Survival analysis of patients with severe acute malnutrition admitted at the in-patient therapeutic care of the Bicol Regional Training and Teaching Hospital

Background@#Severe acute malnutrition (SAM) in children under five years remains a major global health concern. It carries a burden to the overall health of a child, contributes to mortality, and adds financial strain to the family and the hospital. The Philippine Integrated Management of Acute Malnutrition was established to address acute malnutrition in Filipino children. @*Objective@#This study aimed to determine the factors affecting survival of patients admitted at Bicol Regional Training and Teaching Hospital (BRTTH) In-patient Therapeutic Care (ITC).@*Methods@#This is a retrospective cohort study design utilizing survival analysis. Accrual period was from January 1, 2018 to December 31, 2018. Follow-up ended on March 31, 2019. There were 154 admissions and excluded 17 missing charts. Survival analysis was done utilizing STATA 14.@*Results@#The prevalence of SAM requiring ITC admission was 3.0 percent. Majority belonged to 6-59 months of age (63%), with equal predilection for both sexes (1:1) and 71% came from the home province, Albay. Most of patients’ caretakers had middle educational attainment. Sixty-eight percent (68%) were new patients, 16% readmitted, 15% transferred from the Out-patient Therapeutic Care (OTC) and <1% relapsed. The top three most common complications and co-morbidities include: pneumonia, low electrolytes, and fever. Sixty-three percent (63%) of patients at the ITC had a desirable treatment outcome, of which, 8% were cured and 55% transferred to OTC. Undesirable outcomes accounted for 37% of the cases which included non-cured, defaulter, and died at 12%, 8%, and 17%, respectively. The risk of dying was higher in SAM patients with parents having middle and low educational attainment as compared to those with high educational attainment (2-5 folds to 100-200 folds). SAM patients presenting with hypovolemic shock were likely to die by 1.5-19 times (1.5-19x) as compared to those without. SAM patients with malignancy were more likely to die 4-44 folds as compared to patients without malignancy.@*Conclusion and Recommendations@#Educational attainment of parents, malignancy, and hypovolemic shock were significant predictors of mortality. We recommend prompt intervention by educating families, strengthen policies targeting socio-economic determinants, capacitate medical staff, refine current clinical practice guidelines and treatment pathways to reduce the number of children who die from severe acute malnutrition.

Morbidity pattern of underfives with moderate acute malnutrition in southern Nigeria

Background:Moderate acute malnutrition (MAM) is a leading cause of childhood morbidity and mortality globally. The morbidity pattern of underfives with this condition is yet to be described. Objective: To describe the morbidity pattern of underfives with MAM.Method: Across sectional study was conducted in two Primary Health Centres in Uruan Local Government Area of Akwa Ibom State. Caregivers'brought children aged 6- 59 months to the health facilities following community mobilization. Eligible children were recruited into the study after obtaining parental consent. Avalidated proforma was used to obtain the biodata and symptoms of common illnesses in the children. Ageneral physical examination, anthropometric measurements and systemic examination were performed. Results: Atotal of 162 children were recruited into the study. Their mean (±SD) age was 20.4 ± 13.0 months. Over 70% of them were 6 - 23 months of age. Their mean (±SD) length/height was 77.3 ± 29.6 cm, mean (±SD) weight was 8.3 ± 3.4 kg and mean (±SD) mid upper arm circumference was 12.4 ± 4.5 cm. The main symptoms noted in the children were; fever 99 (61.1%), cough 84 (51.9%), weight loss 81 (50.0%), diarrhoea 40 (24.7%) and vomiting 40 (24.7%) while pallor 77 (47.5%), lymphadenopathy 56 (34.6%), hair changes 49 (30.2%), skin changes 27 (16.6%) were the main signs in them.Conclusion: The main symptomatology of underfives with MAM were fever, cough and weight loss

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

Lineamientos para la atención integral de niñas y niños menores de diez años con desnutrición severa / Guidelines for the comprehensive care of children under ten years of age with severe malnutrition

