal and quasi-health systems' perspectives and reduce deaths by up to 89.9%. This study concludes that the PrEP (I) regimen is a cost-effective and life-saving strategy to avert painful mortalities due to rabies in school-aged children in India.
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Affiliation(s)
- Abhishek Royal
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Denny John
- Faculty of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bengaluru 560054, India
| | - Omesh Bharti
- State Institute of Health and Family Welfare, Department of Health & Family Welfare, Government of Himachal Pradesh, Shimla 171009, India
| | - Ritesh Tanwar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal 462002, India
| | - Deepak Kumar Bhagat
- Centre of Social Medicine and Community Health, Jawaharlal Nehru University, Delhi 110067, India
| | - Retna Siwi Padmawati
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Vishal Chaudhary
- Department of Physics, Bhagini Nivedita College, University of Delhi, Delhi 110021, India
| | - Reddicherla Umapathi
- Department of Biological Sciences and Bioengineering, Inha University, Incheon 22212, Republic of Korea
| | - Pradeep Bhadola
- Centre for Theoretical Physics and Natural Philosophy, Mahidol University, Nakhonsawan Campus, Phayuha Khiri, NakhonSawan 60130, Thailand
| | - Adi Utarini
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
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Verma P, Prasad JB. Growth Prediction of Under-5 Children Using Statistical Models for Eastern Region of India. Indian J Community Med 2022; 47:571-578. [PMID: 36742967 PMCID: PMC9891046 DOI: 10.4103/ijcm.ijcm_230_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
Background Percentile curves are often used to assess variances in children's growth pattern. This study is aimed at explaining effect of the respondents' sociodemographic characteristics on under-5 children's birth weight and identifying most suitable models, out of 11 statistical models reviewed, for estimating children's growth in terms of height and weight of a given birth-weight category and obtain estimated growth curves. Material and Methods The study used National Family Health Survey (NFHS)-4 data from four Eastern States of India, consisting of 54,075 under-5 children. Estimated growth curves were obtained, using best-fit models. Results Birth weight was found to be associated with children's age, gender, birth order, body mass index, mother's education, living place and wealth index. Two models - Cubic Model and Power Model - showed best fit to the height and weight measurements. We obtained estimated growth curves of boys and girls for a given birth-weight category. Conclusions All socio-demographic factors studied, except respondent's occupation, were associated with children's birth weight. Cubic and Power Models were most suitable for assessing growth in terms of height and weight of boys and girls, belonging to a given birth-weight category.
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Affiliation(s)
- Pradyuman Verma
- Department of Epidemiology and Biostatistics, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Jang Bahadur Prasad
- Department of Epidemiology and Biostatistics, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
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Chen L, Su B, Zhang Y, Ma T, Liu J, Yang Z, Li Y, Gao D, Chen M, Ma Y, Wang X, Wen B, Jiang J, Dong Y, Song Y, Ma J. Association between height growth patterns in puberty and stature in late adolescence: A longitudinal analysis in chinese children and adolescents from 2006 to 2016. Front Endocrinol (Lausanne) 2022; 13:882840. [PMID: 35937794 PMCID: PMC9354934 DOI: 10.3389/fendo.2022.882840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The relationship between the characteristics of puberty growth and the stature (height and overweight and obesity) in late adolescence was not clear. We aimed to explore the effects of puberty growth patterns on the stature in late adolescence. Methods A total of 13,143 children from a longitudinal cohort from 2006 to 2016 in Zhongshan city of China were included. The Preece-Baines growth curve was fitted for each individual child, and the age at peak height velocity (APHV), peak height velocity (PHV), and age at take-off (TOA) were obtained from the Preece-Baines model. To compare the difference in height in late adolescence (at 18 years old) at different pubertal height growth patterns (height spurt timing, intensity, and duration), the height at baseline was matched by using the propensity score matching. The log-binomial model was applied to assess the association between the three pubertal height growth patterns (timing, intensity, and duration) and overweight and obesity status in late adolescence, controlling the urbanity and body mass index (BMI) at baseline. Results After matching the baseline height, boys and girls in three pubertal patterns with early timing (P < 0.01), small intensity (P < 0.01), and short duration (P < 0.01) of height spurt had the lowest final height in the late adolescence. A 16% increase and 45% increase of risk for overweight and obesity were significantly associated with the early APHV in boys and girls, respectively, relative risk (RR) in boys, 1.16(95% confidence interval, CI: 1.03-1.30), P = 0.011; RR in girls, 1.45(1.21-1.75), P < 0.001. A 21% increase and 59% increase of risk for overweight and obesity were significantly associated with small PHV in boys and girls, respectively, RR in boys, 1.21(1.07-1.36), P < 0.001; RR in girls, 1.59(1.30-1.95), P < 0.001; and an 80% increase of risk for overweight and obesity with small spurt duration in girls (RR = 1.80; 95% CI: 1.49, 2.18; P < 0.001). Conclusion Pubertal growth patterns, including earlier puberty onset timing, smaller puberty intensity, and shorter puberty spurt duration, had a positive association with lower height risks and higher overweight and obesity risks in late adolescence.
