Prédicteurs de mortalité précoce en cours d'hospitalisation des enfants malnutris aigus sévères de 0-59 mois au CHU Sourou Sanou, Bobo-Dioulasso / Predictors of early mortality during hospitalization of severe acute malnourished children aged 0-59 months at CHU Sourô Sanou, Bobo-Dioulasso

Objectifs : étudier les facteurs de risque de mortalité des enfants malnutris aigus sévères (MAS) dans les 72 premières heures d'hospitalisation. Méthode : Nous avons mené une étude rétrospective sur des données d'enfants MAS de 0-59 mois, hospitalisés du 1er juin 2016 au 31 mai 2019 au CHUSourô Sanou (CHUSS) de Bobo-Dioulasso. Une régression logistiquea été réalisée pour déterminer les facteurs de risque de décès. Les variables avec un odds ratio (OR) >1, et p 3s [OR :3.55, 95%IC: 1.50-8.27], le sepsis [OR : 3.39, 95%IC: 1.33-8.50], étaient les facteurs de risque prédictifs de mortalité. Conclusion : Une formation et supervision continue du personnel soignant sur la prise en charge des urgences pédiatriques, l'utilisation du protocole OMS de prise en charge de la MAS, la disponibilité de kits d'urgence pourraient améliorer la prise en charge des MAS. Mots clés : Mortalité, précoce, MAS, BoboDioulasso

Objectives: to study risk factors for mortality in SAM children within the first 72 hours of hospitalization. Methods: We conducted a retrospective study on data from 0-59-month-old SAM children hospitalized from June 1th, 2016, to May 31th, 2019, at CHUSourô Sanou of Bobo-Dioulasso. A logistic regression was performed to determine risk factors for death. Variables with odds ratio (OR) > 1, and p 3seconds [OR :3.55, 95%IC: 1.50-8.27], sepsis[OR :3.39, 95%IC: 1.33-8.50]were the risk factors predictive of mortality. Conclusion: Training and ongoing supervision of healthcare staff in the management of paediatric emergencies, the use of the WHO SAM management protocol and the availability of emergency kits could improve SAM management

Time to Discharge and its Predictors among Children Aged 1-60 Months with Severe Acute Malnutrition Admitted to the Therapeutic Feeding Center in A Tertiary Hospital, North West Ethiopia

BACKGROUND: Standard treatment of severe acute malnutrition with medical complication and/or failed appetite test is admission in therapeutic feeding centers for stabilization. Once stabilized, patients will be linked to Outpatient treatment program for rehabilitation. Information regarding time to discharge from inpatient therapeutic feeding centers is limited in Ethiopia. The main objective of this study was to assess the time to discharge and its predictors among children1-60 months with Severe Acute Malnutrition admitted to University of Gondar Hospital. METHODS: Hospital Based retrospective follow up study was conducted in Gondar University Hospital among 282 children aged 1-60 months admitted to inpatient Therapeutic Feeding Center from June 2018 to December 2020. Participants were selected by Simple random sampling technique. Time to discharge from inpatient treatment was estimated using Kaplan-Meir procedure and Log Rank test was used to test observed difference between covariates. Identification of predictors for time to discharge was done by Stratified cox regression model. RESULTS: Overall 282 children were studied; 242 (85.8%) were discharged improved and 40 (14.2%) were censored. The median time to Discharge was 13 days (IQR: 9-18) and the Incidence of discharge was found to be 6.4 (95% CI: 5.6-7.2) per 100 person- day observations. Kwash-dermatosis (AHR=2.4, 95% CI: 1.17-4.8), Anemia (AHR=1.7, 95% CI: 1.1-2.6), pneumonia at admission (AHR=1.6, 95% CI: 1.01-2.63) and Hospital acquired infection (AHR=4.4, 95% CI: 2.4-8.2) were predictors of time to discharge. CONCLUSION: Hospital stay at the stabilization center was prolonged.Pneumonia, anemia, kwash dermatosis and Nosocomial infections were significant predictors of time to discharge

Les indicateurs de l'alimentation du nourrisson et du jeune enfant prédicteurs de la malnutrition chez les enfants 6-23 mois dans la zone de santé de Kapolowe, Haut-Katanga, R D Congo / NA

