A Comparative study of Hematological Profile and Etiology of Anemia in Patients From Nutritional Rehabilitation Centre with patients from General Pediatric Ward in M.G.M. Hospital, Warangal

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.

Management of Severe Acute Malnutrition in Day Care Settings : Findings fromInnovative Public Private Partnership at Devbhumi Dwarka District, Gujarat

Introduction :Severe Acute Malnutrition (SAM) is a major public health concern that is linked to a high mortality rate in children under the age of five. Government of Gujarat has expanded treatment network from government facilities to private institutions and non-governmental organizations through various initiative in an effort to address the issue of SAM. To assess the treatment outcome among SAMObjective: children (0-5 years) admitted at Niramay Bal Poshan Kendra, Jam Khambhalia, Devbhumi Dwarka District of Gujarat. A longitudinal study was conducted among SAM children admitted at he Niramay BalMethod: t Poshan Kendra (Public Private Partnership model under Bal Poshan Yojana) which is a day care center providing treatment to SAM children for 14 days according to the protocol of NRC (Nutrition Rehabilitation Centre). Under Bal Poshan Yojana, RBSK medical officers screen children for SAM and refer them for treatment at empanelled NGO/Private institution. Total 1557 under five children were screened by them between 6 September 2021 and 5 February 2022. Out of them 121 SAM children were identified, 95th th children could be mobilized at the study site (Niramay Bal Poshan Kendra). Out of 95 children, 76 SAM children completed the treatment along with all three follow up at the study site. The data of these 76 Children was analyzed. Among 76 children, average weight gain was 566 grams at the time ofResults: discharge and 1000 grams at the time of third follow-up. An average weight gain for the cohort is 5.2 gram/kg/day. At the end of treatment, 92% children moved out of the SAM category at the completion of three follow-up, 55% moved to Moderate Acute Malnutrition and 37% to normal weight category. Conclusion: An average weight gain among the study population was satisfactory. Day care treatment model provides advantage of improved treatment completion rate and higher follow-up com

Nutritional Status of Pre-School Children Attending Anganwadi Centres in Chittoor, Andhra Pradesh, India

Context/Background: Malnutrition among children is a major public health problem in India. The objective of the study is to assess the nutritional status of pre-school children and to identify the so-cio-demographic determinants of malnutrition. Methodology: In this community-based cross-sectional study, 194 under-five children were recruited from rural and urban areas of Chittoor district, Andhra Pradesh. Anthropometric measurements were measured and age standardized weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) were calculated. The proportion of under nutrition (WAZ <-2 standard deviation (SD)), stunt-ing (HAZ <-2SD), and wasting (WHZ <-2SD) were calculated along with the determinants. Results: The mean age of the participants was 40.5 months (SD- 9.1 months), 101 (52.1%) were from rural areas, and 96 (495%) females. The HAZ values were significantly low in- urban children (-0.81; 95%CI: -0.4, -1.21), among the non-Hindu children (-0.92; 95%CI: -0.35, -1.5). The overall prevalence of underweight, stunting, and wasting were- 13.4% (95%CI: 8.5%, 18.3%), 23.7% (95%CI: 17.6%, 29.8%), and 19.6% (95%CI: 11.9%, 25.3%) respectively. Urban residence (OR 6.75; 95% CI: 3.03 – 15.04) was a strong predictor of stunting. Conclusion: Malnutrition remains to be a public health problem in this area. Strengthening of existing programs should be the key strategy in combating malnutrition.

Nutritional Status of Under-five Siblings of Severely Wasted Children in Bhopal

Objective: To study the prevalence and associated factors of undernutrition in siblings of children with severe acute malnutrition (SAM). Method: It was a community-based crosssectional study of under-five year siblings of children with SAM. Results: A total of 128 under-five years siblings were studied, 30% had SAM whereas 20% had moderate acute malnutrition (MAM). More than 7 members in a family (OR=4.23, CI 1.9-9.6, P<0.001), underweight mothers (OR=5.2, CI 2.08-13.0, P<0.001), children who received pre-lacteal feeds (OR=3.24, CI 1.33-7.87, P=0.007), and Muslim religion (OR=4.44, CI 1.78-11.1, P<0.001) were significantly associated with finding of another child with SAM in the family. Conclusion: There was high proportion of severe malnutrition in siblings of children with SAM. Consideration should be given to actively screen all under-5 children in the family of a newly diagnosed child with SAM for undernutrition.