Actualmente, 1 de cada 6 niños tiene desnutrición crónica, condición que genera consecuencias preocupantes en el neurodesarrollo y que limitan el progreso del país. En la actualidad la información estadística se enfoca en los primeros 5 años de vida, pero es fundamental realizar intervenciones oportunas en las niñas y niños menores de diez años, ya que en esta etapa se establecen las bases para las funciones cerebrales superiores como la memoria, el lenguaje, el razonamiento lógico, la percepción espacial, la discriminación visual y auditiva. El Sistema Nacional Integrado de Salud, suma esfuerzos para orientar al clínico sobre el abordaje integral de la desnutrición severa, basados en evidencia científica actualizada, siendo vital brindar cuidados cariñosos, intervención oportuna del personal de salud, la familia y comunidad, para evitar o disminuir secuelas o complicaciones

Currently, 1 in 6 children suffer from chronic malnutrition, a condition that has worrying consequences for neurodevelopment and limits the country's progress. Currently the statistical information is focused on the first 5 years of life, but it is essential to make timely interventions in girls and boys under the age of ten, since at this stage the foundations are established for higher brain functions such as memory, language, logical reasoning, spatial perception, visual and auditory discrimination. The National Integrated Health System is working to guide clinicians on the comprehensive approach to severe malnutrition, based on up-to-date scientific evidence, and it is vital to provide loving care and timely intervention by health personnel, family and community, to prevent or reduce sequelae or complications

RUTF (ready-to-use-therapeutic-food): eficácia e segurança no tratamento de crianças com desnutrição grave / RUTF (Ready-to-use-therapeutic-food): efficacy and safety in the treatment of children with severe malnutrition

Contexto O Ministério da Saúde, por meio da Portaria GM/MS nº 28, de 20 de janeiro de 2023, declarou a Emergência em Saúde Pública de Importância Nacional (ESPIN) em decorrência de desassistência à população Yanomami. Desde então, entre 19 crianças indígenas de seis meses e cinco anos de idade com desnutrição grave que foram atendidas pela Casa de Apoio à Saúde Indígena (Casai) de Boa Vista/RR, 15 (78%) ganharam peso e estão evoluindo de quadros graves para moderados de desnutrição, a partir dos protocolos e diretrizes do Ministério da Saúde. No Brasil, a recomendação do Ministério da Saúde para o tratamento da desnutrição grave inclui esquemas para alimentação utilizando preparado alimentar inicial ­ F-75 (75 kcal e 0,9g de proteína/100ml) e o preparado alimentar para crescimento rápido - F-100 (100 kcal e 2,9g de proteína/100ml). O guia de prática clínica (GPC) da Organização Mundial da Saúde (OMS) refere que a maioria das crianças de seis meses ou mais com desnutrição aguda grave, sem complicações médicas, pode ser tratada com segurança por meio de alimentos terapêuticos prontos para uso (Ready-to-use-therapeutic-food - RUTF), sem necessidade de internação em unidade de saúde. Pergunta Qual é a segurança e eficácia de RUTF, no curto e longo prazo, para o tratamento de crianças menores de cinco anos com desnutrição grave? Métodos Após realização de protocolo de pesquisa, cinco bases da literatura eletrônica foram acessadas em março de 2023 para identificar estudos que pudessem oferecer resposta à pergunta de investigação. Utilizando atalhos de revisão rápida, foram realizados os processos de seleção de estudos, extração de dados e avaliação da qualidade metodológica das RS incluídas com a ferramenta AMSTAR 2. Resultados Duas revisões sistemáticas (RS) foram incluídas, sendo avaliadas como de confiança baixa e moderada. Uma RS realizou metanálises, indicando que não houve diferença entre os grupos RUTF e F-100 para ganho de peso e mortalidade. A maioria dos estudos primários, 3 de 5 ensaios clínicos randomizados (ECR) citados nas RS mostram que não houve diferença entre os grupos RUTF e F-100 quanto à altura, circunferência do braço e desnutrição aguda. Dois estudos primários incluídos nas RS indicam que o tratamento com RUFT apresenta os seguintes resultados positivos: maior probabilidade de atingir o escore Z de peso para altura; menor probabilidade de recaída e de recidiva; melhora no ganho de peso e redução do tempo de recuperação. Ressalta-se que um destes ECR apresenta conflito de interesses. Nenhuma RS analisou desfechos acerca da segurança do uso de RUTF. Dois GPC da Organização Mundial da Saúde foram selecionados mediante busca manual. Um GPC recomenda que o RUTF pode ser utilizado para crianças com desnutrição aguda grave que apresentam diarreia aguda ou persistente da mesma forma que crianças sem diarreia, quer sejam tratadas como pacientes internados ou ambulatoriais. O outro GPC recomenda que para tratamento ambulatorial de crianças com desnutrição aguda grave seja utilizado o RUTF padrão (com pelo menos 50% de proteína proveniente de laticínios). Considerações finais Esta revisão rápida aponta que há poucos estudos sobre o tema. As evidências são insuficientes para afirmar quais intervenções (RUTF ou F-100) são mais eficazes. As recomendações dos GPC também são baseadas em evidências escassas. Portanto, não há evidências que sustentem o uso do RUTF em detrimento da F-100, pois não há comprovação de maior eficácia e nenhum estudo abordou a segurança a longo prazo do uso de RUTF.

