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Severe acute malnutrition results in a spectrum of pathological changes in the body including substantial aberrations in hematological system. Aim of the study was to compare children from nutritional rehabilitation center with children from general ward with respect to: hematological profile, prevalence, etiology and severity of anemia. A cross sectional analytical study was done on 350 children aged from 6 to 59 months admitted in M.G.M. Hospital, Warangal. The prevalence of anemia in cases from nutritional rehabilitation center was 89.0% and 45.7% in cases from general ward. 82% cases from nutritional rehabilitation center had microcytic hypochromic picture and 67.4% cases from general ward had normocytic normochromic picture in peripheral smear. Iron deficiency was the most common cause of anemia in both groups, i.e., 92.3% cases from nutritional rehabilitation center and 46.2% cases from general ward. Megaloblastic anemia in 6.5% cases from nutritional rehabilitation center and 7.5% cases from general ward.
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Background: The study was conducted to radiologically demonstrate increase in thymus size with clinical recovery following nutritional rehabilitation in children with severe acute Malnutrition and to correlate the improvement with anthropometric and biochemical parameters.Methods: Prospective observational study was conducted in 60 children in the age group of 6months to 24 months with severe acute malnutrition. Children with severe systemic illnesses were excluded from study. After obtaining informed consent from parents, history focusing on demography, perinatal events, nutrition including breast feeding and immunization status were recorded. Anthropometric parameters were measured. All relevant blood investigations and ultra-sonogram of the chest for thymus size were done. All children were followed up during the course of hospital stay till discharge and were also followed up after 2 months. Relevant blood investigations and ultrasonogram of chest for thymus size were also done during follow up.Results: The difference in means of thymic area by imaging at admission and at discharge (p and lt;0.0001) and at admission and after 8 weeks (p and lt;0.0001) were statistically significant. The increase in weight, length, weight for length, mid upper arm circumference, hemoglobin, total protein, serum albumin, serum globulin from admission to discharge and from discharge to 8 weeks after admission was statistically significant.Conclusions: Thymus size can be used as a marker of immunological dysfunction in severe acute malnutrition and as a marker of severity of the illness. The thymus size was found to be increasing in size during nutritionally rehabilitation and recovery from the illness. Correlations between anthropometric parameters and thymic size are not robust in under-nourished state and during nutritional rehabilitation.
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Background: About half of the under five children are malnourished in India and so is morbidity associated with it. Malnutrition is also associated with multiple vitamin deficiency one of which is vitamin B12. Vitamin B12 is essential for DNA, RNA and protein synthesis; and for myelination of brain during the early childhood period. Deficiency of vitamin B12 can lead to megaloblastic anemia and neurological problems. So, authors aimed to look prevalence of vitamin B12 deficiency and; its hematological and neurological effects in severe acute malnourished children.Methods: it was an observational case control study, in which severe acute malnourished (SAM) children aged 0- 59 months who were admitted in Nutritional Rehabilitation Centre (NRC) were enrolled. Vitamin B12 levels were estimated and levels <200 pg/ml, 200-350 pg/ml, and >350 pg/ml were considered deficient, insufficiency and sufficient. Complete blood count was done for hematological effects and; developmental assessment was done to look for neurological effects.Results: Vitamin B12 was deficient, insufficient, normal in 15(16.3%), 25 (27.5%) and 52 (56.5%) children respectively. Vitamin B12 deficiency was significantly associated with hyperpigmentation and glossitis. Infant and young child feeding practices were not associated vitamin B12 deficiency. Macrocytic anemia was found in 23.4% SAM children and macrocytosis was not significantly associated with vitamin B12 deficiency.' Developmental delay was found in 55.3 % children and was not significantly associated with severe acute malnutrition.'Conclusions: There is high prevalence of Vitamin B12 deficiency and insufficiency in children with severe acute malnourished children. Macrocytic anemia and developmental delay are not significantly associated with vitamin B12 deficiency.
