Severe Acute Malnutrition among Children in Bale Zone Southeast Ethiopia: Treatment Outcome and its Determinant Factors.

OBJECTIVE: To assess the treatment outcomes of severe acute malnutrition (SAM) and its associated factors in children aged 6-59 months in Bale zone, Southeast Ethiopia. DESIGN: A multi-institutionally-based, retrospective cross-sectional study design was conducted, based on records from September 11, 2014 to September 11, 2017. Simple random sampling was used to select the records. A pretested extraction format was used to collect information from the logbook and patient records. Treatment outcome was dichotomized into recovery and censored. Bivariate and multivariable logistic regression analyses were used to analyze the data. Odds ratios with 95% CIs were calculated to determine the association between each independent variable and treatment outcome. RESULTS: A total of 763 records were completed and reviewed. Of these, 711 (93.2%) were recovered from SAM. Provision of deworming treatment (aOR = 6.5; 95% CI: 2.8-15.1), education given to the mother/caregiver (aOR = 8.8; 95% CI: 4.2-18.4), age range 6-24 months (aOR = 0.37; 95% CI: 0.17-0.81), presence of anemia (aOR = 0.33; 95% CI: 0.14-0.78), and use of nasogastric (NG) tube (aOR = 0.42; 95% CI: (0.21-0.85) were associated with recovery from SAM. CONCLUSIONS: Recovery rate of SAM children in this study was in line with international standards. Deworming, maternal education status, child's age, anemia, and NG tube use were associated with recovery. Attention should be given to deworming all children, disease control, and prevention of anemia and other comorbidities.

Arm circumference for age, arm circumference and weight-for-height z-score for the evaluation of severe acute malnutrition: a retrospective cohort study in eastern Democratic Republic of Congo.

BACKGROUND: Little is known about the use of mid-upper arm circumference for age (MUACZ) for diagnosing of severe acute malnutrition (SAM) and its correlation with WHZ (weight-for-height Z-score) in an area endemic for severe acute malnutrition (SAM) and with a high prevalence of kwashiorkor. Our study aims to analyze the concordance between the diagnostic criteria of SAM in a region presenting these characteristics. METHODS: We analyzed a database of children admitted from 1987 to 2008 for the management of SAM in Eastern Democratic Republic of Congo. Anthropometric indicators (z-score) were calculated and classified into 3 categories according to WHO standards. Cohen's kappa coefficient (κ) was calculated to assess the concordance between these indicators. RESULTS: Out of the 9969 selected children aged 6 to 59 months, 30.2% had nutritional edema, 70.1% had a height-for-age (HAZ) z-score <-2, 11.5% WHZ<-3 z-score, 14.9% had a MUAC < 115 mm and 21.8% had a MUACZ <-3 z-score. With the classic combination WHZ and MUAC, 36% of children with SAM had both criteria at the same time and MUAC alone being the indicator that recruited more children with SAM (77%) compared with 65% with WHZ only. By replacing MUAC with MUACZ, 34% of SAM children fulfilled both criteria, WHZ and MUACZ. MUACZ alone recruited more children with SAM (88%) compared with 46% with WHZ alone. Considering these three indicators together, MUACZ remained the indicator that recruited more children with SAM (85%). WHZ and MUAC showed a moderate agreement [ κ (95% CI) = 0.408(0.392-0.424)], WHZ and MUACZ a weak agreement [ κ (95% CI) = 0.363(0.347-0.379)] and MUAC and MUACZ a good agreement [ κ (95% CI) = 0.604 (0.590-0.618)]. CONCLUSION: Adjusting MUAC according to age improves its effectiveness in identifying severe acute malnutrition. With low concordance, MUAC and WHZ remain complementary in our context. MUACZ proves to be crucial, especially in the presence of kwashiorkor and chronic malnutrition, becoming a valuable tool for assessing severe acute malnutrition in our context.

Application of the Boruta algorithm to assess the multidimensional determinants of malnutrition among children under five years living in southern Punjab, Pakistan.