Severe Acute Malnutrition in Tribal Under-Five children in Javvadu Hills, Tamil Nadu

Background: Severe acute malnutrition (SAM) in under-5 children is an important public health problem that is associated with high mortality and long-term health consequences. Globally, 26 million children suffer from SAM, of these more than 8.1 million children are in India. National Family Health Survey-4 indicates a higher prevalence of SAM (7.5%) in the general population than the previous report (6.4%). Indeed the burden of malnutrition is expected to be higher among the tribal children in India. Hence this study aimed to explore the Severe Acute Malnutrition among the tribal under-five children in Javvadu Hills of Tamil Nadu. Methods: A community-based cross-sectional survey was conducted among 450 tribal under-five children and mothers residing in Javvadu Hills in Thiruvannamalai District, Tamil Nadu from September 2019 to Feb 2020 using PPS-Cluster sampling technique with semi-structured questionnaire with anthropometric measurements. Data were analyzed using SPSS. Chi-square test and logistic regression were used. Results: Out of 450 children, about 42(9.3%) had weight-for-Ht (M<-3S.D.) suggestive of SAM. Among those with SAM, 71% were females. About 66% had low birth weight, 79% were Anemic, 81% had calorie and protein inadequacy, 88.1% were partially immunized and 88% had food insecurity and 78% had the recurrent illness. Maternal illiteracy, poor awareness of nutrition, Food insecurity and poor access to health facilities were significant factors in SAM. Conclusions: SAM is highly prevalent among tribal children, a serious threat to child survival and morbidity. Improving literacy, Socioeconomic status, nutritional awareness, food security, health-seeking behaviour will alleviate this public health problem.

Prevalence of severe acute malnutrition and its effect on under-five mortality at a regional hospital in South Africa

Introduction: Severe acute malnutrition (SAM) is an important global and national public health concern. It contributes tounder-five mortality but is also largely a preventable disease. Objective: This study aimed to assess the prevalence of and mortality associated with SAM. Design: A retrospective review of hospital files was conducted. Setting: Dora Nginza Hospital, Eastern Cape, South Africa was the site of the study. Subjects: The study included children from 6 to 59 months of age admitted to the paediatric ward between January 1, 2018 and December 31, 2018. Children with chronic disease were excluded. Ethics approval was granted by Walter Sisulu University (053/2019). Outcome measures: Anthropometric, co-morbid and outcomes data were retrieved and analysed. Results: A total of 1 296 children were included in the study, 93 with SAM. The prevalence of SAM was 7.2%. Children with SAM had a median age of 16 months (IQR 11­25). Gender distribution was 52 (56%) females and 41 (44%) males. The inpatient mortality rate for children with SAM was 6.5%. Children with SAM were at significantly increased risk of mortality (RR 5.97, 95% CI 3.1­11.6, p-value < 0.0005). Three factors were significantly associated with mortality: nutritional oedema, sepsis, and hypokalaemia. Conclusion: The prevalence of SAM at Dora Nginza Hospital is high, and children with SAM are at significantly increased risk of mortality. Specific risk factors for mortality include sepsis, urinary tract infection, nutritional oedema and hypokalaemia. Modifiable factors associated with SAM and SAM-related mortality need to be targeted urgently to improve outcomes.

Evaluación nutricional de niños menores de cinco años de edad durante la estancia hospitalaria en un Servicio de Salud de referencia / Nutritional evolution in children under the age of 5 during hospital stay in a reference health care service

