Prevalence and Risk Factors for Severe Acute Malnutrition among Less Than Five Children from an Urban Locality of Surat City, Western India

Introduction Undernutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays recovery. The percentage of undernutrition, stunting and wasting in children under 5 years of the age in India are 35.7, 38.4 and 21.0 respectively. The etiology of malnutrition is complex and multi-factorial usually a consequence of inadequate dietary intake and various diseases. Methodology: A community based case-control study was conducted among children aged 6 to 59 months, registered at the Anganwadi centers in an urban locality of Surat city, Gujrat. Study population was divided into cases and controls using WHO classification based on anthropometric measurements. Result: The prevalence of undernutrition and severe acute malnutrition among the under-five children were 26.2 and 8.7% respectively. Significant association was found between nutritional status of the children and type of the family( OR 3.84, 95% CI =1.87-7.86, p = 0.000), low birth weight (OR 4.85, 95% CI =2.29 � 10.26, p = 0.000), poor appetite (OR = 2.89, 95% CI = 1.38-6.01, p = 0.004), bottle feeding (OR = 5.41, 95% CI = 1.91-15.29, p= 0.001) and children with habits of eating wafers/candies (OR = 21.99, 95% CI = 9.02-53.60, p = 0.000). Conclusion: Severe acute malnutrition continues to be an important health concern among under five children in the urban area and is affected by many risk factors which can be mitigated through structured and timely interventions using IEC materials.

Neck circumference as a marker of malnutrition among children attending the under five clinic of a tertiary care hospital in Nagpur, Maharashtra

India is facing a dual burden of overweight/obesity and under nutrition among children less than 5 years of age. Neck circumference is recently studied marker for malnutrition among adults and older children. Objective: To correlate neck circumference with body mass index and to associate it with wasting and underweight status. Material & Methods: A cross sectional study was conducted among children less than 5 years of age attending the outpatient setup of a tertiary care setup in Nagpur, Maharashtra. Demographic details and anthropometric measurements were done for the children with necessary permission before the start of the study. Anthropometry was done using standard guidelines and WHO charts were used for classification of wasting and underweight Results: We included 260 study subjects in our study. The mean age of the children was 21.55 ± 17.31 months and majority of them were females, belonged to Hindu religion (58.07%), belonged to Class 4 (33.08%) and the mothers were educated up to senior secondary (34.62%). Neck circumference had significant positive correlation with birth weight (r=0.138) and body mass index (r=0.211). The average neck circumference was significantly lower in case of wasted (p<0.05) and underweight children (p<0.05). Conclusion: Neck circumference correlated significantly with body mass index and was significantly lower in wasted and underweight in children less than 5 years of age.

Assessment of Dietary Diversity Score, Nutritional Status and Socio-demographic Characteristics of Under-5 Children in Some Rural Areas of Imo State, Nigeria

Introduction: The study assessed dietary diversity score (DDS) of rural under-five children and the relationship with their nutritional status and socio-demographic characteristics of their mothers/caregivers. Methods: The study was a descriptive cross-sectional survey involving 226 mothers and their under-five children selected at random from rural communities in Imo state, Nigeria. A pre-tested questionnaire was used to obtain information on socio-demographics. Qualitative recall of the child’s food consumption during the previous 24-h was used to calculate individual dietary diversity score (DDS=representing the number of food groups, based on a scale of 12 groups) and the scores were divided into terciles low= =4, medium=5 - 8, and high= 9 - 12). Weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) Z-scores were used to determine nutritional status of the children. Descriptive statistics, Chi square and linear regression analyses were performed. Results: Average age of the children was 4.2±0.7years, with 51.8% being males, and 48.2% females. Stunting, wasting and underweight were 11.5%, 5.4% and 2.7%, respectively. Mean DDS for all food groups was 6.04±4.18. Cereals and vegetables had higher mean values (0.78±0.29 and 0.78±0.30, respectively), while eggs had the least value (0.15±0.25). The prevalence of low, medium and high DDS (in terciles) was 73.5%, 25.2% and 1.3%, respectively. DDS was significantly associated with HAZ (?2 =10.63;p=0.03), while total family income remained significantly and positively associated with dietary diversity score (p<0.05) in the linear regression model. Conclusion: Children with low DDS were more likely to be stunted. Therefore, efforts aimed at increasing diversity in meals, both at home and in schools, are likely to benefit children at nutritional risk.

Low-quality scientific evidence for the continuation of universal Vitamin A supplementation among under 5 children in India.

Vitamin A supplementation (VAS) is presently being undertaken in India among under 5 (U5) children for two possible benefits (i) to prevent nutritional blindness due to Vitamin A deficiency (VAD) and (ii) to reduce U5 mortality. The existing scientific evidence suggests that nutritional blindness due to VAD has been virtually eliminated and also the difference between U5 mortality rate and infant mortality rate is very low for VAS to have any meaningful impact. On the contrary, scientific evidence indicates that there could be side effects of the administration of mega dose of Vitamin A (MDVA). These side effects of MDVA have not been systematically investigated. The universal VAS should be discontinued immediately as there are no likely benefits to U5 children.