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Los centros de recuperación nutricional (CRN) fueron creados por el Dr. José María Bengoa en Venezuela. En el presente estudio se realizó una revisión sistemática cualitativa, de 1984 al 2011, que permitió analizar las modalidades de funcionamiento de los diferentes CRN en el mundo, mediante indicadores de: criterios de admisión, parámetros utilizados en estos centros, así como las modalidades de tratamiento, tiempo de estancia y criterios de alta. Se encontraron diecisiete artículos que describen algunos o todos estos indicadores. El uso de los CRN se encontró en cuatro países de África (Etiopía, Kenia, Malawi y Nigeria), cuatro de América (Bolivia, Brasil, Chile y Nicaragua) y dos en Asia (India y Nepal). Los resultados reflejan la importancia de los CRN en el tratamiento de la desnutrición, sobre todo si se acompaña con la educación de las madres sobre la alimentación, prácticas higiénicas, etc., para un mejor cuidado en el hogar. Nuevas evidencias en el tratamiento de la desnutrición han motivado la evolución de los centros, pero aún así, sus limitaciones persisten. No obstante, las ventajas de su uso son excepcionales. Se propone, de acuerdo con los diferentes tipos de centros, y en base a las deficiencias o limitaciones observadas en su conceptualización y designación, redefinir las NRC bajo el concepto de Centros Globales de Nutrición (GloNuCen) basados en la comunidad y la personalización nutricional, los cuales podrían ser centros fijos en el caso de hospitales y servicios ambulatorios, e instalaciones móviles para situaciones de emergencia que, si duran con el tiempo, puedan convertirse en centros fijos(AU)
The Nutritional Recovery Centers (NRC) were created by Dr. Jose María Bengoa in Venezuela. In the present study a qualitative systematic review was carried out, from 1984 to 2011, allowing us to analyze the operating modalities of the different CRNs in the world, by means of indicators of: admission criteria, parameters used in these centers, as well as their treatment modalities, time of stay and discharge criteria. Seventeen articles have been found that describe some or all of these indicators. The use of NRCs was found in four African countries (Ethiopia, Kenya, Malawi and Nigeria), four in America (Bolivia, Brazil, Chile and Nicaragua) and two in Asia (India and Nepal). The results reflect the importance of NRC in the treatment of malnutrition, especially if it is reinforced with mothers' education about food, hygiene practices, etc., for better home care. New evidence in the treatment of malnutrition has motivated the evolution of the centers, but still, their limitations persist. Nonetheless, the advantages of their use are exceptional. It is proposed, according to the different types of centers, and based on the deficiencies or limitations observed in their conceptualization and designation, to redefine the NRCs under the concept of Global Nutrition Centers (GloNuCen) based on the community and nutritional customization, which could be fixed centers in the case of hospitals and outpatient services, and mobile facilities for emergency situations that, if they last over time, could turn into fixed centers(AU)
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Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Nutrition Rehabilitation , Food and Nutrition Education , Child Nutrition Disorders , Deficiency Diseases , Protein Deficiency , Public Health , Protein-Energy MalnutritionABSTRACT
Background: Under nutrition is significant health problem in India as well as in Chhattisgarh, recent NFHS 4 data shows that there is increase in number of children who are severely wasted from 5.6% in NFHS 3 to 8.4% in Chhattisgarh. Literature shows appropriate feeding practices and break in malnutrition infection cycle help malnourished child to recover, so present study was planned with the objective to find out the role of mother knowledge regarding feeding practices and management of minor ailments related to improvement of severe acute malnourished children discharged cured from nutritional rehabilitation centres in Chhattisgarh.Methods: A community based study was planned among children discharged as cured from NRC between March to December 2017. They were followed in community to find out socio-demographic factor, feeding practice after discharge, mother knowledge score, household dietary diversity using 24 hour recall method & anthropometric measurements.Results: Out of 156 children discharged as cured from March to December 2017, total 132 children were covered during the survey from January to June 2018. It was observed that improvement in nutritional status after discharge was significantly associated with increasing knowledge score for mother regarding nutrition and children who were separately feed after discharge from NRC.Conclusions: Mother knowledge regarding nutrition and management of minor ailments and feeding practice to child after discharge are important factors associated with the improvement of children from SAM