Introducción: La desnutrición en niños hospitalizados es una causa frecuente de morbi mortalidad. La prevalencia de desnutrición hospitalaria pediátrica en América Latina es del 11 % en promedio (rango de 6 a 35 %). Objetivos: Evaluar la evolución nutricional de los niños menores de cinco años de edad, internados en la Cátedra y Servicio de Pediatría del Hospital de Clínicas, FCM UNA, al ingreso versus al egreso hospitalario durante el periodo 2016. Materiales y métodos: Diseño observacional, descriptivo, retrospectivo. Variables: edad, sexo, procedencia, peso al nacer, edad gestacional, peso al ingreso y al alta, talla, duración lactancia materna exclusiva, inicio de alimentación complementaria, escolaridad y ocupación materna, patología de base, diagnóstico de ingreso, días de internación, alimentación enteral y/o parenteral, días de ayuno, evolución. Tamaño muestral: 361 niños menores de cinco años de edad. Se evaluó el estado nutricional según estándares de la Organización Mundial de la Salud (OMS), a través del Programa ANTHRO v3.2.2. Estadística: medidas paramétricas y no paramétricas. T student. Significancia: p < 0,05. Resultados: Ingresaron 361 niños, 51,5% Masculino, Edad media: 15 meses (1-59 meses) Grupos: 56 % lactantes menores, 21% lactantes mayores y 23% preescolares, 87% de procedencia urbana. El. 26,6% presentó algún grado de desnutrición y 10,5 % desnutrición crónica. El 40 % de los pacientes presentaba alguna comorbilidad. La desnutrición durante la estancia hospitalaria fue del 8,2%. La asociación de uso de alimentación enteral y ganancia de peso fue significativa (p< 0,05). Ningún niño presentó kwashiorkor. Ningún óbito fue registrado. Conclusión: La prevalencia de desnutrición durante la hospitalización en niños menores de cinco años de edad es del 8,2 % en un hospital de referencia, menor al promedio en hospitales de América Latina.

Introduction: Malnutrition in hospitalized children is a frequent morbidity and mortality cause. The prevalence of in-hospital malnutrition in pediatric patients in Latin America has a mean rate of 11% (ranging from 6% to 35%). Objectives: Evaluate the nutritional evolution in children under the age of 5 admitted to the Service of Clinics Pediatrics, FCM-UNA, assessing their first Vs. last day of hospitalization during the 2016 period. Materials and methods: The design of the study was observational descriptive, longitudinal in time. Variables: age, gender, place of origin, birth weight, gestational age, weight at first and last day of hospitalization, beginning of complementary feeding, mother schooling years, mother occupation, previous diseases, admittance diagnose, complications, days of hospitalization, enteral or parenteral feeding, days of fasting, evolution. Sample size: 361 patients under the age of 5 years. Nutritional status was evaluated using z values for Weight/Age, Weight/Height, Height /Age (WHO 2006, ANTHRO Software). Statistical aspects: parametric and nonparametric tests. Student's t-test significant at p<0,05. Results: 361 children were admitted. 51.5% males, mean age of 15 months (1-59 months). Were 56% infants, 21% toddlers and 23% pre-schoolers, 87% from a urban background., 26.6% had some degree of malnutrition and 10.5% suffered from chronic malnutrition; 40,% of patients presented some comorbidity. Malnutrition during hospital stay: 8.2%. Association of enteral feeding and weight gain was significant (p<0,05). None developed Kwashiorkor. No deceased cases were found. Conclusion: The prevalence of malnutrition during hospitalization in children under the age of five years was 8.2% in a reference hospital, below the average among hospitals in Latin America.

Profile of severe acute malnutrition children admitted at nutritional rehabilitation centre at tertiary care treatment centre of Gujarat

Background: Severe acute malnutrition (SAM) may be major obstacle for India to achieve targeted Infant Mortality Rate and under five mortality rate. Malnutrition and infection form vicious cycle and contributes towards mortality. So, malnutrition prevention is major objective of government. Study of malnourished children helps to know aetiology and their response to treatment. The objective of study is to understand clinic-demographic profile of SAM children.Methods: It is retrospective secondary data analysis study. For the purpose of this analysis, we retrieved the data of all children with SAM admitted from 1 January, 2018 to 31 December, 2018 to NRC. At the NRC, a physician conducted a clinical examination in children to detect the presence/absence of medical complications during their admission and these data were available in case sheet.Results: A total of 162 children, aged 6-59 months were referred to the NRC. Around fourty seven percentage of children were in age group 6–12 months Majority of children were in age group of 7 months to one year of age. Majority of children were admitted based on weight of height criteria (Z score < 3SD). Mean admission weight is lower in female compare to male children.Conclusions: Faulty weaning practises and delay in weaning in some cases predisposes later half of infancy period to undernutrition. So, proper health education and good IYCF practices prevent children from undernutrition.

Thymus size and its changes during treatment of children with severe acute malnutrition

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.