Social and environmental determinants of malaria in under five children in Nigeria: a review.

There is no denying that malaria portends a serious present and future global concern; it is present in over one hundred countries worldwide, responsible for over 100 million clinical cases and an estimated 1-2 million deaths annually. However, the burden of mortality and morbidity is worse in poor countries and amongst the most disadvantaged in these countries. The World Health Organisation (WHO) suggests that Africa bear almost 90% of the global burden of malaria, and Nigeria, due to its population of over 160 million people bears the largest share of the burden. The last couple of decades have witnessed unprecedented global interest and efforts towards eradication of malaria. National and multinational bodies have expended millions of dollars on wide-ranging malaria control initiatives; unfortunately, results have not been completely positive, and malaria-related mortality amongst children has remained a core area of concern. This review shows that the persistence of Malaria, especially amongst under 5 children, can be linked to a dynamic interplay of biological, social and environmental risk factors and a host of health determinants. Cultural beliefs and values, knowledge and healthcare awareness of caregivers, the built environment, access, availability and affordability of food, water and healthcare are identified and discussed as the various socio-cultural, behavioural and environmental factors encumbering the success of malaria control initiatives in the country.

Disease Severity and Common Etiology of Diarrhea among Children Under-five in Mirzapur, Rural Bangladesh.

Aim: There is lack of information on the severity of diarrheal disease with etiology. Thus the study aimed to compare the etiology of under-five children with moderate-to-severe disease (MSD) and mild disease (MD). Study Design: Diarrheal disease surveillance. Place and Duration of Study: Mirzapur Kumudini Hospital, Tangail, rural Bangladesh, January 2010 – December 2011. Methodology: Overall, 2,324 under-5 diarrhea children were enrolled in the hospital who came from the demographic surveillance system (DSS) catchment area. Whole stool samples were collected from each enrolled child to detect rotavirus, Shigella, ETEC and V. cholerae. Information on socio-demographic and clinical characteristics was also collected. Results: Among all the study children, 1,098 (47%) were aged 0-11 months; 789 (34%) were 12-23 months, and 437 (19%) were 24-59 months. Rotavirus (33%) was mainly responsible for diarrhea amongst children under-5 and 90% of them were less than 2 years. Shigella represented 14%; of which, 45% were 24-59 months old. However, ETEC and V. cholerae represented only 3% and 2% respectively. Shigella was the most commonly detected pathogen (27%) for MSD followed by rotavirus (16%). Conversely, rotavirus (43%) was responsible for MD. MSD were most likely to be infected with Shigella flexneri [OR-9.81; 95% CI (6.38, 15.18)] and Shigella sonnei [6.29; (3.67, 10.87)] compared to their counterparts with MD. In logistic regression analysis, Shigella was responsible for a 2.25 times higher risk for MSD. Children with Shigella were 3.28 times at higher risk for bloody stool and 2.45 times more likely to have fever. However, rotavirus diarrhea was more likely to be presented with vomiting (OR-2.46) and fever (OR-1.28), and Vibrio cholerae, most often with watery diarrhea (OR-4.35). None of the clinical features were significantly associated with ETEC. Conclusion: Shigella was the leading pathogen that was detected most often in MSD, whereas rotavirus was often associated with MD.

Sociodemographic Determinants of Mortality in Hospitalized Under-Five Children at a Secondary Health Care Centre in the Niger Delta.

Aims: To determine the socio-demographic factors associated with mortality in hospitalized under-5 children in the Niger Delta region of Nigeria. Study Design: Cross-sectional study. Place and Duration of Study: Paediatric unit of Mariere Memorial Central Hospital Ughelli, Nigeria between October 2011 and February 2012. Methodology: All inpatients aged 29 days to ≤ 60 months who met the inclusion criteria were consecutively enrolled and information on a range of demographic and clinical factors obtained using a structured questionnaire. The primary outcome variable was mortality. Data was coded and analysed using SPSS version 16 software. Results: Of the 600 children recruited for the study, 345(57.5%) were males while 255(42.5%) females. The case fatality rate was 51(8.5%). Significant risk factors associated with mortality were maternal age >30 years (p=0.001), low maternal educational status (0.001), lower socioeconomic class (p=0.006), late presentation (p=0.004). However, multiple logistic regression analysis showed late presentation to be the strongest determinant of mortality. ((OR=4.83, 95%CI: 1.458 to 15.993, p=0.01). Conclusion: Social factors play a significant role in the eventual health outcomes in hospitalized under-5 children with late presentation being the strongest predictor of mortality. Effort should therefore be made at creating awareness on seeking early treatment for childhood illnesses in recognized hospitals.