Introduction. L'étude visait évaluer les indicateurs de l'alimentation du nourrisson et du jeune enfant liés à l'état nutritionnel dans la zone de santé de Kapolowe, province du Haut Katanga avant les essais cliniques. Matériel et méthodes. Nous avons conduit une étude descriptive transversale dans la communauté auprès des 568 couples mère-enfant 6-23 mois évalués sur les indicateurs nutritionnels associés à la malnutrition. Résultats. L'allaitement maternel optimal était observé chez 10,7% des couples mère-enfant et l'alimentation complémentaire adéquate bénéficiée par 5,5% des enfants. Presque 25,6% des ménages utilisaient des toilettes améliorées, 98,8% des ménages buvaient l'eau des sources protégées et 12,1% des mères pratiquaient un minimum de lavage de mains. Le premier aliment complémentaire donné à la moitié des enfants (46%) était importé, mais 60,3 % des mères utilisaient le mélange farine de maïs + huile + sucre comme aliment de complément. La prévalence de la malnutrition aiguë, de la malnutrition chronique et de l'insuffisance pondérale était respectivement de 11,9%, 37% et 26,8%. La malnutrition aiguë était associée à l'occupation de la mère, au niveau socio-économique du ménage, à la Religion de la mère, à la consultation prénatale suivie par la mère, au Minimum de Diversité Alimentaire, à l'allaitement maternel non optimal, aux infections récurrentes et au faible poids de naissance. L'insuffisance pondérale était associée au sexe, à l'occupation de la mère, au niveau socio-économique, à la religion de la mère, au minimum de diversité alimentaire, à l'allaitement maternel non optimal, aux infections récurrentes et au faible poids de naissance. La malnutrition chronique était associée au sexe, au niveau socio-économique,

Introduction. The aim of the study was to assess infant and young child feeding indicators related to nutritional status in the Kapolowe health zone, Haut Katanga province prior to the clinical trials. Material and methods. We conducted a descriptive cross-sectional study in the community among568 mother-child pairs 6-23 months of age assessed on nutritional indicators associated with malnutrition. Results. Optimal breastfeeding was observed in 10.7% of the mother-child pairs and adequate complementary feeding in 5.5%. Almost 25.6% of households used improved toilets, 98.8% of households drank water from protected springs and 12.1% of mothers practiced minimal hand washing,12.1% of mothers practiced minimal handwashing. The first supplementary food given to half of the children (46%) was imported food, but 60.3% of mothers used maize flour + oil + sugar as a complementary food. The prevalence of acute malnutrition, chronic malnutrition and under weight were 11.9%, 37% and26.8% respectively. Acute malnutrition was associated with the mother's occupation, household socio-economic level, mother's religion, prenatal consultation attended by the mother, minimum dietary diversity, non-optimal breastfeeding, recurrent infections, and low birth weigh. Underweight was associated with gender, maternal occupation, socio-economic level, maternal religion, minimum dietary diversity, non-optimal breastfeeding, recurrent infections and low birth weight. Chronic malnutrition was associated with gender, socio-economic level, minimum meal frequency, type of toilet used, non-optimal breastfeeding, recurrent infections, and low birth weight. Conclusion. The prevalence of malnutrition, in all its forms, is still very high and worrying among children aged 6-23 months. The feeding practices are predictors of it.

Determinants of developmental milestones among children 0- 23 months at Kabale Hospital, Uganda

BACKGROUND :Approximately 200 million children globally fail to fulfil their development potential due to malnutrition, poor health, and unstimulating environments. Children in Kabale, Uganda, may be at particularly high risk as the rate of malnutrition in the region is likely to impact development. The study aimed to identify possible determinants influencing developmental milestones of breastfed and non-breastfed children aged 0-23 months. MATERIALS AND METHODSThe study was conducted at the young child clinic of Kabale hospital, among 250 children aged 0-23 months and their caregivers, for two months. The study adopted a comparative cross-sectional design, and systematic random sampling was used to select the respondents for the study. The socio-demographic characteristics, nutritional status, and feeding practices were assessed using structured pretested questionnaires. Developmental milestones of the children (communication, motor, fine motor, problem-solving, and social skills) were assessed using the modified ages and stages questionnaires. The data collected was tabulated, analysed statistically, and the results interpreted. RESULTS :Developmental scores were not associated with breastfeeding and minimum meal frequency. A milestone achievement of communication skills was associated with caregiver's education, caregiver's age and length-for-age. Gross motor scores were associated with the caregiver's age, weight-for-age, and length for age. Achievement of fine motor skills was associated with caregiver's education, caregiver's age, child's age, length for age, and children who met the minimum dietary diversity score. Problem-solving scores were associated with child's age, weight for age, length for age, and children who met the minimum dietary diversity. Personal social scores were associated with lower caregiver's age and normal weight for age Conclusion: Developmental scores were not associated with breastfeeding and minimum meal frequency. Development in early childhood was mainly associated with caregiver's age, caregiver's education, child's age, weight for age, length for age, and minimum dietary diversity score. Children under the care of younger caregivers and those who attained normal nutrition status had significantly more developed motor and social skills compared to children with older caregivers and undernourished children, respectively.

