scholarly journals Predictive Model for the Risk of Severe Acute Malnutrition in Children

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Olivier Mukuku ◽  
Augustin Mulangu Mutombo ◽  
Lewis Kipili Kamona ◽  
Toni Kasole Lubala ◽  
Paul Makan Mawaw ◽  
...  

Background. The nutritional status is the best indicator of the well-being of the child. Inadequate feeding practices are the main factors that affect physical growth and mental development. The aim of this study was to develop a predictive score of severe acute malnutrition (SAM) in children under 5 years of age.Methods. It was a case-control study. The case group (n = 263) consisted of children aged 6 to 59 months admitted to hospital for SAM that was defined by az-score weight/height < −3 SD or presence of edema of malnutrition. We performed a univariate and multivariate analysis. Discrimination score was assessed using the ROC curve and the calibration of the score by Hosmer–Lemeshow test.Results. Low birth weight, history of recurrent or chronic diarrhea, daily meal’s number less than 3, age of breastfeeding’s cessation less than 6 months, age of introduction of complementary diets less than 6 months, maternal age below 25 years, parity less than 5, family history of malnutrition, and number of children under 5 over 2 were predictive factors of SAM. Presence of these nine criteria affects a certain number of points; a score <6 points defines children at low risk of SAM, a score between 6 and 8 points defines a moderate risk of SAM, and a score >8 points presents a high risk of SAM. The area under ROC curve of this score was 0.9685, its sensitivity was 93.5%, and its specificity was 93.1%.Conclusion. We propose a simple and efficient prediction model for the risk of occurrence of SAM in children under 5 years of age in developing countries. This predictive model of SAM would be a useful and simple clinical tool to identify people at risk, limit high rates of malnutrition, and reduce disease and child mortality registered in developing countries.

2019 ◽  
Vol 6 (6) ◽  
pp. 2489
Author(s):  
Gargi H. Pathak ◽  
Anuya V. Chauhan ◽  
Sunita O. Beniwal

Background: Indicators showing levels of nutritional status in children are often regarded as representative of the health and general well-being of a society at large. Malnutrition stands as a consequence of several key social and economic factors such as lack of education, inadequate health care services and ill-informed cultural behaviors.  In order to holistically address the issues surrounding malnutrition, a comprehensive understanding of the multi-dimensional complexities at play in society is crucial. Objective was to identify determinants of severe acute malnutrition among children with severe acute malnutrition under 5 years (between 6 months to 60 months) of age. Methods: A cross sectional study design involving 64 patients with severe acute malnutrition between 6 to 60 month of age was employed to identify the risk factors of severe acute malnutrition among children admitted in pediatric wards and nutritional rehabilitation centers, Civil hospital Ahmedabad, from April 2018 to march 2019. A detailed history of all the patients were taken and data collected using structured interviewer-administered questionnaire.Results: Thus, from the above study, it is clear  that age of the child <2 years, female gender, bigger family size, poverty, illiteracy in mother, poor feeding practices, improper complementary feed introduction, poor nutritional status of mother whose child were breastfed, acute or chronic illness in child and narrow birth spacing were the chief determinants of SAM in under five children.Conclusions: Socio demographic characters, nutrition and child caring practices, infection and other childhood illness as well as obstetric history of mother are important determinants of severe acute malnutrition in children under five years of age. As a result, collaborative efforts should be organized to improve promotion of better child caring practices through appropriate age specific child and maternal feeding practices, prevention and early treatment of acute childhood illnesses and promotion of family planning.


2018 ◽  
Vol 22 (8) ◽  
pp. 1406-1414 ◽  
Author(s):  
Natasha Lelijveld ◽  
Alhaji A Jalloh ◽  
Samuel D Kampondeni ◽  
Andrew Seal ◽  
Jonathan C Wells ◽  
...  

AbstractObjectiveTo assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children.DesignProspective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children.SettingBlantyre, Malawi.ParticipantsChildren discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children.ResultsSAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73).ConclusionsDespite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.


BMC Nutrition ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Christine Chimanuka Murhima’Alika ◽  
Ghislain Maheshe Balemba ◽  
Pacifique Mwene-Batu Lyabayungu ◽  
Guy Mulinganya Mulume’oderhwa ◽  
Grace Munthali ◽  
...  

