Mortality in relation to profiles of clinical features in Ghanaian severely undernourished children aged 0-59 months: an observational study.

Severe acute malnutrition (SAM) is associated with a complex pattern of various clinical conditions. We investigated how risk factors cluster in children with SAM, the relationship between clusters of risk factors and mortality as well as length of stay in children with SAM. A prospective observational study design was used. Data were extracted from medical records of 601 infants and children aged 0-59 months admitted and treated for SAM in three Ghanaian referral hospital between June 2013 and June 2018. Among the 601 medical records extracted, ninety-nine died. Three clusters of medical features clearly emerged from data analyses. Firstly, an association was defined by eye signs, pallor, diarrhoea and vomiting with gastrointestinal infections and malaria. In this cluster, pallor and eye signs were related to 2- to 5-fold increased mortality risk. Secondly, HIV, oedema, fast pulse, respiratory infections and tuberculosis; among those features, HIV increased child mortality risk by 2-fold. Thirdly, shock, convulsions, dermatitis, cold hands and feet, weak pulse, urinary tract infections and irritability were clustered. Among those features, cold hands and feet, dermatitis, convulsions and shock increased child mortality risk in a range of 2- to 9-fold. Medical conditions and clinical signs in children diagnosed with SAM associate in patterns and are related to clinical outcomes.

Protein and fat meal content increase insulin requirement in children with type 1 diabetes - Role of duration of diabetes.

BACKGROUND AND OBJECTIVE: Hyperglycaemia remains a challenge in type 1 diabetes since current regimes used to determine meal insulin requirements prove to be ineffective. This is particularly problematic for meals containing high amounts of protein and fat. We aimed to determine the post-prandial glycaemic response and total insulin need for mixed meals, using sensor-augmented insulin pumps in children with type 1 diabetes. METHODS: Twenty-two children with type 1 diabetes, aged 4-17 years on insulin pump therapy completed this home-based, cross-over, randomised controlled trial. Two meals with identical carbohydrate content - one with low fat and protein (LFLP) and one with high fat and protein (HFHP) contents - were consumed using normal insulin boluses. Blood glucose monitoring was done for 10 h post-meal, with correction bolus insulin given two-hourly if required. RESULTS: The HFHP meal required significantly more total insulin (3.48 vs. 2.7 units) as a result of increased post-meal correction insulin requirement (1.2 vs. 0.15 units) spread over a longer duration (6 vs. 3 h). The HFHP meals significantly increased the time spent above target glucose level. Duration of diabetes and total daily insulin use significantly influenced the post-prandial blood glucose response to the two meals. CONCLUSION: When consuming carbohydrate-based mixed meals, children with type 1 diabetes on insulin pump therapy, required significantly more insulin over a longer period of time than the insulin requirement calculated using current regimes. This additional amount required is influenced by the duration of diabetes and total daily insulin use.

Factors Affecting Mothers' Choice Ofbreastfeeding Vs. Formula Feeding in the Lower Umfolozi District War Memorial Hospital; Kwazulu-Natal

The aim of this study was to determine which factors influence choice of breast- versus the formulafeeding of infants. This may help to understand where the focus should lie in the promotion of breastfeeding. A structured questionnaire was completed by a 100 women and focus-group discussions were held with 22 women who delivered babies at the Lower Umfolozi District War Memorial Hospital (LUDWM) in Kwazulu-Natal. Most of the mothers (72) chose breastfeeding and 58intended to breastfeed for only 6 months. One-third (33) were influenced by health care professionals and 44of the mothers made their own decisions in their feeding method. Only one participant stated that she chose formula-feeding due to her HIV-positive status; but in the focusgroup discussions; the fear of transmission of HIV through breast-milk was stated as an important reason why mothers chose replacement-feeding. Significantly more HIV-infected than uninfected mothers chose replacement-feeding as the feeding method and mothers who chose breastfeeding were significantly older than mothers who selected replacement-feeding. They made their infantfeeding decision earlier than those who chose replacement-feeding. Findings showed that the majority of women in this study did not have access to running water and flush toilets in their houses. In these areas where replacement-feeding will not be acceptable; feasible; affordable; sustainable and safe; due to lack of sanitation and poor socio-economic status; health professionals should promote exclusive breastfeeding for 6 months; even though there is a high prevalence of HIV infection