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Affiliation(s)
- Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Binbin Su
- Institute of Population Research, Peking University Asia-Pacific Economic Cooperation (APEC) Health Science Academy, Beijing, China
| | - Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Zhaogeng Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yanhui Li
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Di Gao
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Ying Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Xijie Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Bo Wen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jun Jiang
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, United States
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing, China
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Khadilkar V, Oza C, Khadilkar A. Relationship between height age, bone age and chronological age in normal children in the context of nutritional and pubertal status. J Pediatr Endocrinol Metab 2022; 35:767-775. [PMID: 35487031 DOI: 10.1515/jpem-2021-0698] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 04/04/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Bone age (BA) is a quantitative determination of skeletal maturation. The role of puberty in variations in BA is poorly understood as hypothalamic-pituitary-gonadal (HPG) axis maturation and skeletal maturation are regulated in parallel but independently by multiple different factors. In countries like India where there is rapid nutrition transition and increase in prevalence of obesity, their impact on height and BA is not well understood. OBJECTIVES To study if in 2-17 year old healthy children, the difference between chronological age (CA), height age (HA) and BA is less than 1 year on either side of the chronological age and to assess relationship of BA with height, weight and BMI with special reference to gender and puberty. METHODS This cross-sectional study included 804 preschool/school-going Indian children. Anthropometric measurements and pubertal assessments were performed using standard protocols and were converted to age and sex standardized z-scores using Indian references while BA was estimated by Tanner-Whitehouse (TW3) method. p<0.05 was considered statistically significant. RESULTS The mean age and gender standardized z-scores for height, weight, body mass index (BMI) and BA were -0.3 ± 0.7, -0.7 ± 0.8, -0.1 ± 1.0, and -0.2 ± 0.9 respectively. HA was more delayed in girls while BA was more delayed in boys. The mean BA z-score increased with increasing BMI. After the onset of puberty, there was higher increment in BA in girls and HA in boys (p<0.05). CONCLUSIONS HA, BA and CA were tightly correlated in healthy Indian children with a significant role of nutritional status and puberty in causing variation in the same.
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Affiliation(s)
- Vaman Khadilkar
- Senior Pediatric Endocrinologist, Jehangir Hospital, Bombay Hospital, Pune, India.,Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Anuradha Khadilkar
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.,Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
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Verma P, Prasad JB, George N. Growth Estimation of Under-Five Children Using Statistical Models in Central Region of India. Diabetes Metab Syndr 2022; 16:102463. [PMID: 35334409 DOI: 10.1016/j.dsx.2022.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS To determine the suitability of 11 basic statistical models for estimating child-growth of under-five children and to bring-forth estimated growth curves for mean height & mean weight by their selected birth-weight categories for Central Region of India. METHODS The study used fourth round of National Family Health Survey-4 (NFHS-4) data of India, consisting of 75,645 under-five children, belonging to 3 Indian States - Chhattisgarh, Madhya Pradesh & Uttar Pradesh. The children of the Region were first divided into 4 sub categories according to their birth-weight: (i) < 2000 gm, (ii) 2000-2499 gm, (iii) 2500-2999 gm (iv) 3000+gm, growth curve for mean height and mean weight were estimated for two sexes. RESULTS The significant association of 7 socio-demographic factors studied, namely - age & sex of child, birth-order, BMI, mother's highest level of education, place of residence and wealth index. Further, Cubic Model and Power Model, demonstrated best-fit to height & weight data of under-five children, belonging to different birth-weight categories, for estimating growth of boys & girls separately. These models enabled us to estimate mean height and mean weight, with 95% CI, for boys and girls separately by different birth-weight categories. CONCLUSIONS Study concluded that 7 socio-demographic factors were significantly associated with birth-weight. Further, Cubic Model and Power Model were most suitable for estimating child growth in terms of mean height & mean weight for boys and girls - considering specific birth-weight categories.
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Affiliation(s)
- Pradyuman Verma
- Department of Epidemiology and Biostatistics, KLE Academy of Higher Education & Research, Belgaum, 590010, Karnataka, India.
| | - Jang Bahadur Prasad
- Department of Epidemiology and Biostatistics, KLE Academy of Higher Education & Research, Belgaum, 590010, Karnataka, India.
| | - Noel George
- Department of Epidemiology and Biostatistics, KLE Academy of Higher Education & Research, Belgaum, 590010, Karnataka, India.