Les métaux lourds plus polluant dans la malnutrition chez l'enfant de moins de 5 ans à Lubumbashi / NA

Introduction : Lubumbashi, première ville du Katanga et deuxième grande ville de la République Démocratique du Congo, est une zone minière et le poumon économique du pays. De ce fait, elle constitue le siège d'une effervescence d'activités minières artisanales et industrielles. Ce travail vise à évaluer la bioaccumulation ou l'intoxication des métaux lourds dans la population des enfants malnutris. Matériel et méthodes : Le cobalt, le chrome, l'antimoine et le Plomb ont été dosés dans le sérum chez les enfants de moins de 5ans (n = 311). L'ICP OES ou le spectrophotomètre d'absorption atomique couplé à un spectrophotomètre à émission optique ont été utilisés pour le dosage. Trois cent onze enfants ont été colligés au cours de la période allant du 1 Juillet 2013 au 31 décembre 2014. Les analyses statistiques ont été réalisées au moyen du logiciel Epi Info 7.1.1.0. Résultats : Parmi les métaux lourds, l'antimoine s'est révélé moins toxique que les autres, tandis que les prévalences et risques de pollution significatifs suivants ont été observés chez les enfants malnutris : 76 % (OR [IC 95 %] : 1,5[1,04-2,25]) pour le chrome, 58 % (OR [IC 95 %] : 1,7[1,18-2,59]) pour le cobalt et 58 % pour le Plomb (OR [IC 95 %] : 1,7[1,15-2,65]). Conclusion : L'intoxication aux métaux lourds reste un problème de santé à Lubumbashi dans la population en général, particulièrement chez les malnutris. Plus l'enfant est jeune, de sexe féminin plus, il était exposé à l'intoxication aux métaux lourds plus polluants dans la majorité des cas. Pour la plupart les zscores PPA et TPA étaient au-delà de 2 avec une différence statistique hautement significative.

Double trouble: Addressing stunting and obesity via school nutrition

Background. South Africa (SA), as a middle-income country, faces the nutrition transition and associated double burden of undernutrition and obesity. School feeding programmes are one way of ensuring that malnutrition in children is addressed, but questions remain about whether they can address both undernutrition and obesity.Objectives. To compare the obesity and stunting outcomes for children receiving different combinations of school feeding programmes in a rural district of SA.Methods. The evaluation involved a comparative design that compared the stunting obesity levels of three groups of children. Group 1 received one lunch meal a day for a prolonged period, group 2 both lunch and breakfast, and group 3 had started receiving a daily lunch shortly before the commencementofthresearch.Results. Group 1 had stunting levels in line with the national average. Group 2 had lower stunting levels than those receiving only the lunch meal. Children from group 3 had lower stunting levels than groups 1 and 2. Rates of obesity and overweight were markedly different between the groups. Group 3 had very high rates of overweight and obesity ­ above the national average of 28%. In contrast, group 1 had far lower rates of overweight and obesity, and group 2exhibited the lowest levels. There was a significant decrease in the percentage of learners classified as overweight in group 3 over the 6-month period, from 26.1% to 19.2%.Conclusion. One lunch meal a day is associated with positive outcomes in relation to rates of stunting and obesity, and the lowest rates of obesity were measured when a breakfast meal was added. The addition of a breakfast meal to a lunch feeding programme shows promise,but this requires further investigation to understand whether causal linkages exist

Risk Factors of Poor Anthropometric Status in Children Under Five Years of Age Living In Rural Districts of the Eastern Cape and Kwazulu-Natal Provinces; South Africa

Objectives: Factors associated with children's anthropometric status were determined. Design: Secondary analysis was done using data from a cross-sectional survey including children under five years of age (n = 2 485) and their mothers in rural districts of the Eastern Cape and KwaZulu-Natal provinces; South Africa. Methods: Data generated by questionnaire and anthropometric indices were used to construct a logistic regression model; taking into account hierarchical relationships of risk factors to determine the odds of a child being stunted; underweight or overweight. Statistical significance was set at p 0.05. Results: Factors associated with stunting were child of male gender (odds ratio (OR)