BACKGROUND: Malnutrition causes nutrient deficiencies that have both physical and clinical consequences in severe acute malnutrition children. Globally, there were 47 million wasted children under the age of five in 2019. One in four were located in sub-Saharan Africa, with half being in South Asia. This study aims to apply the Boruta algorithm to identify the determinants of undernutrition among children under five living in Dera Ghazi Khan, one of the marginalized districts of densely populated Punjab Province in Pakistan. METHODS: A multicenter cross-sectional study design was used to collect data from 185 children with severe acute malnutrition aged under five years visiting the OTPs centers located in Dera Ghazi Khan, Punjab, Pakistan. A purposive sampling technique was used to collect data using a pretested structured questionnaire from parents/caregivers regarding family sociodemographic characteristics, child nutrition, and biological and healthcare characteristics. Anthropometric measurements, including height, weight, and mid-upper arm circumference, were collected. The Boruta models were used to incorporate the children's anthropometric, nutritional, and household factors to determine the important predictive variables for undernutrition using the Boruta package in R studio. RESULTS: This study included 185 children, with a mean age of 15.36 ± 10.23 months and an MUAC of 10.19 ± 0.96 cm. The Boruta analysis identifies age, mid-upper arm circumference, weaning practices, and immunization status as important predictors of undernutrition. Income per month, exclusive breastfeeding, and immunization status were found to be key factors of undernutrition in children under the age of five. CONCLUSION: This study highlights age, mid-upper arm circumference, weaning practices, and immunization status as key determinants of weight-for-height and weight-for-age in children under five years. It also suggests that economic context may influence undernutrition. The findings can guide targeted strategies for combating undernutrition.

Stabilizing time and its predictors among 1-59 months old children managed for severe acute malnutrition during the humanitarian crisis in Tigray regional state of Ethiopia, 2023: a prospective cohort study.

BACKGROUND: Higher rate of acute malnutrition is observed in emergencies compared to non-emergency settings and severe acute malnutrition upsurges alarmingly and become deadly in humanitarian crises due to lack of food, lack of quality water supply and insufficient healthcare. Research is one learning tool by identifying strength and areas of improvement. However, little is known about outcomes of therapeutic feeding programmes in comparison with the standard indicators set in humanitarian setting. METHODS: Health facility based prospective cohort study was conducted using routinely collected programme data of children hospitalized to the inpatient therapeutic feeding center in suhul general hospital from January 1st, 2023 to June 30, 2023. Data was collected using a form developed relating to the federal ministry of health standard management protocols for severe acute malnutrition then it was cleaned, coded and entered to EpiData version 4.2.0 and then exported to SPSS version 25 for analysis. RESULTS: From 184 children, 96.2% were stabilized while the remaining 3.8% were censored with overall median stabilizing time of 8 days. Weight gain was used as one of the discharging criteria for infants less than six months and their mean weight gain found to be 12.89 g per kilogram daily. Appetite test (AHR = 0.338; 95% CI: 0.221-0.518), blood transfusion (AHR = 5.825; 95% CI: 2.568-13.211), IV fluid resuscitation (AHR = 2.017; 95% CI: 1.094-3.717), IV antibiotics (AHR = 2.288; 95% CI: 1.164-4.500) and NG tube feeding (AHR = 1.485; 95% CI: 1.065-2.071) were identified as significant predictors of stabilizing time. CONCLUSION: All the outcome indicators for stabilization center are consistent with the SPHERE association set of standards during humanitarian intervention. The hospital and other concerned humanitarian organizations should focus on sustaining these achievements as suhul hospital is the main treatment center for children suffering from severe acute malnutrition in the northwest zone of Tigray regional state. Further pre-post experimental studies which compare the stabilizing time before and after crisis are recommended.

Diagnostic Accuracy of Waist Circumference and Waist-to-Height Ratio for Moderate and Severe Acute Malnutrition in Under-5 Children.