Context: The Ministry of Health, through Ordinance GM/MS No. 28, of January 20, 2023, declared a Public Health Emergency of National Importance (ESPIN) due to lack of assistance to the Yanomami population. Since then, among 19 indigenous children aged between six months and five years old with severe malnutrition who were assisted by the Casa de Apoio à Saúde Indígena (Casai) in Boa Vista/RR, 15 (78%) have gained weight and are evolving from serious conditions. for moderate malnutrition, based on the protocols and guidelines of the Ministry of Health. In Brazil, the recommendation of the Ministry of Health for the treatment of severe malnutrition includes feeding schemes using initial food preparation - F-75 (75 kcal and 0.9g of protein/100ml) and food preparation for rapid growth - F-100 (100 kcal and 2.9g of protein/100ml). The clinical practice guide (CPG) of the World Health Organization (WHO) states that most children aged six months or more with severe acute malnutrition, without medical complications, can be safely treated with ready-to-use therapeutic foods ( Ready-to-use-therapeutic-food - RUTF), without the need for hospitalization in a health unit. Question: What is the safety and efficacy of RUTF, in the short and long term, for the treatment of children under five with severe malnutrition? Methods: After carrying out a research protocol, five electronic literature databases were accessed in March 2023 to identify studies that could answer the research question. Using rapid review shortcuts, the processes of study selection, data extraction and methodological quality assessment of the SR included with the AMSTAR 2 tool were carried out. Results: Two systematic reviews (SR) were included, being assessed as having low and moderate confidence. An SR performed meta-analyses, indicating that there was no difference between the RUTF and F-100 groups for weight gain and mortality. Most of the primary studies, 3 out of 5 randomized clinical trials (RCTs) cited in the SR show that there was no difference between the RUTF and F-100 groups in terms of height, arm circumference and acute malnutrition. Two primary studies included in the SR indicate that treatment with RUFT has the following positive outcomes: increased likelihood of achieving weight-for-height Z-score; lower probability of relapse and recurrence; improvement in weight gain and reduced recovery time. It should be noted that one of these RCTs has a conflict of interest. No SR analyzed outcomes regarding the safety of using RUTF. Two World Health Organization CPGs were selected by manual search. A CPG recommends that RUTF can be used for children with severe acute malnutrition who have acute or persistent diarrhea in the same way as children without diarrhea, whether they are treated as inpatients or outpatients. The other CPG recommends that standard RUTF be used for outpatient treatment of children with severe acute malnutrition (with at least 50% protein from dairy products). Final considerations: This quick review points out that there are few studies on the subject. There is insufficient evidence to state which interventions (RUTF or F-100) are most effective. The CPGs recommendations are also based on sparse evidence. Therefore, there is no evidence to support the use of RUTF over F-100, as there is no evidence of greater efficacy and no study has addressed the long-term safety of using RUTF.

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.

