Physicochemical, proximate and sensory evaluation of pearl millet and pigeon pea based nutrient dense mix

Severe acute malnutrition serves a high risk of mortality among children aged 6-59 months. At a community level anganwadi centers play a vital role in identifying malnutrition among children and enabling resources for growth and development. The aim of this study was to develop a nutrient dense mix using pearl millet and pigeon pea and evaluate its sensory, physicochemical and proximate properties. The nutrient dense mix was formulated using pearl millet and pigeon pea in several variations and the best accepted variation was selected through sensory evaluation and analyzed for its physiochemical and proximate composition. Variation 3 of the nutrient dense mix prepared by balancing pearl millet with rice had the highest acceptability in all sensory parameters. It had favorable physicochemical properties including water solubility index (20.1%), swelling power (3.7%) and low moisture content (3.7%). The proximate analysis revealed high energy (347.10±0.85 kcals), protein (14.28±0.04 g), fat (19.53±0.03) and calcium content (154.63±2.2 mg). The percentage adequacy of the nutrients from the nutrient dense mix showed that 31.27% of energy as per the estimated average requirements was met for 1-3 year olds and 25.5% for 4-6 year olds. The high sensory acceptability, low cost and good micro and macronutrient profile encourages further exploration for the product in curbing malnutrition.

No time to waste for wasted children in Bihar: time to reset

Background: Severe acute malnutrition (SAM) with severe wasting remains a major killer of children. In Bihar, 48% of children are stunted, 21 % are wasted, and 7% are severely wasted. Even during the first six months of life, 31% are wasted. The objective of this study was to study wasting trends and contributing factors responsible for changes in Bihar among children 0-5 years. Methods: This cross-sectional study was done using a data of NFHS-5 survey in Bihar (N=35,834) conducted in all 38 districts of the state from July, 2019 to February, 2020. The Bihar NFHS-5 report and factsheets, including NFHS-4 data, were downloaded and converted to excel to enable data visualization and trend analysis. The outcome variable Wasting was measured using NFHS-5 relevant questionnaires given under nutrition category. We analyzed trends between NFHS-5 and NFHS-4 Bihar data for severe wasting/wasting, determinants, and coverage of interventions.Results: The prevalence of severe wasting has increased from 7% to 8.8%, while wasting increased from 20.8% to 22.9% (NFHS-5). The severe wasting and wasting has reversed or worsened in 27 districts. There is a mixed picture of infant feeding- early initiation of breastfeeding worsening and some improvements in exclusive breastfeeding and timely introduction of complementary feeding. Consistent improvement across districts for underlying determinants, but slight, in women抯 education, teenage pregnancy, and marriage before 18 years. Conclusions: Need to invest in improving maternal determinants-age at marriage, education, ANC coverage, and teenage pregnancy. It is imperative to focus on preventing, identifying, and treating wasting.

Growth monitoring and nutritional outcome of severe acute malnutrition children in the presence and absence of edema: a facility based retrospective study

Background: Severe acute malnutrition (SAM) is the leading cause of death in children. SAM affects approximately 20 million preschool children, mainly in Africa and South Asia. Children with severe acute malnutrition and severe edema (+++) have an increased risk of death compared with children with severe acute malnutrition and no edema. This study evaluated the nutritional outcome of SAM patients in the presence and absence of edema.Methods: This retrospective study was conducted in malnutrition treatment centre, JK Lon Hospital attached with Govt Medical College, Kota from January 2021 to December 2022 on children of age 6 months to 59 months, with clinical diagnosis of severe acute malnutrition. Ethics committee approval was not required as the study was a retrospective observational study. Patients were divided into three categories, viz. recovered, defaulted and non-responders.Results: A total of 270 patients were selected for this study on the basis of date made available through past records. Of the total patients studied, 32.2% (87) had bilateral edema while the rest (183) were non edematous. From edematous arm, 79.9% children recovered, 9.1% defaulted, and 11% were non-respondents. Conversely, of those without oedema 55.7% recovered, 7.0% defaulted, and 37.3% were non-respondents.Conclusions: Severe acute malnutrition is a preventable and treatable cause of childhood morbidity and mortality. The determinants of SAM include illiteracy, low socio-economic status, malnourished mother, low birth weight, ignorance about specific nutritional requirements of infants and young children, repeated infections, etc. In this study, we documented that the edematous children in the study area had a better likelihood of recovery as compared to those with severe wasting.