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Background: Childhood undernutrition remains a key public health challenge in India and is a significant contributor of Under-5mortality as these children have significantly higher risk of mortality and morbidity. Nutritional rehabilitation centres have beenset up by Government of India at facility level to provide medical and nutritional care to Severe Acute Malnourshied childrenunder the age of 5 years who have medical complications.Materials and Methods: Retrospective record based observational study conducted in NRC located at SMGS Hospital, GMCJammu. All the children upto 60 months of age, admitted in NRC during the study period, from September2018 to February2019 were included in the study.Aims and Objectives: To know the demographic details and clinical profile of comorbidities in children with Severe AcuteMalnutrition and to assess the outcome of these children.Results: A total of 118 children were admitted in the Nutritional Rehablitation Center during the study period 60% werefemales. 60% of the children were less than 12 months of age 20 % were between 13 and 24 months of life.Children belongedto all the districts, 22% from Jammu, 18% Reasi, 16% Udhampur, 15% Rajouri, 8% Kathua, 7% Poonch and 6% Samba.Bronchopneumonia (39.8%), Diarrhoea (30.5% ) and skin infections(11%) were the commonest morbidities. 73.5% of thechildren had associated anemia. Other comorbidities were septicemia (10.1%), CSOM (5.9%), UTI (5%), measles (5%) andtuberculosis (2.5%).Conclusion: Early diagnosis and standardized protocol based treatment in the NRCs has been very effective in reducing themorbidity and mortality in SAM patients.
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Background: The life cycle dynamics of the causes and consequences of malnutrition demand a holistic and all inclusive approach to prevent and treat under-nutrition and nutritional deficiencies. In response, Government of Gujarat launched “Mission Balam Sukham” in the year 2012 which focuses on both preventive and curative aspects. Curative aspect consist of three tier approach for integrated management of malnutrition at three different levels. Nutritional rehabilitation Center is a unit in a district health facility where children with severe acute malnutrition are admitted and provided with the nutritional & therapeutic care. Methods: Analysis of data of all the children admitted to Nutritional Rehabilitation Centre of Surendranagar district from June-2012 to November 2013. Statistical analysis was done using SPSS. Results: A total of 280 children were included in the study. The overall mean weight at admission was found 8.30 kg with standard deviation of 2.09 kg and the mean weight at the time of discharge was 8.97 kg with standard deviation of 2.16 kg. Average weight gain among 141 boys was 6.63 g/kg/day and among girls was found 7.60 g/kg/day. Out of total 280 children, 103 (36.79%) children had weight gain as per the standard criteria (8 gm/kg/day). Diarrhoea was found to be the associated medical condition in majority of the children. Out of total 184 children without medical complications, 97 (52.72%) children had weight gain as per the standard criteria. Conclusions: Present study reflected that Nutritional Rehabilitation Centers have been playing a key role to cope with malnutrition as demonstrated by high weight gain rate as well as high recovery rate.
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Introduction: Severe acute malnutrition is widely prevalent problem in developing countries and a major cause of morbidity and mortality in India. nutritional rehabilitation of such patients is very important aspects of management and often inadequate. This study was planned to understand catch up growth in severe acute malnourished patients admitted to rehabilitation ward for providing nutrition. Objectives: (1) To study the weight gain pattern of the patients with severe acute malnutrition admitted to hospital based nutritional rehabilitation center. (2) To study the factors associated with good or poor weight gain in the patients with severe acute malnutrition admitted to nutrition rehabilitation centre. Materials and methods: In this case record based retrospective study; records of severe acute malnourished patients admitted to nutritional. rehabilitation ward during the period of February 2012 to December 2012 were included. Results: A total of 98 patients were admitted during this period for nutrition rehabilitation. Mean baseline weight/ height z score (WHZ), Weight/age z score (HAZ) was - 1.67 (2.48), -4.19 (0.98) and -4.90 (2.50) respectively. 76 patients who stayed for more than 7 completed days were analysed for comparative statistics. Mean WHZ score of this 76 patients was-1.70 (2.25). Mean weight gain of these patients was 5.56 gm/kg/day. Patients age (p=0.03, OR=1.12, 95% CI: 1.040-1.211), educated mother (p=00.048, OR=1.29, 95% CI: 1.320-2.478) and recommended dietary intake of at least 80% (p=0.001, OR=7.94, 95%CI: 2.247-28.79) were the only statistically significant factors associated with good weight gain. Conclusion: Our study highlighted important role of nutritional rehabilitation of the severe acute malnourished children in hospital for early catct-up of the growth.