OBJECTIVE: To determine the most appropriate cut-off values of Waist Circumference (WC) and Waist-to-Height Ratio (WHtR) for diagnosing moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) in under-five children. METHODS: This cross-sectional diagnostic accuracy study was conducted between January 2021 and August 2022 in the Department of Pediatrics of a tertiary hospital in Delhi. Children aged 6 months to 5 years attending the outpatient or emergency services were included in the study. Detailed clinical evaluation and anthropometry including measurement of WC were done at enrollment. Body mass index (BMI) and WHtR were calculated. Malnutrition was classified as per the WHO criteria. Receiver operating characteristic curves (sensitivity, specificity) for WC and WHtR (absolute values) were drawn against the standard test of WHO definitions for MAM and SAM to determine the most appropriate cut-offs for diagnosing MAM and SAM. RESULTS: 1500 children with a median (IQR) age of 29 (14, 43) months were enrolled; 21% children had MAM and 11% had SAM as per the WHO criteria. WC < 44.5 cm (sensitivity 74.1%, specificity 71.1%) and WHtR < 0.565 (sensitivity 75.6%, specificity 33.7%) were the best cut-offs to identify MAM, whereas WC < 42.3 cm (sensitivity 67.5%, specificity 81.3%) and WHtR < 0.563 (sensitivity 81.3%, specificity 33.4%) were the best cut-offs to diagnose SAM. CONCLUSION: Waist circumference (< 44.5 cm for MAM; < 42.3 cm for SAM) had a reasonably good sensitivity and specificity for diagnosing MAM and SAM, but the same was not true for WHtR.

Survival status and predictors of mortality among severely acute malnourished under-5 children admitted to stabilisation centers in selected government hospitals in Addis Ababa, Ethiopia, 2022: a retrospective cohort study.

OBJECTIVE: This study aims to assess the survival status and predictors of mortality among under-5 children with severe acute malnutrition in Addis Ababa, Ethiopia. DESIGN: A retrospective cohort study was employed on randomly selected 422 medical records of children under the age of 5 admitted to stabilisation centres in Addis Ababa, Ethiopia. Survival analysis and Cox regression analysis were conducted to determine time spent before the outcome and predictors of desired outcome. SETTINGS: The stabilisation centres in four governmental hospitals in Addis Ababa, Ethiopia: Tikur Anbessa Specialised Hospital, Zewditu Memorial Hospital, Yekatit 12 Hospital and Tirunesh Beijing Hospital PARTICIPANTS: Of 435 severely malnourished children under the age of 5 admitted to four governmental hospitals in Addis Ababa, Ethiopia, from January 2020 to December 2022, we were able to trace 422 complete records. The remaining 13 medical records were found to be incomplete due to missing medical history information for those children. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is the survival status of under-5 children with severe acute malnutrition after admission to the stabilisation centres. The secondary outcome is predictors of survival among these children. RESULTS: Of 422 children, 44 (10.4%) died, with an incidence rate of 10.3 per 1000 person-days. The median hospital stay was 8 days. Full vaccination (adjusted HR (AHR) 0.2, 95% CI 0.088 to 0.583, p<0.05), feeding practices (F-75) (AHR 0.2, 95% CI 0.062 to 0.651, p<0.01), intravenous fluid administration (AHR 3.7, 95% CI 1.525 to 8.743, p<0.01), presence of HIV (AHR 2.2, 95% CI 1.001 to 4.650, p<0.05), pneumonia (AHR 2.2, 95% CI 1.001 to 4.650, p<0.01) and occurrence of shock (AHR3.5, 95% CI 1.451 to 8.321, p<0.01) were identified as significant predictors of mortality. CONCLUSION: The study identified a survival rate slightly higher than the acceptable range set by the social and public health economics study group. Factors like vaccination status, HIV, pneumonia, shock, intravenous fluid and the absence of feeding F-75 predicted mortality.

HIV prevalence among children admitted with severe acute malnutrition and associated factors with mother-to-child HIV transmission at Mulago Hospital, Uganda: A mixed methods study.