Abstract Background Malnutrition is a public health problem, as wasting affects 7.5% of children worldwide. The harmful effects of severe acute malnutrition (SAM) can last a lifetime, but how SAM in childhood affects later breastfeeding ability is not clear. In the present study, we assessed the human milk output and body composition among mothers with a history of childhood SAM. Methods This retrospective cohort study was carried out in Miti-Murhesa Health Zone (Democratic Republic of Congo) from January 15 to March 17, 2020. We selected lactating mothers with breastfed infants aged 2–12 months. Two categories of mothers were included: those who had been treated for SAM during their childhood (years 1988–2003; n = 39) and a community control with no history of SAM (n = 40). The weight, height, and mid-upper arm circumference were measured and body mass index (BMI) calculated as weight/height2. Body composition and human milk output were assessed using standard deuterium dilution methods. Student t and chi2 tests ware applied to compare two groups. Results The mean age ± standard deviation of the mothers was 24.4 ± 5.1 and 26.0 ± 6.1 years for the SAM and control groups, respectively (p = 0.186). The age of their infants was 5.4 ± 2.3 months in both groups (p = 0.962). In the SAM and control groups, the mean maternal BMI was 23.8 ± 2.3 and 23.6 ± 3.7 kg/m2 (p = 0.849), mean Fat Mass 27.1% ± 5.0 and 27.1% ± 5.8% (p = 0.708), and the mean Fat Free mass 72.9% ± 5.0 and 72.9% ± 5.8% (p = 0.998), respectively. Human milk output was 833.7 ± 152.1 g/d in SAM group and 827.4 ± 171.4 g/d in the control group (p = 0.864). Conclusions We found no significant difference in human milk output and body composition in mothers treated for SAM during childhood compared to community controls.


2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Desire Banga ◽  
Melvis Baren ◽  
Namale Vivian Ssonko ◽  
Franck Katembo Sikakulya ◽  
Yves Tibamwenda ◽  
...  

Background. Mortality among children with severe acute malnutrition remains an immense health concern in the hospitals in developing countries, but its attributes are not completely assessed in various hospital settings. The aim of this study was to determine the proportion of mortality, the comorbidities, and factors associated with in-hospital mortality among children under five years of age admitted with severe acute malnutrition at Jinja Regional Referral Hospital, Eastern Uganda. Methods. This was a hospital-based analytical and descriptive prospective cohort study conducted in the nutritional unit of Jinja Regional Referral Hospital. A total of 338 children and their caretakers who met the criteria were consecutively enrolled into the study. Descriptive statistics were used to each of the independent factors, and comorbidities were subjected to chi-squared test followed by logistic regression analysis to assess its association incidence of mortality among children. All independent variables with p values ≤ 0.05 were entered into a multivariate model for factors and comorbidities independently. Factors and comorbidities with p values ≤ 0.05 were considered as associates of mortality among children. Results. Of the 338 children under 5 years of age enrolled, 49 (14.5%) died, although the majority of children were diagnosed with dehydration, 128 (37.9%); pneumonia, 127(37.6%); and malaria, 87(25.7%). Anemia ( aRR = 2.9 , 95% CI: 1.23-6.62, p = 0.01 ), bacteremia ( aRR = 10.0 , 95% CI: 3.62-29.01, p = 0.01 ), HIV ( aRR = 4.8 , 95% CI: 1.42-16.30, p < 0.01 ), TB ( aRR = 4.3 , 95% CI: 1.28-14.49, p < 0.02 ), and shock ( aRR = 60.9 , 95% CI: 9.05-410.28, p < 0.01 ) were the comorbidities significantly associated with a likelihood of mortality. Conclusions. The mortality among children under 5 years of age admitted with severe acute malnutrition is still high (14.5% versus 5%). The comorbidities are significantly associated with mortality. The clinicians are recommended to follow-up closely patients with severe acute malnutrition and to focus on the critical comorbidities identified.


2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 183-183
Author(s):  
Emmanuel Kigbu Francis ◽  
Titilayo Bamidele ◽  
Micheal Enemali

Abstract Objectives Malnutrition is a major public health challenge in developing countries and as such the nutritional status of children serve as an indicator to rate the overall well-being of a society. In this study, we assessed the nutritional status of under-five children attending Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Methods After ethical clearance, 165 under five children were randomly recruited into the study. The socio-demographic and nutritional information of the children and mother were obtained using structured questionnaires. Anthropometric assessment was done on each child and blood samples analyzed using standard biochemical techniques. The data obtained were statistically analyzed using the Statistical Package for Social Sciences (SPSS) version 20. Results Out of the 165 children recruited for this study, 51.5% were males. 41.2% of the children showed prevalence of Global Malnutrition, 15.8% and 25.5% indicated moderate acute malnutrition (MAM) and Severe Acute Malnutrition (SAM) respectively. 66.1% of the children had Mid-upper arm circumference (MUAC) measures in the normal range of 12.5–14.6 cm. There is a significant relationship between nutritional knowledge of the mother, socioeconomic status, child feeding practices, and the nutritional status of their children (P &lt; 0.05). The biochemical parameters studied reported that average PCV (33.32 ± 4.49) and total protein (34.53 ± 13.26 g/L) were lower than the normal range, glucose (4.52 ± 0.97 mmol/L) and Calcium (2.14 ± 0.25 mmol/L) were within the normal range and Albumin (64.16 ± 16.87 g/L) was above the normal range. Conclusions This study has successfully revealed the nutritional status of under five years children in Nasarawa State, Nigeria. Our findings have critical implications for intervention initiatives among children in Nigeria. Funding Sources Self funded.