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

Declaración conjunta sobre nutrición en el contexto de la pandemia de COVID-19 América Latina y el Caribe: febrero de 2021 / Joint Declaration on Nutrition in the Context of the COVID-19 Pandemic Latin America and the Caribbean: February 2021

La crisis del COVID-19 representa una amenaza para todos los componentes del sistema alimentario, poniendo en riesgo el bienestar nutricional de las poblaciones de los países de América Latina y el Caribe. La crisis amenaza la disponibilidad de alimentos y el acceso físico y económico a alimentos de calidad, lo que lleva a un mayor consumo de productos ultraprocesados ​​o preenvasados ​​y cambia los patrones de consumo hacia dietas menos diversificadas. La COVID-19 presenta un mayor riesgo en personas con obesidad y otras enfermedades crónicas no transmisibles. Además, el acceso a los servicios relacionados con la nutrición, incluidos los exámenes de detección, el tratamiento y el asesoramiento, también está en riesgo en esta crisis. La OPS se ha unido al Fondo de las Naciones Unidas para la Infancia (UNICEF), la Organización para la Agricultura y la Alimentación (FAO) y el Programa Mundial de Alimentos (PMA) para emitir una "Declaración conjunta sobre nutrición en el contexto de la pandemia de COVID-19 - América Latina y el Caribe ", instando a todos los gobiernos, organizaciones de la sociedad civil y la comunidad de donantes a proteger y priorizar el estado nutricional de todas las personas. La Declaración establece cinco acciones principales recomendadas.

Medición de inseguridad alimentaria-nutricional, hambre y estrategias de afrontamiento de niños y adolescentes en Medellín-Colombia / Measurement of food-nutrition insecurity, hunger and coping strategies in children and adolescents in Medellin-Colombia

La inseguridad alimentaria (IA) y hambre afectan a 820 millones de personas en el mundo, 187 millones en América Latina y el Caribe, 18,5 millones en Latinoamérica con más severas crisis humanitarias y a más de la mitad de la población en Colombia. En niños y adolescentes la IA ha sido poco estudiada en Colombia, en parte por ausencia de instrumentos válidos y confiables. El objetivo de esta investigación es determinar la validez y confiabilidad de escalas que miden la IA y las estrategias de afrontamiento (EA) ante la falta de alimentos en niños y adolescentes. Estudio transversal (n=4051) realizado en Medellín-Colombia que midió la IA (10 ítemes) y EA (9 ítemes) con instrumentos desarrollados previamente. Se utilizó SPSS v21 para realizar análisis de componentes principales (ACP), validez y confiabilidad. Siete de cada 10 niños se preocupan por la falta de alimentos. El ACP de instrumento IA arrojó dos componentes: 1. cantidad, calidad y preocupación; 2. episodios de hambre, que explican 57 % de varianza. El ACP de las EA explica 43 % de varianza. Los instrumentos de IA y EA poseen una buena confiabilidad (α-Cronbach's de 0,78 y 0,82). El instrumento de IA se validó comparándolo con la talla para la edad, que arrojó una asociación inversa y significativa entre baja talla y la seguridad alimentaria. Esta investigación es la primera en evidenciar que la problemática de IA está presente en los niños y adolescentes de Medellín. Los instrumentos de IA y EA utilizados resultaron ser altamente válidos y confiables(AU)

Food insecurity (FI) and hunger affected 820 million people in the world, 187 million in Latin America and the Caribbean, 18.5 million in Latin America lived the worst severe food crises, and more than half of the Colombian population live with FI. FI in children and adolescents has been little measure, partly due to absence of valid and reliable instruments in Colombia. The aim of this study is to determine the validity and reliability of the FI and coping strategies (CS) tools in children and adolescents. Cross-sectional study (n = 4051) carried out in Medellín-Colombia. A 10-ítemes scale is used to measure FI and 9-ítemes scale capture the CS. SPSS v21 program was used to analyze data. Principal component analysis (PCA), validity and reliability were applied. Seven out of 10 children mentioned they were worry for FI. PCA showed two main components of FI: 1. Related with quantity, quality and worry about food; 2. Hunger episodes, that explain 57% of variance. PCA of the CS scale resulted in one component that explains 43% of variance. FI and CS instruments resulted in good reliability (α-Cronbach 0.78; 0.82). FI instrument was validated by comparing it with height-for-age indicator, which showed an association between stunting (low height-for-age) and food insecurity. This study is the first to show that children and adolescents living in Medellín are facing FI and CS. The FI and CS scales used were found to be highly valid and reliable(AU)

Evaluation de la prise en charge de la malnutrition aigue severe dans le Service de pediatrie du centre hospitalier universitaire (CHU)Gabriel toure, Bamako, Mali