BACKGROUND: Despite global efforts to eliminate mother-to-child-transmission of HIV (MTCT), many children continue to become infected. We determined the prevalence of HIV among children with severe acute malnutrition (SAM) and that of their mothers, at admission to Mwanamugimu Nutrition Unit, Mulago Hospital, Uganda. We also assessed child factors associated with HIV-infection, and explored factors leading to HIV-infection among a subset of the mother-child dyads that tested positive. METHODOLOGY: We conducted a cross-sectional evaluation within the REDMOTHIV (Reduce mortality in HIV) clinical trial that investigated strategies to reduce mortality among HIV-infected and HIV-exposed children admitted with SAM at the Nutrition Unit. From June 2021 to December 2022, we consecutively tested children aged 1 month to 5 years with SAM for HIV, and the mothers who were available, using rapid antibody testing upon admission to the unit. HIV-antibody positive children under 18 months of age had a confirmatory HIV-DNA PCR test done. In-depth interviews (IDIs) were conducted with mothers of HIV positive dyads, to explore the individual, relationship, social and structural factors associated with MTCT, until data saturation. Quantitative data was analyzed using descriptive statistics and logistic regression in STATAv14, while a content thematic approach was used to analyze qualitative data. RESULTS: Of 797 children tested, 463(58.1%) were male and 630(79.1%) were ≤18months of age; 76 (9.5%) tested positive. Of 709 mothers, median (IQR) age 26 (22, 30) years, 188(26.5%) were HIV positive. Sixty six of the 188 mother-infant pairs with HIV exposure tested positive for HIV, an MTCT rate of 35.1% (66/188). Child age >18 months was marginally associated with HIV-infection (crude OR = 1.87,95% CI: 1.11-3.12, p-value = 0.02; adjusted OR = 1.72, 95% CI: 0.96, 3.09, p-value = 0.068). The IDIs from 16 mothers revealed associated factors with HIV transmission at multiple levels. Individual level factors: inadequate information regarding prevention of MTCT(PMTCT), limited perception of HIV risk, and fear of antiretroviral drugs (ARVs). Relationship level factors: lack of family support and unfaithfulness (infidelity) among sexual partners. Health facility level factors: negative attitude of health workers and missed opportunities for HIV testing. Community level factors: poverty and health service disruptions due to the COVID-19 pandemic. CONCLUSION: In this era of universal antiretroviral therapy for PMTCT, a 10% HIV prevalence among severely malnourished children is substantially high. To eliminate vertical HIV transmission, more efforts are needed to address challenges mothers living with HIV face intrinsically and within their families, communities and at health facilities.

Acute malnutrition relapse and associated factors among 6-59 months old children treated in the community-based management of acute malnutrition in Dessie, Kombolcha, and Haik towns, Northeast Ethiopia.

Introduction: Undernutrition is a major health concern in many developing countries, and is one of the main health problems affecting children in Ethiopia. Although many children experience multiple relapses following the management of severe acute malnutrition, it is scarcely studied in Ethiopia. Methods: A community-based cross-sectional study was conducted in Dessie, Kombolcha, and Haik towns among 6-59-month-old children enrolled and discharged from community-based acute malnutrition management (CMAM). The total sample size was 318 children, and data were collected from April 15, 2021, to May 14, 2021. The data were entered into EPI data version 4.4.1 before being exported and analyzed with SPSS version 25 software. A multivariate logistic regression analysis was performed, and a 95% confidence interval and p-value <0.05 were used to identify significantly associated variables. Additionally, the weight-for-height z-score (WHZ) was generated using the WHO Anthro 3.2.2 software. Result: The overall acute malnutrition relapse after discharge from CMAM was 35.2% (6.6% relapsed to severe acute malnutrition and 28.6% relapsed to moderate acute malnutrition). The following variables were significantly associated with the relapse of acute malnutrition: child age (AOR: 3.08, 95% CI; 1.76, 5.39), diarrhea after discharge (AOR: 2.93, 95%CI; 1.51, 5.69), have not immunized (AOR: 3.05, 95% CI; 1.14, 8.23), MUAC at discharge (AOR: 3.16, 95% CI; 1.56, 6.40), and poorest and poor wealth index (AOR: 3.65, 95% CI; 1.45, 9.18) and (AOR: 2.73, 95% CI; 1.13, 6.59), respectively. Conclusion: Over one-third of children treated with the CMAM program reverted to SAM or MAM. The age of the child, diarrhea after discharge, lack of immunization, MUAC at discharge (<13 cm), and poor and poorest wealth index were significantly associated with acute malnutrition relapse. Therefore, adequate health education and counseling services are essential for mothers to improve child immunization coverage and maintain adequate hygiene to prevent diarrhea. In addition, further experimental research is needed to investigate the effect of MUAC at discharge on the risk of acute malnutrition relapse.