Under 5 pneumonia a forgotten pandemic: an insight into risk factors predicting outcome of severe pneumonia in children aged 2 months to 5 years of age

Background: Pneumonia is the leading cause of morbidity and mortality in the pediatric population. In developing countries like India, multiple sociodemographic and environmental factors influence the outcome of severe pneumonia so this study explores these risk factors with aim of finding ways to improve the outcome.Methods: It is a prospective observational study conducted over a period of 12 months on 2 months to 5 years, children with severe pneumonia admitted in ward and PICU of tertiary medical care institute. A total of 100 patients were enrolled in the given study after meeting the inclusion criteria. Predesigned proforma was used to record sociodemographic details, patient history, detailed examination findings and laboratory reports. Outcome in terms of mortality and morbidity was noted. Data analyzed using appropriate statistical tests, p values <0.05 accepted as statistically significant.Results: The severe pneumonia was more common in the age group of 2 months to 1 year of age (59%) and in males (60%). Malnutrition and leukocytosis was statistically significant. 53 subjects were exclusively breastfed. Type of family, mother & father抯 education status, mother抯 employment status, tobacco exposure and contact with tuberculosis were not found statistically significant in the given study. 21 participants required PICU and 10 patients required mechanical ventilation. 92 patients were discharged, while 2 patients expired.Conclusions: Pneumonia is an important preventable and treatable cause of under 5 mortalities. In developing countries like India an awareness and proper management of risk factors like malnutrition, low birth weight, immunization status can improve the outcome.

Critical period for better nutrition among severely acute malnourished children up to two years of age: a hospital-based case-control study, Gujarat, Western India

Background: Nutrition in the first two years of life is important for growth and development among children. To tackle undernutrition during this period, timely initiation of breastfeeding and quality of complementary feeding practices are essential. So, this study was planned to determine feeding practices associated with severe acute malnutrition children. Methods: This was hospital-based case-control study with 1:1 ratio of cases (77) and controls (77). Cases and controls were matched for age and sex. Cases were selected from Nutritional Rehabilitation Centre and controls from Immunization clinic. Mothers were interviewed about feeding practices, immunization status and illness of their child. Weight and height of children were also measured. Results: Children who received pre-lacteal feeding were associated with SAM. Most of cases (62.3%) and controls (70.1%) had received breastfeeding within 1 hour of birth. Among children of <7 months age, 71.4% cases breast-fed <8 times in 24 hours. Among children of 7 months to 2 years, SAM was associated with children who were not received complementary feeding (CF) at correct age, not received semi-solid/solid diet, CF not added with ghee/oil and feeding frequency <5 times in day. Among cases 18.2% and only 1.3% controls had >3 ARI episodes in last 6 months. Conclusions: Among identified independent risk factors (p<0.05), type of CF, not adding ghee/oil in CF and feeding frequency (BF+CF) <5 times were associated with SAM among 7 months to 2 years. Hospitalization history and >3 ARI episodes in last 6 months were also associated with SAM.

Study on the effect of severe acute malnutrition on various echocardiographic parameters of the heart

Background: Malnutrition is a major cause for morbidity and mortality in children below 5 years of age in developing countries. According to National family health survey-5 (NFHS-5), stunting has reduced from 38.4% to 35.5%. Wasting has reduced from 21.0% to 19.3% and underweight prevalence has reduced from 35.8% to 32.1%. Acute malnutrition can lead to biochemical changes based on metabolic, hormonal and glucoregulatory mechanisms and can affect various organ systems. This study aims to determine the effect of malnutrition on various cardiac parameters by M mode echocardiography.Methods: A cross sectional observational study was conducted in 50 severe acute malnutrition children selected by convenient sampling between 6 months and 5 years of age of Government Cuddalore medical college for a period of 2 years and M mode echocardiography was done to assess various parameters of cardiac wall dimensions and cardiac mass and compared with age/body surface area specific values.Results: Among SAM children, 74% had decreased end diastolic diameter, 80% had decreased end systolic diameter and 88% had decreased posterior wall dimension. Ejection fraction and fractional shortening was in normal range for all children. 64% had decreased left ventricular mass and 56% had decreased left ventricular mass index.Conclusions: Dimensions of the heart and cardiac mass was reduced in majority of malnourished children. Systolic function of the heart was relatively preserved as demonstrated by normal ejection fraction and fractional shortening. Thus, echocardiography can serve as a valuable tool in detecting changes in cardiac structure and function in malnourished children.