2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Alido Soumana ◽  
Aboubacar Samaila ◽  
Lamine Mahaman Moustapha ◽  
Moumouni Kamaye ◽  
Balkissa Daouda ◽  
...  

While there have been very few fatal cases, SARS-CoV-2 has been reported in paediatric patients. This study aims to describe a fatal case of COVID-19 in a child with severe acute malnutrition. The eight-month-old child presented with fever, diarrhoea, and difficulty in breathing. The mother of the child had fever and shortness of breath four weeks before she died. Physical examination revealed lethargy, dehydration, and severe weight loss with a weight of 5 kg at a height of 78 cm tall. The weight-for-height index was less than three Z-scores, which corresponds to severe acute malnutrition. The pulmonary examination revealed moderate respiratory distress, and the chest X-ray presented features suggestive of pneumonia in the right lung area. In the context of the COVID-19 outbreak in Niger and the circumstances of the mother’s death, a nasal swab was taken for laboratory confirmation. Treatment provided to the child included intranasal oxygen, antibiotics, and a dietary program with therapeutic milk. The child died 48 hours after his admission. The history of contact with a SARS-CoV-2 suspect or positive patient should lead to screening for infection by using RT-PCR. It is important to investigate malnutrition as a potential risk factor for severe SARS-CoV-2 infection and resultant mortality.


2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6577-6577 ◽  
Author(s):  
A. R. Mato ◽  
A. N. Miltiades ◽  
M. Guo ◽  
D. F. Heitjan ◽  
M. P. Carroll ◽  
...  

6577 Background: In a previous retrospective study of 194 patients undergoing AML induction chemotherapy, we described a TLS predictive model entitled the Penn Predictive Score for Tumor Lysis Syndrome (PPS-TLS). TLS incidence was 9.8%. The PPS-TLS is defined as the sum of the scores for pre-induction lactate dehydrogenase (LDH), uric acid (UA), and gender (see table ). The area under the receiver operator characteristic (ROC) curve for this cohort was 89% (SD 4%). Methods: To validate the PPS-TLS, we retrospectively analyzed a second dataset of 166 AML patients undergoing induction chemotherapy from 2003–2006 at our institution. All patients received TLS prophylaxis. TLS was defined as (i) doubling of baseline serum creatinine (Cr) in association with elevated serum phosphate, UA, or potassium or (ii) elevations in 2 of the above electrolytes within 7 days of initiation of therapy. Potential TLS predictive factors were analyzed for statistical significance. Results: In this new dataset, TLS incidence is 9.6%. Significant in univariate analysis are male sex (OR=6.0, CI 1.31–27.15), Cr (OR=13.0, CI 2.88–58.23), UA (OR=48.6, CI 5.78–408.95), and LDH (OR=1.2, CI 1.03–1.48). In multivariate analysis, LDH (OR=1.3, CI 1.04–1.70) and Cr (OR=6.8, CI 1.48–30.89) remain significant. PPS-TLS scores were calculated and tested for their ability to predict TLS in this dataset. The area under the ROC curve for the PPS-TLS in this dataset was 75% (CI 61%-89%), indicating that the probability that a patient with TLS would have a higher PPS-TLS score than one without TLS is 75%. The current result is not statistically significantly different from the area under the ROC curve in the initial dataset (89%). Conclusions: The PPS-TLS is the first TLS predictive model in AML. The reproducibility of this model is supported by this study. A prospective multisite study is being designed to further validate this model. This analysis may lay the groundwork for the first evidence-based guidelines for TLS monitoring and management in AML. [Table: see text] No significant financial relationships to disclose.


Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 363
Author(s):  
Mohamed Abu-Manga ◽  
Ayoub Al-Jawaldeh ◽  
Abdul Baseer Qureshi ◽  
Amira M. Elmunier Ali ◽  
Damiano Pizzol ◽  
...  