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Mehta S, Oza C, Karguppikar M, Khadilkar V, Khadilkar A. Field Testing of Synthetic Growth Charts in 1-60-Month-Old Indian Children. Indian J Endocrinol Metab 2022; 26:180-185. [PMID: 35873931 PMCID: PMC9302412 DOI: 10.4103/ijem.ijem_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/17/2022] [Accepted: 03/30/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Malnutrition among under-five children (U5C) in India is a major public health problem due to double burden caused by nutritional transition. WHO cut-offs are adopted as global growth standards which define how children should grow in condition of optimal nutrition and health. Growth references which are representative of population-specific existing growth patterns need to be updated regularly which is cumbersome; hence, the author's group published 'synthetic growth references' for Indian children of age 0-18 years. OBJECTIVES The objective of this study is to field test the new synthetic growth references in U5C for height-for-age, weight-for-age and body mass index (BMI)-for-age against WHO charts in urban and rural Indian children to estimate prevalence of various indices of malnutrition. METHODS A cross-sectional anthropometric assessment of apparently healthy rural and urban Indian U5C attending vaccination centre was performed using standard protocols. They were converted to Z-scores using WHO and Indian synthetic growth references. The equality of proportion of parameters of malnutrition was tested by McNemar's test and P value <0.05 was considered significant. RESULTS WHO charts significantly overestimated stunting and malnutrition as compared to synthetic references with difference in sensitivity of 7.2% and 8.5%, respectively, and converse for over-nutrition by 2.1%. The most commonly affected parameter of malnutrition was underweight. Stunting was significantly higher in rural population using both cut-offs (P < 0.05). CONCLUSION The synthetic references limit the spread of weight and BMI and do not overestimate stunting and wasting. They may be more useful for identification of malnutrition and may thus be recommended for routine screening in Indian U5C.
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Affiliation(s)
- Sajili Mehta
- Department of Paediatric Endocrinology, Consultant Pediatric Endocrinologist, Surya Mother and Children Super Speciality Hospital, Pune, Maharashtra, India
- Department of Paediatric Endocrinology, Consultant Pediatric Endocrinologist, Maharashtra Institute of Medical Education and Research, Pune, Maharashtra, India
| | - Chirantap Oza
- Department of Endocrine and Growth, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Madhura Karguppikar
- Department of Endocrine and Growth, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
- Department of Paediatric Endocrinology, Senior Pediatric Endocrinologist, Jehangir Hospital, Pune and Bombay Hospital, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Department of Endocrine and Growth, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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Thomas JK, Gaikwad VS, Babu TR, Mathai J, Srinivas R, Karl IS. Functional outcomes in children with reduction glossectomy for vascular malformations - "less is more!". J Korean Assoc Oral Maxillofac Surg 2021; 47:209-215. [PMID: 34187961 PMCID: PMC8249192 DOI: 10.5125/jkaoms.2021.47.3.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Vascular malformation (VM) of the tongue can cause true macroglossia in children. Reduction glossectomy provides primary relief when sclerotherapy has failed or is not possible. In this study, we evaluated the surgical role in functional outcome of reduction glossectomy performed for VM of the tongue. PATIENTS AND METHODS : We evaluated the functional and surgical outcomes of seven children who were treated at a tertiary care centre in Southern India between 2013 and 2018. RESULTS : Six children underwent median glossectomy, while one child underwent lateral glossectomy. Functional assessment was performed at least 2 years after the date of surgery. At the time of assessment, speech was comprehensible for three children and was occasionally unintelligible in four children. Taste and swallowing were normal in all seven children. Six children exhibited a minimal residual lesion after surgery, of which only one was symptomatic. Residual lesions were managed with sclerotherapy (n=3), observation (n=2), or repeat surgery (n=1). CONCLUSION Reduction glossectomy in children with macroglossia secondary to VMs has acceptable outcomes in terms of cosmesis and speech, with no gastronomic restriction.
