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Tsegaye AT, Pavlinac PB, Turyagyenda L, Diallo AH, Gnoumou BS, Bamouni RM, Voskuijl WP, van den Heuvel M, Mbale E, Lancioni CL, Mupere E, Mukisa J, Lwanga C, Atuhairwe M, Chisti MJ, Ahmed T, Shahid AS, Saleem AF, Kazi Z, Singa BO, Amam P, Masheti M, Berkley JA, Walson JL, Tickell KD. The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6-23 Months in Sub-Saharan Africa and South Asia. Nutrients 2022; 14:3481. [PMID: 36079736 PMCID: PMC9460249 DOI: 10.3390/nu14173481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6−23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.
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Affiliation(s)
| | | | | | - Abdoulaye H. Diallo
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina Faso
| | - Blaise S. Gnoumou
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina Faso
| | - Roseline M. Bamouni
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina Faso
| | - Wieger P. Voskuijl
- Amsterdam UMC, University of Amsterdam, Amsterdam Centre for Global Child Health & Emma Children’s Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Meta van den Heuvel
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Emmie Mbale
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 265, Malawi
| | - Christina L. Lancioni
- Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA
| | - Ezekiel Mupere
- Uganda-CWRU Research Collaboration, Kampala P.O. Box 663, Uganda
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda
| | - John Mukisa
- Uganda-CWRU Research Collaboration, Kampala P.O. Box 663, Uganda
| | | | | | - Mohammod J. Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Abu S.M.S.B. Shahid
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Ali F. Saleem
- Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Zaubina Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | | | - Pholona Amam
- Kenya Medical Research Institute, Nairobi 54840, Kenya
| | - Mary Masheti
- Kenya Medical Research Institute, Nairobi 54840, Kenya
| | - James A. Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi 80108, Kenya
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi 184742, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Judd L. Walson
- Departments of Global Health, University of Washington, Seattle, WA 98195, USA
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi 184742, Kenya
| | - Kirkby D. Tickell
- Departments of Global Health, University of Washington, Seattle, WA 98195, USA
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