Objectif: Etudier la prise en charge des enfants souffrant de malnutrition aiguë sévère avec complications au niveau de l'URENI de la Pédiatrie du CHU Gabriel TOURE.Patients et méthode:Ils'agissait d'une étude transversale exhaustive avec un recueil rétrospectif des données sur les enfants suivis pour le traitement de la malnutrition Aiguë sévère du 1erjanvier au 31 décembre 2014. Nous avons, aussi, procédé à une enquête qualitative auprès du personnel et des accompagnants des enfants sous traitement pendant la période de l'enquête.Résultats:Il y avait 490 patients admis directement à l'URENI.La tranche d'âge de 12-23 mois était prédominante (46,5%). Le sexratio était de 1,09 en faveur du sexe masculin. Le taux de succès au traitement à l'URENI était de 51,40%. A l'URENAS, le taux d'abandon était de 27,50%. A l'URENAM, le taux d'abandon était de 72,70%. La quasi totalité des accompagnantes interviewées, en entretien individuel et en focus groupe, étaient satisfaites delpriseenchargenutritionnelle.Conclusion:L'absence de salles d'hospitalisation autonome à l'URENI et les insuffisances constatées au niveau des indicateurs de performance doivent motiver la création d'une URENI répondant aux normes au niveau de la pédiatrie du CHU GabrielTOURE

Severe malnutrition after bariatric surgery and clinic manifestations of infection

SUMMARY This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.

RESUMO Este relato descreve a evolução pós-cirurgia bariátrica de uma paciente obesa que apresentou baixa adesão à dieta e suplementação de micronutrientes. Quatro anos após duas cirurgias bariátricas, a paciente foi internada por perda transitória de consciência, raciocínio lento, anasarca, hipoalbuminemia grave, além de deficiências vitamínicas e minerais. Apresentava abscesso subcutâneo no pé, mas não apresentava febre. Recebeu antibióticos, vitaminas A, D, B12, tiamina, cálcio e nutrição parenteral. Após a internação (28 dias) houve redução significativa do peso corporal, provavelmente devido ao desaparecimento clínico da anasarca. A nutrição parenteral foi suspensa após 25 dias e a dieta oral foi mantida fracionada. Após a internação (atendimento ambulatorial semanal) houve uma melhora gradativa dos dados laboratoriais, que estavam próximos dos valores de referência. Tal desfecho mostra a necessidade de cuidados especializados na prevenção e tratamento de complicações nutricionais após cirurgias bariátricas, bem como manifestações clínicas de infecção em pacientes previamente desnutridos.

Outcome of Children with Severe Acute Malnutrition and Diarrhea: a Cohort Study / 대한소아소화기영양학회지

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.

Malnutrition aiguë chez les enfants âgés de plus de 5 ans. A propos de 26 cas, dans un site des populations déplacées à Alindao

Introduction : Nous avons réalisé une enquête sur des cas de malnutrition inhabituelle dans le site de populations déplacées en post crise militaro-politique dans le district sanitaire d'Alindao. L'objectif de cette étude était de décrire les aspects sociodémographiques et cliniques de la maladie chez les enfants hors cibles de la malnutrition aiguë dans un site des personnes déplacées à Alindao. Matériels et méthode : A l'aide d'un questionnaire, les données sociodémographiques et cliniques ont été collectées chez les enfants de plus de 5 ans atteints de malnutrition aiguë dans le site des déplacés dans la sous-préfecture d'Alindao en octobre 2018. Résultats : Au total 26 enfants souffrant de la malnutrition aiguë ont été enrôlés dans l'étude. Dix-huit (69,2%) malades provenaient de la ville contre 8 (30,8%) du milieu rural. 76,9% des mères de ces enfants n'avaient aucun niveau d'instruction et 23,1% avaient un niveau primaire. Treize enfants sur 26 (50%) avaient déjà été hospitalisés pour la malnutrition aiguë. Les âges extrêmes étaient 6 et 10 ans. L'âge, le poids et la taille moyens étaient respectivement de 7,2 ans [écart type ; 1,3], 13,9 kg [écart type ; 2,8] et 104 cm [écart type ; 12,9]. Dix-neuf (73,1%) malades étaient du sexe féminin. 57,6% (n=15) d'enfants avaient un indice de masse corporelle inférieur à 13 et deux enfants étaient en surpoids (IMC à 20,5 et 23,3). Les principaux signes cliniques observés étaient la décoloration des cheveux (88,5%), la fièvre (76,9%), la diarrhée (73,1%) et l'amaigrissement (69,2%). Conclusion : En situation de déplacement une attention particulière doit être apportée aux enfants en général et surtout ceux du sexe féminin souvent plus affecté par la malnutrition aiguë. Une stratégie particulière doit d'être développée en faveur des mères d'enfants à faible niveau d'instruction pour une bonne alimentation de leurs enfants