Predictors of mortality in children hospitalized with severe acute malnutrition

Background: Severe acute malnutrition (SAM) is a leading cause of morbidity and mortality in children worldwide. Identification of factors contributing to mortality is crucial to decrease the mortality due to SAM. This study aims at identification of factors affecting mortality in hospitalized SAM children.Methods: This study was done in general pediatric wards of a Government tertiary care center from July 2015 to June 2016. Total 200 children admitted to the hospital with Severe Acute Malnutrition (SAM) as per World Health Organization (WHO) criteria were enrolled. Demographic and clinical data were recorded in structured proforma. These children were followed up till death or discharge and their progress and outcome were noted. The risk factors considered were younger age (infancy), female sex and presence of systemic illness, sepsis, retroviral positivity, severe anaemia, pneumonia and diarrhea and these were compared between those who died and survivors.' Univariate analysis and logistic regression analysis were performed to determine the significant risk factors.Results: The mortality rate was 10.5%. Presence of systemic illness, sepsis and retroviral positivity were significant risk factors at the end of univariate analysis and multivariate logistic regression, while the others were insignificant.Conclusions: Systemic diseases, sepsis and retroviral disease are poor prognostic features and are risk factors of mortality in hospitalized SAM children.

Estimation of serum folate and vitamin B12 levels in children with severe acute malnutrition

Background: Severe acute malnutrition is the important health issue children affected in India. It is often associated with Iron, Vitamin B12 and Folic acid and other micronutrient deficiencies. These reports of declining trend of Iron and folic acid deficiency with implementation of national anemia control programme. Estimation of Serum Folate and Vitamin B12 levels in SAM children aged 6-60 months with anemia was the objective of the study.Methods: A hospital based observational study on 80 children admitted to nutritional rehabilitation center were suffering from severe acute malnutrition (SAM) in the age group of 6-60 months enrolled in the study during the period November 2018 to May 2019 .Data was collected using a predesigned and pretested Proforma, containing details of feeding, socio-economic and development history. Blood samples were sent for measurement of plasma vitamin B12 and serum folate levels. Statistical analysis was done using SPSS version 20.0.Results: Out of 80 children, majority were between the age group of 24-60 months and majority were boys (53.8%). Mean Vitamin B12 and folic acid levels being 384.61 and 8.95 respectively. 45% and 3.8% had vitamin B12 and folic acid deficiencies respectively. Majority of neurological changes and developmental delays were noted in B12 deficient group. Of the 36, B12 deficient children, majority had moderate anaemia (40.2%), normal total count (41.7%), 60% had neutropenia, 44.4% had lymphocytosis, majority had normocytic (30.9%) anemia.Conclusions: There was a moderate to high prevalence of vitamin B12 deficiency among malnourished children. Folate deficiency was found only in few. Efforts should be directed to prevent its deficiency in pregnant and breastfeeding women and their infants with special attention on malnourished children.B12 and folate deficiency shall be considered in all cases with SAM irrespective of blood indices. Treatment will have impact on prognosis of child.

Clinicoepidemiological and laboratory profile of children with severe acute malnutrition admitted to a tertiary care centre

Background: Severe Acute Malnutrituon (SAM) is a form of malnutrition where there is an imminent threat of death to the child. The chances of complications are very high and in most case child requires hospitalization for stabilization and rehabiliatation. Objective of study the clinicoepidemiological and laboratory profile of children with severe acute malnutrition (SAM) admitted to a Nutritional Rehabilitation Centre (NRC) of our hospital.Methods: A retrospective chart review of admitted patients. Nutritional Rehabilitation centre (NRC) at GB Pant Hospital Government Medical College Srinagar over a one year period between June 2017 and June 2018.Results: Total of 187 patients of SAM was admitted in NRC during the study period. One hundred and eight (57.7%) were males and 79(42.3%) were females .Patients were equally among various districts. Infants (<12months) constituted the majority of admissions (54.5%). Marasmus was by far the commonest phenotype presenting as SAM (85.5%).Respiratory comorbidity was the commonest present in about' 41 (26.3%) followed by daiarrhea in' 32(20.5%). Delayed initiation of complimentary feeding was found in 75(40.1%) while early weaning was found in another 55 children (29.4%). Birth order more than three was present in 92 children (49%). Mother's literacy status had a direct bearing on the prevalence of SAM. Most of the children were from rural background (75%).Most belonged to low economic and income class as around 65.2% had a very meager' family income.Conclusions: SAM is more common in Infants and in children from rural background. It is highly associated with faulty feeding practices including lack of breast feeding and presence of mixed and faulty feeding. It is also associated with increasing birth order, low maternal education and low family income Pneumonia and diarrhea are leading comorbidities. Hypoglycemia and hypothermia are leading complications.' Marasmus is the commonest phenotype.