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Affiliation(s)
- John K. Thomas
- Departments of Paediatric Surgery, Christian Medical College, Vellore, India
| | | | | | - John Mathai
- Departments of Paediatric Surgery, Christian Medical College, Vellore, India
| | - Rohit Srinivas
- Departments of Paediatric Surgery, Christian Medical College, Vellore, India
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Khadilkar V, Ekbote V, Gondhalekar K, Khadilkar A. Comparison of Nutritional Status of Under-Five Indian Children (NFHS 4 Data) Using WHO 2006 Charts and 2019 Indian Synthetic Charts. Indian J Endocrinol Metab 2021; 25:136-141. [PMID: 34660242 PMCID: PMC8477744 DOI: 10.4103/ijem.ijem_18_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/25/2021] [Accepted: 06/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There is a growing body of evidence against using World Health Organization (WHO) charts for developing nations. Our objectives were: 1) To compare nutritional status of <5-year-old Indian children using WHO charts and synthetic Indian charts (SC) 2019. 2) To study nutritional status across wealth index categories. 3) To study nutritional status of predominantly breast-fed infants <6 months of age using both charts. MATERIALS AND METHODS Data from 4th National Family Health Survey (n ~ 236117, 0--59-month-old children) were used for assessing nutritional status using the WHO charts and SC. Z-scores were calculated for length/height, weight, and weight-for-height (WAZ) using both charts. Children were classified into degrees of malnutrition using appropriate cutoffs. RESULTS Stunting, wasting, and underweight were significantly higher using WHO charts. The prevalence of stunting (height for age) and wasting (WHZ) changed from high to medium and critical to poor when the reference changed from WHO to SC. All Z-scores showed an improving trend with increasing wealth index. On SC, almost all WHZ (wasting) from the richest to poorer were >-0.5 (clinically significant), whereas on WHO charts all wealth classes had WHZ <-0.5. For children under the age of 6 months, WHZ from richest to poorest was between -0.97 and -0.89 by WHO and 0.27 and 0.38 by SC. CONCLUSIONS Use of Indian synthetic growth charts for growth monitoring of under-five children may be more appropriate; infants under 6 months and children from well off families performed well on these charts.
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Affiliation(s)
- Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India
- School of Health Sciences, Savitribai Phule Pune University, Ganeshkhind Rd, Ganeshkhind, Pune, Maharashtra, India
| | - Veena Ekbote
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India
| | - Ketan Gondhalekar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, India
- School of Health Sciences, Savitribai Phule Pune University, Ganeshkhind Rd, Ganeshkhind, Pune, Maharashtra, India
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El Shafie AM, El-Gendy FM, Allahony DM, Hegran HH, Omar ZA, Samir MA, Kasemy ZA, El-Bazzar AN, Abd El-Fattah MA, Abdel Monsef AA, Kairallah AM, Raafet HM, Baza GM, Salah AG, Galab WS, Alkalash SH, Salama AA, Farag NA, Bahbah WA. Development of LMS and Z Score Growth References for Egyptian Children From Birth Up to 5 Years. Front Pediatr 2020; 8:598499. [PMID: 33537262 PMCID: PMC7849193 DOI: 10.3389/fped.2020.598499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The Lambda-Mu-Sigma (LMS) and Z score methods are important for assessment of growth and nutritional status. In Egypt, there is a lack of this tool for monitoring growth in preschool children. Objective: To develop LMS and Z score growth references for assessment of growth and nutritional status for Egyptian children from birth up to 5 years. Methods: A total of 27,537 children [13,888 boys (50.4%) and 13,649 girls (49.6%)] from birth up to 5 years were included in a multistage cross sectional randomized study from different Egyptian geographic districts to create LMS and Z score references for weight, length/height, and body mass index corresponding to age in addition to weight for length/height. Healthy term infants and children, exclusive breast feeding for at least 4 months and not suffering from any chronic diseases were included in this study. Children with dysmorphic features, preterm infants, admitted in neonatal or pediatric intensive care units and having any chronic diseases (hematological, cardiac, hepatic, and renal) were excluded. In addition any health condition that affects child growth including nutritional disorders was also excluded. Un-paired t-test was calculated to compare the means of weight for age, length/height for age, weight for length/height, and BMI for-age z scores of the Egyptian and WHO reference values. Results: Through detailed tables and graphs, LMS and Z scores for weight for age, length/height for age, weight for length/height, and BMI for age of both sexes were represented. Our findings showed no statistically significant difference between reference charts of WHO and Egyptian Z score charts (P > 0.05). Conclusion: This study provides the first reference for Egyptian children from birth up to 5 years based on Z score tool for assessment the growth and nutritional status in various clinical conditions and research, also allows comparison with references of other countries.
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Affiliation(s)
- Ali M El Shafie
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Fady M El-Gendy
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Dalia M Allahony
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Hossam H Hegran
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Zein A Omar
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Mohamed A Samir
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Zeinab A Kasemy
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | | | | | | | | | | | | | | | | | - Safa H Alkalash
- Family Medicine Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Amal A Salama
- Family Medicine Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Nagwa A Farag
- Family Medicine Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Wael A Bahbah
- Department of Pediatrics, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
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