Etude des manifestations dermatologiques chez les enfants dénutris sévères admis aux CRENI des trois hôpitaux de Niamey (Hôpital National Lamordé, hôpital national et Centre hospitalier Régional Poudrière) de février à juillet 2018

La malnutrition reste à ce jour un problème majeur de santé publique, notamment dans nos pays en voie de développement. Ce travail avait eu comme objectif d'étudier les aspects épidémiologiques et cliniques de dermatoses associées à la dénutrition sévère chez les malnutris admis aux CRENI de 3 hôpitaux (HNL, CHR et HNN) de la ville de Niamey, capitale du Niger. Il s'agissait d'une étude prospective transversale effectuée du 1er février au 31 juillet 2018, avec une collecte de données s'étendant sur trois mois (février, mars et avril) de la même année. Au total, 464 enfants malnutris étaient admis et 80 étaient atteints de dermatoses, soit une fréquence relative de 17,24%. Les garçons étaient plus touchés (53,75%) avec un sexe ratio de 1,16. l'âge de nos patients variait de 2 à 48 mois avec une moyenne de 17,55. Dans 93,8% les enfants étaient affectés au cours de trois premières années de vie. La résidence de patients était urbaine dans 51,2% et 71,3% étaient des enfants des cultivateurs et des commerçants. 87,5% de ces enfants étaient nés de mères ménagères dont les non instruites représentaient 66,2%. Dans 63,7%, les parents de ces malnutris avec dermatoses avaient un bas niveau socioéconomique. L'analyse de l'accès aux soins et services de santé montrait que 68,8% des mères de nos patients avaient été suivies pendant leurs grossesses, mais seulement 38,8% avaient accouché au niveau d'une formation sanitaire. Aussi, 26,2% des patients avaient bénéficié d'une vaccination complète (selon le programme élargi de vaccination), 32,8% avaient déjà raté des doses pour un ou plusieurs antigènes. Au cours de cette étude, deux formes cliniques de malnutrition étaient identifiées. Il s'agissait du marasme et du kwashiorkor avec respectivement 67,5% et 32,5%. Aussi, plusieurs types de dermatoses associées étaient diagnostiquées dont les plus fréquentes étaient l'eczéma avec 33,8% et le muguet et/ou chéilite avec 38,8%. Les lésions dermatologiques étaient donc surtout localisées au niveau des muqueuses dans 44%, mais l'ensemble du tégument ainsi que les phanères étaient concernés Dans 62,5%, ces dermatoses étaient survenues au cours de deux premières semaines suivant le début de la malnutrition. Avec un traitement spécifique en fonction du type de dermatose et la prise en charge de la malnutrition, l'évolution était favorable pour beaucoup de nos patients. Ainsi, les lésions dermatologiques étaient guéries dans 80% des cas, améliorées dans 8,8% avec 10% de décès. 92% des enfants guéris ou améliorés étaient sortis entre la deuxième et la quatrième semaine d'hospitalisation

Performance of mid-upper arm circumference to diagnose acute malnutrition in a cross-sectional community-based sample of children aged 6–24 months in Niger