A prospective study to determine social demographic pattern in severe acute malnutrition in 6 months to 5 years aged children

Background: Burden of malnutrition is much higher in South Asia as compared to that in Africa and rest of the World. South Asia contributes to about 60% of the cases. Education of women has been seen to be the most effective in improving child's health. Present study is done to evaluate social demographic pattern in cases of severe acute malnutrition.Methods: Present study is prospective observational comparative study conducted at Department of Pediatrics included 175 cases after taking a informed written consent from the parent. Out of which 22 were lost to follow up and remaining 153 cases were analysed and further evaluated in the studyResults: Cases who were from 6 month to 24 months of age were 73.2% (n=112) and rest of them were above 24 months of age. Girls were 53.6 % and 46.4% were boys. Percentage of illiterate mother was 41.2%, till primary were 28.8% and Only 10.4% of mothers were graduate. Nearly 50% of the households had per capita income less than or equal to 1000.Conclusions: SAM was more common in children < 24 months of age, boys and girls were almost equally affected. Maternal literacy and low per capita income was an important factor associated with SAM patients.

Prevalence and clinical manifestations of vitamin K deficiency in complicated severe acute malnutrition

Background: In Severe Acute Malnutrition (SAM) clinical and biochemical abnormalities are commonly observed. In this institute author observed that many children of complicated SAM had bleeding manifestations but there is no defined prevalence of vitamin K deficiency in SAM that's why author have planned this study.Methods: This was the hospital based prospective study conducted in 150 complicated SAM children. All children were treated according to WHO protocol for SAM management. Prothrombin Time (PT), International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT) along with routine investigations were done on admission. All the collected data was managed and analyzed with standard software Biostatics (SPSS Version 20).Results: Total 150 complicated SAM children were studied for prevalence and clinical manifestations of vitamin K deficiency. Mean age of children was 17.03'11.0 months, 52.0% were male and 48.0% were female children. Average weight was 5.92'1.57 kg. Average height/length was 70.66'8.38 cm and mean MUAC was 10.47'1.31 cm. Out of 150, 42(28%) children had abnormal INR and 28(18.7%) had abnormal aPTT with abnormal INR. The mean INR was 2.11'1.1 and mean aPTT was 45.30'9.59 in children those had abnormal INR. Twelve out of 42(28.6%) had various bleeding manifestations and majority (66.6%) had gastrointestinal bleeding.Conclusions: More than one fourth children (28%) of complicated SAM children are having vitamin K deficiency and majority of children present with gastrointestinal bleeding.

Determinants of severe acute malnutrition in children between six months to five year of age enrolled in nutritional rehabilitation centre at a tertiary care level

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.

Development delay in children with severe acute malnutrition and its association with Vitamin B12 deficiency

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.

Nutrition rehabilitation of children with severe acute malnutrition: Revisiting studies undertaken by the National Institute of Nutrition

Severe acute malnutrition (SAM) in children under five years is an important public health problem due to associated high mortality and long-term health consequences. Research on the dietary causes of SAM, especially the role and relative importance of dietary protein, in the aetiology of oedematous malnutrition, has led to considerable debates and controversies. The present article revisits some of the debates in this field, where the researchers at the National Institute of Nutrition (NIN), Hyderabad, India, with their pioneering work, have contributed to the global literature on the various facets of the disease. Highlighting the importance of energy as a bigger problem than protein malnutrition is a noteworthy contribution of NIN's research. It is, however, important to examine the protein quality of the diets in light of the new information on the lysine requirements. The article argues that the currently dominating hypothesis of free radical theory requires a critical review of the supporting evidence. Over the past few decades, the research has focused on low-cost diets using locally available foods. The article also argues that solutions based on local foods, being acceptable and sustainable, need to be strengthened for their effective delivery through the existing nutrition programmes. Recent evidence shows that the use of ready-to-use therapeutic foods (RUTF) with high micronutrient density may be linked with higher mortality possibly due to the high iron content, which could be counterproductive. There are several unaddressed concerns regarding the potential long-term impact of consumption of RUTF in children with SAM. More evidence and a cautious approach are, therefore, needed before implementing these solutions.