Risk Factors of Poor Anthropometric Status in Children Under Five Years of Age Living In Rural Districts of the Eastern Cape and Kwazulu-Natal Provinces; South Africa

Objectives: Factors associated with children's anthropometric status were determined. Design: Secondary analysis was done using data from a cross-sectional survey including children under five years of age (n = 2 485) and their mothers in rural districts of the Eastern Cape and KwaZulu-Natal provinces; South Africa. Methods: Data generated by questionnaire and anthropometric indices were used to construct a logistic regression model; taking into account hierarchical relationships of risk factors to determine the odds of a child being stunted; underweight or overweight. Statistical significance was set at p 0.05. Results: Factors associated with stunting were child of male gender (odds ratio (OR)

Effet des malnutritions mineure et moderee sur les proteines immunitaires; inflammatoires et nutritionnelles chez l'enfant en Cote d'Ivoire

But : le but de cette etude a ete de determiner les perturbations des proteines immunitaire; inflammatoires et nutritionnelles chez 142 enfants dont 42 ont presente une malnutrition (30 malnutris mineurs et 12 moderes). Materiel et methodes : Cette etude a ete realisee en Cote d'Ivoire chez les enfants de 5 a 15 ans. L'etat nutritionnel ou l'etat de malnutrition a ete apprecie par le rapport Poids/Taille qui est de loin le plus utilise. Les proteines immunitaires; inflammatoires et nutritionnelles ont ete dosees par immunodiffusion radiale de Mancini. Resultats : Les resultats de cette etude ont montre que l'Albumine a ete abaissee (p0;05) au cours de la malnutrition moderee et mineure en comparaison aux sujets normonutris. En revanche; il a ete observe une elevation de la CRP dans les deux formes de malnutrition (p0;01). De meme ; l'index pronostique nutritionnel et inflammatoire qui permet d'apprecier simultanement l'etat inflammatoire et nutritionnel (PNI) a ete augmente dans la malnutrition moderee par rapport a la malnutrition mineure (p0;05) et aux sujets normonutris (p0;01). Par ailleurs; les proteines immunitaires restent inchangees dans les deux formes de malnutrition en comparaison aux sujet normonutris (p0;05). Conclusion : Cette etude a montre que les malnutritions moderee et mineure chez les enfants de plus de 5 ans sont accompagnes toujours de processus inflammatoire et d'une consommation proteique notamment l'Albumine. Enfin; ces observations suggerent que la determination du statut nutritionnel avec les parametres anthropometriques (Poids/Taille) necessite l'utilisation des examens biologiques

Evaluation de la qualite du depistage et de la prise en charge de la malnutrition infantile a Cotonou; Benin

La presente etude tente d'evaluer la qualite du depistage et de la prise en charge des enfants malnutris dans les centres socio-sanitaires de Cotonou; ville la plus importante du Benin. Elle a pu etre realisee dans 19 centres prives; publics; medicaux et sociaux. Cinq enquetes ont ete necessaires : une enquete retrospective a partir des registres des centres; une evaluation des moyens materiels dont disposait chaque centre; une enquete d'observation des prestataires de soins (n=90); un questionnaire du responsable des activites nutritionnelles de chaque centre (n=19); un questionnaire des meres des enfants malnutris venus consulter dans ces centres (n=43). La prevalence globale des enfants malnutris depistes dans les centres socio-sanitaires etait tres faible (2;2) par rapport a la prevalence de la malnutrition a Cotonou (20;3). Moins de la moitie des centres (47;4) utilisaient une fiche de suivi de croissance. Aucun ne possedait de diagramme de maigreur. Le materiel de demonstration culinaire etait utilise dans 28;6des centres. Les 3/4 de l'ensemble des centres realisaient des seances d'IEC (Information Education Communication) de bonne qualite; et tous les centres habilites possedaient les principaux medicaments essentiels. L'evaluation des soignants a montre que 35d'entre eux ne maitrisaient pas les techniques de mesure anthropometriques de base. Ce sont les medecins et les aides-soignants qui utilisaient le moins la courbe de croissance. Aucun medecin ne donnait de conseil nutritionnel. Le questionnaire aux soignants amis en evidence des connaissances correctes dans l'ensemble malgre un defaut de supervision et de formation continue. L'analyse du questionnaire des meres a montre que la malnutrition de leur enfant n'etait jamais le motif de consultation initiale; et que seules 39avaient compris que leur enfant etait malnutri en sortant de la consultation. Cette etude met donc en evidence a Cotonou un deficit du depistage de la malnutrition chez les enfants et une mauvaise qualite de la prise en charge des enfants malnutris. La malnutrition qui est un veritable probleme de sante publique dans cette ville necessite donc la mise en place d'un programme de lutte contre la malnutrition en milieu urbain