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Objective: To study the output indicators of a nutritional rehabilitation center to assess its performance. Methods: Data of 182 children aged between 6-59 months with severe acute malnutrition in a nutritional rehabilitation center were analyzed retrospectively. Identification and treatment of severe acute malnutrition was done according to World Health Organization recommendations. Results: The recovery rate, death rate, defaulter rate, mean (SD) weight gain and mean (SD) duration of stay in the nutritional rehabilitation center were 68%, 2.2%, 4.4%, 13.0 (9.0) g/kg/d, 12.7 (6.8) days, respectively. Conclusion: Nutritional rehabilitation centers are effective in management of severe malnutrition.
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dation, transiently inercasod food efficiency,and a faster growth rate of visceral adipose tissue versus body weight after nutritional rehabilitation. These findings are consistent with the characteristics of human catch-up growth.
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There is evidence that the auditory evoked potential (AEP) is altered by malnutrition both in laboratory animals and in humans. The objective of the present study was to determine whether changes in the AEP caused by malnutrition could be reversed by nutritional rehabilitation and sensorymotor and environmental stimulation during hospitalization. Six children aged 5-33 months with severe malnutrition (kwashiorkor, marasmus and marasmic-kwashiorkor) were admitted to the Pediatric Ward of a University Hospital. Normal age and sex-matched children from the hospital day-care center were enrolled as a control group. The AEP was tested in an electrically and acoustically isolated room using a Nicolet CA 2000 microcomputer. Clicks of 90; 80; 70 and 60 dBn HL were presented through earphones. The results suggest that malnutrition leads to an increase in wave I latencies in patients with marasmus, and in waves I, III and V in those with kwashiorkor or marasmic-kwashiorkor type at 90 dB HL. At discharge, all but one patient with kwashiorkor showed reduced latencies of waves I, III and V compared to the values on admission. Despite the small sample, these preliminary results pointed out that the process of sensory stimulation used in our study in a properly directed, systematic and individualized manner showed encouraging results in terms of AEP recovery in these children.
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Objective: To evaluate the effectiveness of bowel nutritional rehabilitation therapy in patients with gut dysfunction caused by acute mesenteric artery occlusion. Methods: Two patients with acute mesenteric artery occlusion received management of revascularization by operative and nonoperative approach. Viability dusky bowel was leaved in one patient. Second look laparotomy was performed to access the viability of the bowel in another patient. The patients remained gut dysfunction and received bowel nutritional rehabilitation therapy early after operation. Results: The gut function of the patients recovered and had normal diet after bowel nutritional rehabilitation therapy. Conclusions: The gut dysfunction caused by acute mesenteric artery occlusion should be treated with bowel nutritional rehabilitation early.
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Malnourished pups were obtained by increasing litter size to 20 pups/dam VS 10 pups/dam in controls. Rehabilitation was started when the pups were 17 days old. The normalized growth rate (% body weight increase/day) of the malnourished pups was significantly lower than that of controls at 10-17 days of age. After starting ad libitum feeding, the normalized growth rate became the same as that of control when both groups were at 17-23 and 23-34 days of age. The body weight of the previously malnourished pups was still lower than that of controls at 34 days of age. Serum growth-promoting activity (GPA) in malnourished and control rat pups was determined by measuring the degree of stimulation of thymidine incorporation into lymphocytes treated with low dose of phytohemagglutinin (PHA). The serum GPA in malnourished pups was lower than that of controls at 17 days old. When malnourished pups were weaned onto laboratory chow ad libitum starting at 17 days, their serum GPA at 23 and 34 days of age was found to be similar to that of control pups of the same age. We conclude that immediate postnatal malnutrition is associated with reduction of serum GPA and reduced growth.