ABSTRACT
Purpose@#Approximately 30% of children with chronic liver disease (CLD) are malnourished.However, proper assessment of their nutritional status is difficult. The subjective global nutritional assessment (SGNA) is a comprehensive approach that uses nutrition-focused history and examination, followed by grading of malnourishment. We aimed to study the prevalence of malnutrition in children with CLD using the SGNA tool. @*Methods@#This cross-sectional observational study included patients aged <18 years with CLD. Nutritional assessments were recorded using SGNA tool. Conventional anthropometric measurements were performed and corroborated with nutritional status using SGNA tool. @*Results@#A total of 85 children with CLD and mean age of 62 months were enrolled in this study. The prevalence of malnourished children according to SGNA was 34%; 22% were moderately malnourished and 12% were severely malnourished. We found statistically significant differences in anthropometric parameters among the three groups. A moderate degree of agreement was found between SGNA and weight-for-age (W/A) (p=0.020), midupper arm circumference (MUAC) (p<0.001), and triceps skin-fold thickness (TSF)-for-age (p=0.029). Furthermore, a fair degree of agreement was found between height-for-age (H/A) (p=0.001) and weight-for-height (W/H) (p<0.001). The sensitivity of W/A for detecting malnutrition was 93%, H/A was 90%, MUAC was 86%, and TSF was 88%. The sensitivity was much lower for W/H and body mass index for age (55% for both). @*Conclusion@#In our study, more than one-third of children with CLD were malnourished.Nutritional assessment using SGNA is a reliable method for evaluating nutritional status and is significantly correlated with common anthropometric measurements.
ABSTRACT
PURPOSE: Severe acute malnutrition (SAM) is an important public health problem which contributes to significant number of under five deaths. Protocol based management significantly decreases risk of deaths in children with medical complications. METHODS: Outcome of children aged 2 months–5 years admitted and fulfilling definition of SAM having diarrhea (group A) was compared to children with SAM having medical complications other than diarrhea (group B). Both groups were managed according to standard recommended protocols and monitored and followed up for 12 weeks after discharge. RESULTS: The average weight gain, defaulter rate, primary failure, secondary relapse rate and readmission rate were similar in both groups. Length of stay in group A was three days longer (p-value=0.039). Discharge rate was comparable with overall 68% of children successfully discharged and 50% of children reaching weight/height >−2 standard deviation at follow-up of 12 weeks. CONCLUSION: The current management protocol is equally effective for managing children with SAM having diarrhea. Good adherence to management protocol of dehydration and timely modification of therapeutic feeds in children with persistent diarrhea results in satisfactory weight gain.
Subject(s)
Child , Humans , Cachexia , Cohort Studies , Dehydration , Diarrhea , Follow-Up Studies , Length of Stay , Malnutrition , Public Health , Recurrence , Severe Acute Malnutrition , Weight GainABSTRACT
Plasmodium vivax [Pv] malaria is being increasingly recognized as a cause of severe malaria in children. To describe the various severe manifestations associated with vivax malaria by retrospective analysis of records. Children between the ages of 0 and 18 years with a confirmed diagnosis of Pv malaria monoinfection done by peripheral blood film [PBF] and/or rapid diagnostic test [RDT] admitted between June and September 2009 were included. Their clinical, hematological and biochemical manifestations were analyzed. Twenty-three patients of Pv malaria were retrospectively analyzed. Thrombocytopenia was present in 22 [96%] patients with counts less than 50,000/ micro L in 9 patients. Severe anemia [hgb < 5 mg/dl] was present in 8 [34%] patients. Cerebral malaria was present in 3 patients. Liver enzymes were elevated [>3 times normal] in 4 [17.3%] patients while jaundice [bilirubin > 2.5 mg/dl] was present in 2 patients [total bilirubin 5.2 mg/dl and 14.3 mg/dl]. Renal dysfunction [creatinine > 3 mg/dl] was present in 6 [26%] patients with 2 patients showing severely deranged renal functions [blood urea 168 mg/dl, 222 mg/dl and serum creatinine 5.0 mg/dl, 5.6 mg/dl, respectively]. Hypernatremia was present in one patient. One patient expired within 12 h of presentation because of severely deranged hepatic and renal dysfunction. Pv malaria can lead to unusual and fatal complications. All new guidelines should include "Severe Vivax malaria" as a clinical entity. Further research into the etiopathogenesis and treatment would be important