Prevalence of Tuberculosis among Children with Severe Acute Malnutrition at Ola during Children’s Hospital in Freetown Sierra Leone

Prevalence of Tuberculosis among Children with Severe Acute Malnutrition at Ola during Children’s Hospital in Freetown Sierra Leone. Worldwide, pediatric tuberculosis account for about 1million cases, annually, accounting for 10-15% of all tuberculosis; with more than 100,000 estimated mortality annually, it is also one of the 10 most common causes of childhood mortality. Aim of this study was to determine the prevalence of tuberculosis among children with severe acute malnutrition at Ola During Children’s Hospital in Freetown Sierra Leone. It was a descriptive cross-sectional study, carried out at the therapeutic feeding center (TFC) of Ola During Children’s Hospital in 2018. An opportunistic sampling method inwhich every next patient whose mother gave consent was recruited until the number 74 was reached. Patients who met the World Health Organisation (WHO) criteria for diagnosis of severe acute malnutrition were admitted into the TFC and consecutively selected and interviewed using a structured questionnaire after obtaining written informed consent, from their mothers or caregivers. All the mothers approached during the study period consented for the study. Diagnosis of tuberculosis was both clinically and by laboratory investigations, 74 children whose mothers/caregivers consented for the study were recruited. Data was entered into an excel spread sheet and analyzed using Epi info version 7. There were 74 children with a median age of 11months ± 9.9SD. Forty (54.1%) Males and 34(45.9%) Females, with a M:F ratio of 1.18:1. Prevalence of tuberculosis was 20%. Diagnosis of Tuberculosis was based on clinical findings of extreme weight loss or failure to gain weight, Chest x-ray findings of perihilar infiltrates. Gene Xpert MTB RIF results were all negative 0(0%). Most of the mothers 59 (79.7%) were aged between 20-29years, 45(60.9%) of them were petty traders, while 15(20.3%) had no formal education. The chi square was used to determine the statistical difference, there was no statistically significant difference between gender and TB, P= 0.3415, there is a statistically significant difference between no formal education and occurrence of tuberculosis in their children P= 0.0467.Conclusions/Recommendations:Prevalence of Tuberculosis is still high among children with severe acute malnutrition. Gene Xpert MTB RIF was unable to make a bacteriological confirmation. There are difficulties with making bacteriological confirmation of tuberculosis inresource poor settings. Guidelines requiring mainly clinical parameters need to be developed for use in resource limited countries.

Role of mother’s knowledge and feeding practices in improvement of children from severe acute malnutrition

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

Response to gluten free diet in sero-positive celiac disease children suffering from severe acute malnutrition in age group 1-5 years

Background: Diagnosis of celiac disease in children suffering from severe acute malnutrition without duodenal biopsy or HLA typing is a dilemma. The objective of this study was to study the response to gluten free diet in sero-positive Celiac Disease children suffering from severe acute malnutrition in age group 1-5 years.Methods: This prospective, observational, hospital-based study was conducted at MTC of tertiary care medical college hospital of southern Rajasthan from Dec. 2017 to Nov. 2018. Total 110 children with SAM were enrolled and screened for celiac disease on the basis of tissue tTg-IgA/IgG serology. Seropositive cases were kept on gluten free diet for short period of time and observed for the resolution of symptoms and improvement in growth, monitored by anthropometry on discharge and follow up visit.Results: Mean weight gain (gm/kg/day) on follow up was 3.87'3.49 in seropositive and 1.88'3.79 in seronegative cases (P-value<0.05). Mean weight gain was 6.43'3.28gm/kg/day in only tTg-IgA positive and 3.04'2.95 gm/kg/day in only tTg-IgG positive cases (P-value-<0.05). The mean weight gain in strictly gluten free adherent sero-positive cases was 4.89'2.97 gm/kg/day while in gluten free non-adherent patients it was -0.49'1.70 (P-value <0.001). Mean weight gain in probable (tTg-Ig-A <10 times ULN) and presumptive (tTg-IgA >10 times ULN) Celiac disease were 3.44'3.73 and 5.44'3.78, respectively without statically significant difference (P-value >0.05).Conclusions: In situations where facility of duodenal biopsy and or HLA DQ2/DQ8 typing is not available, resolution of symptoms and improvement in growth on gluten free diet confirms the diagnosis of celiac disease.