BACKGROUND/OBJECTIVES: Accurate, early identification of acutely malnourished children has the potential to reduce related child morbidity and mortality. The current World Health Organisation (WHO) guidelines classify non-oedematous acute malnutrition among children under five using Mid-Upper Arm Circumference (MUAC) or Weight-for-Height Z-score (WHZ). However, there is ongoing debate regarding the use of current MUAC cut-offs. This study investigates the diagnostic performance of MUAC to identify children aged 6–24 months with global (GAM) or severe acute malnutrition (SAM). SUBJECTS/METHODS: Cross-sectional, secondary data from a community sample of children aged 6-24 months in Niger were used for this study. Children with complete weight, height and MUAC data and without clinical oedema were included. Using WHO guidelines for GAM (WHZ < −2, MUAC < 12.5 cm) and SAM (WHZ < −3, MUAC < 11.5 cm), the sensitivity (Se), specificity (Sp), predictive values, Youden Index and Receiver Operating Characteristic (ROC) curves were calculated for MUAC when compared with the WHZ reference criterion. RESULTS: Of 1161 children, 23.3% were diagnosed with GAM using WHZ, and 4.4% with SAM. Using current WHO cut-offs, the Se of MUAC to identify GAM was greater than for SAM (79 vs. 57%), yet the Sp was lower (84 vs. 97%). From inspection of the ROC curve and Youden Index, Se and Sp were maximised for MUAC < 12.5 cm to identify GAM (Se 79%, Sp 84%), and MUAC < 12.0 cm to identify SAM (Se 88%, Sp 81%). CONCLUSIONS: The current MUAC cut-off to identify GAM should continue to be used, but when screening for SAM, a higher cut-off could improve case identification. Community screening for SAM could use MUAC < 12.0 cm followed by appropriate treatment based on either MUAC < 11.5 cm or WHZ < −3, as in current practice. While the practicalities of implementation must be considered, the higher SAM MUAC cut-off would maximise early case-finding of high-risk acutely malnourished children.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica: desnutrición aguda. No. 09 / Protocol of the National Epidemiological Surveillance System: acute malnutrition. No. 09

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país.

Calidad proteica de la dieta en lactantes con desnutrición severa / Protein quality in the diet of infants with severe malnutrition

Introducción: la desnutrición severa infantil constituye un problema vigente en países pobres, porque los requerimientos nutrimentales se proporcionan de manera inadecuada. Las necesidades proteicas relacionadas con la tasa de crecimiento, se reflejan en la cantidad requerida de aminoácidos esenciales; del total de proteínas, la dieta de adultos debe contener 15 por ciento, y la de lactantes entre 33 y 37 por ciento de estos aminoácidos. La calidad proteica se obtiene calculando el escore de aminoácidos, a partir del cual se diseñó el patrón seguro para diferentes grupos de edades, que incluye composición en aminoácidos esenciales, sus proporciones y digestibilidad, y es adecuada cuando estas proporciones satisfacen los requerimientos de nitrógeno para crecimiento, síntesis, y reparación tisular. Objetivos: determinar la calidad proteica de la dieta de lactantes con desnutrición severa, ingresados en el Hospital Francisco Icaza Bustamante de Guayaquil, Ecuador, durante el periodo 2009-2010; y los específicos, diagnosticar el tipo de desnutrición severa de los pacientes, identificar el perfil de aminoácidos en la dieta de los casos de estudio, así como establecer el valor biológico de las proteínas dietéticas que reciben. Métodos: estudio de enfoque cuantitativo, observacional, descriptivo, analítico y de corte transversal, en lactantes con diagnóstico de desnutrición severa. La población incluyó a todos los pacientes con desnutrición severa, menores de 24 meses de edad; la muestra fue de 33 pacientes, basada en criterios de selección. Para evaluar calidad proteica se utilizó el Escore de Aminoácidos Corregido por Digestibilidad Proteica, comparando el perfil dietético con las necesidades del niño(AU)

Introduction: severe childhood malnutrition is a current health problem in poor countries because nutritional requirements are inadequately met. Protein needs related to growth rates are reflected in the volume required of essential amino acids. Of the total proteins, the diet of adults should contain 15 percent and that of infants between 33 and 37 percent of these amino acids. Protein quality was obtained by estimating the score of amino acids, starting from which a safe pattern was designed for different age groups, including the composition as to essential amino acids, their proportions and digestibility. It is considered to be adequate when these proportions meet the nitrogen requirements for growth, synthesis and tissue repair. Objectives: determine the protein quality of the diet of infants with severe malnutrition staying at Francisco Icaza Bustamante hospital in Guayaquil, Ecuador, during the period 2009-2010. Specific objectives are to diagnose the type of severe malnutrition of patients, identify the amino acid profile in the diet of the study cases, and establish the biological value of the diet proteins they receive. Methods: a quantitative cross-sectional analytical descriptive observational study was conducted of infants diagnosed with severe malnutrition. The study population included all the patients with severe malnutrition aged under 24 months. The sample was 33 patients, based on selection criteria. Protein quality was evaluated with the Protein Digestibility Corrected Amino Acid Score, comparing the dietary profile with the needs of the child. Results: statistical analysis showed that all patients had several limiting amino acids in their diet. Conclusions: the diet of infants with severe malnutrition has a poor protein quality, with an amino acid coefficient inadequate for synthesis functions and the consequent negative impact on growth and development(AU)