Background: Malnutrition places a heavy burden on the health, well-being, and sustainable development of populations in Sudan, especially a country affected by conflict, which continues to experience high levels of food insecurity, undernutrition, and micronutrient deficiencies; 3.3 million are acutely malnourished, with 522,000 children suffering from severe acute malnutrition and approximately 2.2 million children requiring treatment for moderate acute malnutrition. This study aims to describe the nutritional status of children under five years old and identify the progress toward the achievement of the Global Nutrition Targets. Methods: This is a secondary data analysis of a quantitative survey, using the second-round of the Simple Spatial Survey Method (S3M II) in Sudan in the period 2018–2019. The analysis used an area-based sampling methodology in all 18 Sudanese states. Data from the WHO Tracking Tools of the Global Nutrition Targets was used to reflect the progress in achieving the targets in Sudan. Results: Global stunting prevalence was at 36.35 percent including moderate stunting prevalence and severe stunting prevalence (21.25 percent and 15.06 percent respectively). Global wasting prevalence was 13.6 percent including moderate wasting prevalence and severe wasting prevalence (10.8 percent and 2.7 percent respectively). Sudan has made great progress in achieving the target of increasing exclusive breastfeeding. However, despite the welcome commitments by the Government and all stakeholders, Sudan is still struggling to implement strategies, policies, and regulatory measures to address malnutrition and achieve the Global Nutrition Targets in 2025 and the Sustainable Developmental Goals in 2030. Therefore, more than ever, there is a need for comprehensive, multi-sectoral action to address malnutrition in all its forms.


2015 ◽  
Vol 2 ◽  
pp. 2333794X1559418 ◽  
Author(s):  
Mohammod Jobayer Chisti ◽  
Tahmeed Ahmed ◽  
Abu S. M. S. B. Shahid ◽  
K. M. Shahunja ◽  
Pradip Kumar Bardhan ◽  
...  

We aimed to evaluate sociodemographic, epidemiological, and clinical risk factors for pulmonary tuberculosis (PTB) in children presenting with severe acute malnutrition (SAM) and pneumonia. Children aged 0 to 59 months with SAM and radiologic pneumonia from April 2011 to July 2012 were studied in Bangladesh. Children with confirmed PTB (by culture and/or X-pert MTB/RIF) (cases = 27) and without PTB (controls = 81; randomly selected from 378 children) were compared. The cases more often had the history of contact with active PTB patient ( P < .01) and exposure to cigarette smoke ( P = .04) compared with the controls. In logistic regression analysis, after adjusting for potential confounders, the cases were independently associated with working mother ( P = .05) and positive tuberculin skin test (TST; P = .02). Thus, pneumonia in SAM children is a common presentation of PTB and further highlights the importance of the use of simple TST and/or history of contact with active TB patients in diagnosing PTB in such children, especially in resource-limited settings.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pacifique Mwene-Batu ◽  
Daniel Lemogoum ◽  
Laurène de le Hoye ◽  
Ghislain Bisimwa ◽  
Michel P. Hermans ◽  
...  

Abstract Introduction Little is known about the long-term outcomes of Severe Acute Malnutrition (SAM) during childhood. As such, this study aims to explore the association between childhood SAM and blood pressure (BP) in adulthood in a context without nutrition transition. Methodology We identified 524 adults (Median age: 22 years) who were treated for SAM during childhood in Eastern DRC between 1988 and 2007. They were compared with 407 age-and-sex matched subjects with no history of SAM in the community. The variables examined for this study were the systolic (SBP), diastolic (DBP), mean (MBP) blood pressure (BP) and pulse pressure (PP), as well as high blood pressure (HBP) defined as BP ≥ 140/90 mmHg and/or use of BP-lowering drug(s) in adulthood. For comparison, linear and logistic regression models were used for analysing continuous and dichotomous variables, respectively. Results Of the 524 exposed located, 145 were selected according to age. A total of 97 unexposed were recruited. Compared to unexposed, exposed had slightly higher SBP and PP after adjusting for occupation, body mass index (BMI) and food consumption [SBP = 1.4 mmHg (− 2.2, 4.8) and PP = 2.6 mmHg (− 0.3, 6.0)]. However, their DBP was lower than that of the unexposed [− 1.6 mmHg (− 4.6, 1.5)]. MBP and creatinine levels were similar between the two groups. The prevalence of HBP adjusted for age was higher among exposed than unexposed (9.7% vs 5.3%). In addition, the odds of having HBP was higher among exposed than unexposed, however the observed difference was not statistically significant [Odds Ratio (OR) 1.9 (0.7, 5.6)]. Finally, using multiple regression analysis, although the effect was not significant, SAM was a major contributor to HBP [adjusted OR 3.1 (0.9,10.9), p = 0.064], while only male gender and higher BMI (overweight/obesity) emerged as independent predictors of HBP among this young study population. Conclusions This study suggests that an episode of SAM in childhood has a weak impact on BP variability in young Congolese adults (from DRC) living in an environment without nutrition transition. However, people who experienced a period of SAM tended to have a higher prevalence of HBP and a much higher risk of developing HBP than unexposed. Additional multicentre studies involving a larger cohort would provide greater understanding of the impact of SAM on the overall risk of BP disorders during adulthood.


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