Etat nutritionnel des enfants infectes par le VIH et suivis au Centre National de Prescription des antiretroviraux (ARV) pour les enfants du CHU de Yopougon

Notre travail est une etude prospective de type transversal; portant sur 99 enfants ages de 6 mois a 16 ans; et suivis au centre accredite pour la prise en charge des enfants vivant avec le VIH du CHU de Yopougon.L'analyse des resultats a montre:AU PLAN EPIDEMIQUE-un sex-ratio de 0;8;-un age moyen de 77 mois;-predominance du VIH 1 a 98pour cent;-la transmission mere-enfant etait le principal mode de contamination.AU PLAN NUTRITIONNEL-54pour cent des nourrissons n'avaient pas une alimentation diversifiee;-Les enfants de 2 ans et + avaient en moyenne 3 repas et plus par jour;-La consommation de fruits et de legumes n'etait pas frequente.L'etude de l'etat nutritionnel a mis en evidence:-la frequence du retard de croissance (42;42pour cent);-35;35pour cent d'enfant ayant une malnutrition globale et 10;1pour cent etaient emacies.La recherche des determinants de l'etat nutritionnel a mis en evidence l'influence significative de la candidose buccale et de la diarrhee chronique dans la survenue de la malnutrition.Au regard de ces resultats; la prise en charge correcte des candidoses buccales et des diarrhees chroniques; l'amelioration de la prise en charge nutritionnelle des enfants vivant avec le VIH en collaboration avec un nutritionniste; I' elaboration de protocoles de rehabilitation nutritionnelle adaptes; pourraient etre des voies de solutions a l'amelioration de la qualite de vie des enfants vivant avec le VIH

Survivorship and nutritional response among HIV-1 seropositive and seronegative paediatric patients admitted as cases of Protein-Energy Malnutrition (PEM)

This paper presents results of study that was carried on 110 malnourished children aged 3-84 months who were admitted in the Child Nutrition Ward in Old Mulago Hospital-Kampala; Uganda. The children were admitted for intensive nutritional therapy and came from a radius of about 15 kilometres from the treatment center. Permission from relevant review boards was sought and given; as was permission from the parents or guardians sought before any child was recruited in the study; other inclusion criteria having also been fulfilled. The survival curves derived from life tables for oedema loss did not show any significant difference between the two serostatuses; although HIV-1 seronegative tended to loose oedema faster than their counterparts. However; there was a significant difference when considering cumulative probabilities of survival in the two groups. This suggested that some of the HIV-1 seropositive could actually have had active paediatric AIDS. Therefore; seropositivity affected the outcome of treatment in that there was a much higher case fatality rate among HIV seropositive cases than the other group; other factors remaining constant

Nutritional rickets in Ghanaian children

Eighteen (18) Ghanaian children with nutritional rickets seen in the Department of Child Health; Korle-Bu Teaching Hospital (KBTH) from 1985-1994 are reported. Their ages ranged from 14 months to 44 months. Their mean age at presentation is 29.4 months. There were eight (8) boys and ten (10) girls. None of these 18 children was receiving the daily recommended allowance (DRA) of Vitamin D. They all had characteristic diagnostic X-ray findings in their wrist and ankle bones. The product of their serum calcium (Ca2+) and serum inorganic phosphate (Pi) that is (Ca2+ x Pi) was less than 30 in all of them and all had markedly raised serum alkaline phosphatase levels

The prognostic significance of the QRS amplitudes of electrocardiogram in kwashiorkor

Electrocardiograms (ECGs) were performed on 52 children with kwashiorkor and 52 age-and sex-matched controls. Heart rates were higher (p0.05) and QTc intervals longer (p0.05) in patients with kwashiorkor than in the controls. The QRS amplitude in all the leads in patients with kwashiorkor was smaller (p0.05) than those of the controls. The QRS amplitudes in the survivors were significantly wider (p0.05) controls. The QRS amplitudes in the survivors were significantly wider (p0.05) than in those of the patients who died. Average QRS amplitude of less than 5mm in the standard limb leads and less than 10mm in the chest leads indicated poor prognosis