RESUMO
Background: Protein-Energy Malnutrition is a major problem in most developing countries. The earliest age for accurate assessment is still a challenge
Objectives: To compare the prevalence of malnutrition and determine the impact of bednets on overall morbidity and mortality in preschool children in two groups; aged 0 to 5 months and 6 to 59 months in a high malaria endemic area in Western Kenya
Study design, settings and duration: Three cross-sectional surveys were conducted in Asembo, Rarieda Division, South-West of Kisumu city, Western Kenya between 1999 and 2005 as part of the bednet project
Subjects and Methods: Nutritional status of the children aged between 0 to 6 months then 6 to 59 months, in the study area was done using anthropometric measurements. Statistical analysis was carried out using Chi-square tests or Fisher's exact test, relative risk and odds ratio [OR] with 95% confidence intervals
Results: Out of 2112 children, stunting was present in 29.5%. Children in the first 3 months of life were relatively unaffected by stunting or underweight. The prevalence of stunting showed a rise from the age of 3 months onwards, peaked between 18-24 months [42.1%] and remained relatively stable between 36-59 months [35.7%]. The overall prevalence of underweight was 20.2% and age related pattern was similar to that observed for stunting. The weight gain was only apparent in infants aged 0-3 months
Conclusion: Children in the first 3 months of life were relatively unaffected by stunting or underweight but intervention showed a positive effect on general nutritional status
Policy message: Protein Energy malnutrition could be assessed with accuracy in children between 6 to 59 months
RESUMO
To determine the levels and possible role of pro-inflammatory cytokines TNF alpha, IL-1 and IL-6 in children with clinical protein energy malnutrition [kwashiorkor, marasmic kwashiorkor or marasmus] alone and in combination with malaria in Western Kenya. Webuye District Hospital, Western province and Moi Teaching and Referral Hospital in Rift Valley province in Western part of Kenya. This hospital based study was done from 2003 to 2005 on inpatient children in the paediatric ward and children at the outpatient clinic. Children aged between 6 to 60 months, admitted to paediatric wards of Webuye sub-District Hospital or Moi teaching and referral hospital Eldoret suffering from either protein-energy malnutrition or malaria or both conditions during the study period were included. Protein energy malnourished was diagnosed both clinically and through anthropometric measurements. Malaria was diagnosed through blood smears using field stain diagnostic method. Controls were children in outpatient clinic on routine medical check-up and ascertained to be without protein energy malnutrition or malaria. A blood drop was taken for malaria blood smears without fasting. Plasma samples from children taken. Equal number of controls were taken. Enzyme linked immunosorbent assay kit was used to assay for the concentrations of the cytokines [TNF alpha, Il1 and IL6] using test kits from Roche diagnostics, Germany. A total of 59 children were included in the study. The mean concentrations of cytokine [TNF alpha] were 41.3 pg/ml in kwashiorkor, 45.2 pg/ml in marasmic/kwashiorkor and 41.9 pg/ml in marasmus patients. The values for IL1 were 67.2 pg/ml in kwashiorkor, 0 pg/ml in marasmic/kwashiorkor and 25.1pg/ml in marasmus patients. The values for IL6 were 65 pg/ml in kwashiorkor, 40.5 pg/ml in marasmic/kwashiorkor and 10 pg/ml in marasmus patients showing, significantly low [p<0.005] values when compared to IL1. Those with kwashiorkor and malaria were 48.8% [p<0.005], marasmic kwashiorkor with malaria [81.8%], marasmus with malaria [88.2%] and Controls [83.3%]. The cytokines were more elevated in kwashiorkor than marasmic kwashiorkor, marasmus or malaria alone. TNF alpha and IL6 could be used as indicators of protein energy malnutrition in malaria infected population