Prevalence and risk factors associated with severe acute malnutrition (SAM) in ICDS block of rural Hubli, Karnataka, India

Background: Malnutrition is one of the leading causes of morbidity and mortality in children under the age of five years in developing countries. Despite economic growth of nearly 10% per annum, in India in 2006 the NFHS-3 indicated that 6.4% of children below 60 months of age were suffering from severe acute malnutrition. This study was undertaken to know the prevalence and the risk factors associated with SAM in ICDS block of rural Hubli.Methods: This was a cross sectional observational community based study conducted in the ICDS block of rural Hubli. All children in the age group of 0- 59 months were included in the study. The study is conducted by the department and it is self-funded by the authors, no monetary benefit either from the institute or from the government or its organization.Results: Among 1796 children who were examined in present study, the prevalence of SAM children was 5.79% (104 children). 48% were in the age group of 37 months to 59 months. Male: female ratio was 2:3. 51% of the mothers and 47.1% of fathers were illiterate. 82.7% of the parents had per capita income belonged to class 5 of the modified B.G. Prasad classification. 60% of the SAM children were seen in families who had 3 or 4 children. Maternal anemia, IUGR and PIH were seen in 53.6%, 21.6% and 18% respectively. Low birth weight (<2.5kg) and Birth asphyxia were seen in 80.6% and 11.1%.Conclusions: The risk factors for SAM were illiteracy, low per capita income, high order births, maternal anemia, IUGR, PIH, low birth weight and Birth asphyxia. Due emphasis should be given in improving the knowledge and practices of the parents on appropriate infant and young child feeding practices.

Prevalence of hypomagnesemia in children admitted to pediatric intensive care unit and its correlation with patient outcome

Background: Magnesium deficiency is common in critical illness and is said to be associated with increased need for mechanical ventilation, mortality and prolonged ICU stay. The knowledge of hypomagnesemia is essential as available data is scarce and it could have prognostic and therapeutic implications. This study was undertaken to estimate the prevalence of hypomagnesemia at the time of admission in PICU and its correlation with length of PICU stay, duration on mechanical ventilator and outcome at the end of hospital stay-death or discharge.Methods: This is a prospective observational study including 343 children aged 1month to 12years admitted to PICU. Detailed history taking and clinical examination was done for all enrolled children. At admission, blood was collected for estimation of serum magnesium. Patients were categorized into three groups i.e., hypomagnesemia, normomagnesemia and hypermagnesemia and data was analysed.Results: Out of 343 children, 28% had hypomagnesemia, 7.3% had hypermagnesemia and 64.7% had normomagnesemia. Hypomagnesemia was more common in neurological disorders. No association was found between magnesium and length of mechanical ventilation. PICU stay was significantly longer in hypomagnesemia group (p=0.031). 37.5% patients with hypomagnesemia also had hypocalcemia and 35.4% had hypokalemia. Mortality rate was higher in those with hypomagnesemia (30.2%) compared to those with normomagnesemia (22.1%).Conclusions: Patients with hypomagnesemia had increased duration of PICU stay, other associated electrolyte abnormalities and higher mortality. Hence monitoring of magnesium levels in critically ill patients is indicated.

Clinico-laboratory profile of pediatric HIV in Karnataka.

OBJECTIVE: To study the clinical manifestations and incidence of opportunistic infections in HIV/AIDS seropositive proven hospitalized children. METHODS: Proven HIV seropositive children aged between 18 months to 12 years, admitted between April 2004 to June 2005 (15 months) to pediatric medical ward, KIMS, Hubli, were enrolled. Socio-demographic characteristics and clinical manifestations were recorded in the predesigned proforma. A complete physical examination and laboratory investigations were performed at the time of admission. Children were categorized as per 1994 revised CDC classification of pediatric HIV infection. RESULTS: Number of HIV seropositive children admitted during study period was 71. Vertical transmission was noted in 94.37%, which is the major route of transmission. The common symptoms noted were persistent fever (70.42%), persistent cough (59.15%), loss of appetite (59.15%), loss of weight (56.33%) and recurrent diarrhea (30.99%). The common signs present were, hepatomegaly (69.04%), skin lesions (59.15%), lymphadenopathy (57.75%) and severe malnutrition (54.93%). The common opportunistic infections observed were tuberculosis (38.03%), recurrent diarrhea (30.99%), oral candidiasis (21.13%) and recurrent bacterial pneumonia (12.68%). Six (8.45%) children died during the study period, which included 4 (5.63%) cases of HIV-encephalopathy. CONCLUSION: Vertical transmission was the major route of HIV infection. Persistent fever, cough, loss of appetite and loss of weight were common presenting clinical features. Tuberculosis was the commonest opportunistic infection.

Scurvy in infantile tremor syndrome.

Infantile Tremor Syndrome is a distinct clinical entity most commonly seen in Indian Subcontinent. Syndrome consists of tremors, mental and developmental retardation, abnormal skin pigmentation and anemia in children between 6 months to 2 years. The etiology is still elusive. Amongst various theories, nutritional theory is the most accepted. So far there are no cases reported of vitamin C deficiency in ITS. In this article, three cases of ITS associated with vitamin C deficiency are reported.

Clinical profile and outcome of Dengue fever cases.

Dengue fever is on rise globally. In India, Dengue epidemics are expanding geographically, even into the rural areas. Dengue can present with varied manifestations. The mortality rate has been brought down with high index of suspicion, strict monitoring and proper fluid resuscitation. Herewith, we are presenting clinical features and outcome of Dengue cases seen in and around Hubli (North Karnataka).