Neurodevelopmental outcome of children with severe acute malnutrition

Background: Severe acute malnutrition is known to be a major risk factor for impaired motor, cognitive, and socio-emotional development. Not much work has been done to study the neuro development of these patients. The aim of this study was to assess the neurodevelopment and outcome of children between 1 and 30 months with diagnosis of SAMMethods: The study was an observational prospective study conducted from November 2018 to April 2020. A total of 61 patients were enrolled in our study. Patients admitted in NRC with diagnosis of SAM were assessed for neurodevelopment after stabilization. Developmental assessment scale of Indian infants was used to calculate the motor developmental quotient and mental developmental quotient. Patients were followed till 6 months and after 6 months, they were again assessed by DASII to see the improvement in neurodevelopment status. Developmental quotient of less 70 was taken as delayed.Results: Mean DMeQ after stabilization and at 6 months after discharge was 53.672 and 72.591 respectively. Mean DMoQ after stabilization and at 6 months after discharge was 50.50 and 68.23 respectively. Mean DQ after stabilization and at 6 months after discharge was 52.186 and 70.4105 respectively.Conclusions: Severe acute malnutrition results in neurodevelopmental impairment in children but early and effective intervention results in significant improvement in neurodevelopment status.

Prevalence of severe acute malnutrition among 6-59 months children from community-based SAM management program in Dungarpur district of southern Rajasthan: diving deeper through study of block-wise prevalence

Background: Acute malnutrition (severe and moderate) is a major public health problem in India and especially Rajasthan. National family health surveys now provide prevalence of SAM children till district level but there’s an undenying need for data at even more granular, like block level, to assess the field reality in more depth. The present study tries to demystify the same at block level by studying data collected from a community-based SAM management program i.e., AMMA (acute malnutrition management action) program in Dungarpur.Methods: As part of AMMA program, block wise data from 20 districts of Rajasthan was collected monthly during implementation and its dedicated MIS was used as the source of this data. The data includes information of all children screened in the age-group of 6-59 months in Dungarpur district which was subsequently analyzed and studied till block level. The SAM prevalence is assessed, using Mid Upper Arm Circumference (MUAC) of 6-59 months children. <12.5 cm of MUAC was considered as acute malnutrition while <11.5 cm of MUAC was considered as SAM as per WHO standards.Results: A total of 1,13,547 children were screened (84.91%) in the study period. A total of 4829 children (4.25%) were found with Acute Malnutrition, out of which 4622 were identified with moderately acute malnutrition (MAM) and 207 are identified with SAM. Out of total 207 children with SAM, 118 were girls (57%) while 89 (43%) were boys. The prevalence of SAM children in the district came out as 0.18% whereas state prevalence is 0.9%. Among blocks the SAM prevalence varied from as low as 0.02% in Dowda and Chikhali to as high as 0.63% in Jothari block.Conclusions: Prevalence of SAM in Dungarpur district is low at 0.18% but block-wise analysis helped in further disaggregating the burden. To identify all children with acute malnutrition in the district there’s an urgent need to do screening based on WFH Z-score instead of complete reliance on MUAC tape.

Clinico-epidemiological profile and outcome of children with severe acute malnutrition

Background: Severe acute malnutrition is a significant crisis which can cause great morbidity and mortality in children. The aim of this study was to study the clinic-epidemiological profile and outcome of these children in a tertiary care hospital.Methods: The study was an observational prospective study conducted from November 2018 to April 2020. A total of 61 patients were enrolled in our study. All Children were managed in nutritional rehabilitation centre as per WHO protocol.Results: Male to female ratio was 1:1.6. Majority of patients were of age less the 2 years (83.4%) and were of birth order 3 or more (65.5%). The mean age of presentation was 12.016±7.72 months. Mean duration of exclusively breast feeding in our study was 3.643±1.81 months. Weight-for-height <-3 SD was the most commonly used diagnostic criteria. 67.2% patients recovered completely, 24.6% patients recovered partially and 8.2% patients were defaulters. Mean duration of hospital stay of patients in our study was 12.918±7.9735 days and average weight gain in our study was 8.808±3.7312 g/kg/day. The most common presenting symptom in our study was fever (45.9%). The most common co-morbidity in our study was bronchopneumonia (27.9%).Conclusions: The problem of severe malnutrition is multi-dimensional and inter-generational in nature. Most of patients come to hospital with complaints like fever, cough, loose motions, vomiting and are then discovered as patients of severe acute malnutrition. Thus, screening the patients who report to hospital with various complaints can help in early detection and proper rehabilitation. NRCs provide live-saving care for children with SAM as demonstrated by the high survival rates in this study.

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.