A comparison of mid upper arm circumference with other Indices for discharge from community-based management of malnutrition clinics in Jigawa State, Nigeria

Background: Community-based management of acute malnutrition (CMAM) program has saved millions of children with severe acute malnutrition (SAM) globally. World Health Organization recommended discharge indices include Midupper arm circumference (MUAC) =12.5cm, =15-20% weight gain and weight-for-height Z score (WHZ) =-2. We compared MUAC with WHZ and percentage weight gain as discharge criteria from CMAM. Methods: It was a community based cohort study of children aged 6-59 months with SAM discharged from CMAM clinics in Jigawa State, Nigeria. Socio-demographic data, nutrition history and anthropometry were recorded at enrolment and discharge. Results: Of a total of 405 children studied, 209(51.6%) were females and had a peak age group of 12-23months (43.7%, range 6-42 months). At discharge, 353(87.2%) had MUAC = 12.5cm while 231(57.0%) and 204(50.4%) had percentage weight-gain =15% and WHZ=-2 respectively. There was weak agreement between MUAC and WHZ (agreement 50.8%, ê=0.012) and MUAC and percent weight-gain (agreement 54.8%, ê=-0.004). Children aged between 11-23 months (OR 2.12, p=0.006) and 24-35 months (OR 2.60, p=0.002) had increased risk of discharge with inadequate percentage weight gain. WHZ <-3 at enrolment was associated with increased risk of discharge with WHZ <-3 (OR 3.21, p<0.001) and reduced risk of discharge with inadequate percentage weight gain (OR 0.45, p<0.001). Age sex, WHZ at enrollment were not associated with MUAC at discharge. Conclusion: The use of MUAC alone as discharge criterion allows a significant proportion of children still needing urgent care exiting CMAM clinic prematurely. Stratifying these criteria may lead to better recovery before discharge

Management of severe acute malnutrition in children under 5 years through the lens of health care workers in two rural South African hospitals

Background: Despite the widespread implementation of the World Health Organization (WHO) guidelines for the management of severe malnutrition in South Africa, poor treatment outcomes for children under 5 years are still observed in some hospitals, particularly in rural areas.Objective: To explore health care workers' perceptions about upstream and proximal factors contributing to poor treatment outcomes for severe acute malnutrition in two district hospitals in South Africa.Methods: An explorative descriptive qualitative study was conducted. Four focus group discussions were held with 33 hospital staff (senior clinical and management staff, and junior clinical staff) using interview guide questions developed based on the findings from an epidemiological study that was conducted in the same hospitals. Qualitative data were analysed using the framework analysis.Findings: Most respondents believed that critical illness, which was related to early and high case fatality rates on admission, was linked to a web of factors including preference for traditional medicine over conventional care, gross negligence of the child at household level, misdiagnosis of severe malnutrition at the first point of care, lack of specialised skills to deal with complex presentations, shortage of patient beds in the hospital and policies to discharge patients before optimal recovery. The majority believed that the WHO guidelines were effective and relatively simple to implement, but that they do not make much difference among severe acute malnutrition cases that are admitted in a critical condition. Poor management of cases was linked to the lack of continuity in training of rotating clinicians, sporadic shortages of therapeutic resources, inadequate staffing levels after normal working hours and some organisational and system-wide challenges beyond the immediate control of clinicians.Conclusion: Findings from this study suggest that effective management of paediatric severe acute malnutrition in the study setting is affected by a multiplicity of factors that manifest at different levels of the health system and the community. A verificatory study is encouraged to collaborate these findings