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.

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.

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.

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.

NUTRITIONAL STATUS AND RISK FACTORS ASSOCIATED WITH SEVERE ACUTE MALNUTRITION AMONG HIV-INFECTED CHILDREN ENROLLED IN THE PAEDIATRIC HIV CLINIC, KORLE BU TEACHING HOSPITAL, ACCRA, GHANA.

Background: Malnutrition remains a common problem among Human Immunodeficiency Virus (HIV)-infected children even while receiving antiretroviral therapy leading to disease progression and reduced survival. Aim: To assess the nutritional status and risk factors associated with severe acute malnutrition (SAM) among HIV-infected children aged 1 to 15 years attending the Paediatric HIV Clinic at Korle Bu Teaching Hospital (KBTH), Accra. Methods: A cross-sectional study was conducted from October 2018 to January 2019 at the Clinic during which 150 participants aged 15 to 179 months were systematically recruited. A structured interview, physical examination, including anthropometric measurements, data extraction from hospital records, and laboratory investigations were conducted. Weight-for- age, weight-for-length/height, length/height-for-age, body mass index Z scores, and mid-upper arm circumference-for-age were obtained. Logistic regression models were used to assess the crude and adjusted odds of the nutritional status on the socio-demographic, clinical, and HIV-related characteristics of the participants at alpha= 0.05. Results: The prevalence of SAM, moderate acute malnutrition and normal nutrition were 4.0% (6/149), 13.4% (20/149) and 80.5% (120/149), respectively, whilst 1.3% (2/149) were overweight and 0.7% (1/149) obese. Stunting and severe stunting were 18.1% (27/149) and 6.7% (10/149) prevalent, respectively. SAM was significantly associated with oral thrush among participants in the adjusted model. The prevalence of mild-, moderate- and severe-anaemia were 23.7% (33/139), 38.8% (54/139) and 1.4% (2/139), respectively. Conclusion: Malnutrition is prevalent among HIV-infected children on antiretroviral therapy at KBTH. SAM is associated with oral thrush.

Prevalence and predictors of mortality among hospitalized children with severe acute malnutrition in a hospital in North Cameroon.

BACKGROUND: Severe acute malnutrition (SAM) is a major public health concern responsible for paediatric hospitalizations and more than one-third of deaths across the world. In 2013, SAM caused ≥20% of deaths in severely malnourished infants in Douala, the economic capital of Cameroon. There is little data on SAM in economically, sanitary and socially disadvantaged Cameroonian regions including the North region. OBJECTIVES: To determine the prevalence and potential predictors of mortality among children with SAM in a reference health facility in Garoua, North region, Cameroon. METHODS: A cross-sectional analytical study was conducted from November 2021 to May 2022 at the paediatric ward of Garoua Regional hospital. Data collected on sociodemographic, clinical and therapeutic characteristics in this study were questionnaire based. RESULTS: A total of 6769 children were admitted for hospitalization during the study period, among them 701 SAM cases, giving a hospital prevalence of 10.4%. Of the 347 children included, 51% of the study population were males and 87.6% were children aged 6-23 months. Seven predictors of mortality were identified: orphan status [adjusted odds ratios (AOR) = 8.70, p = 0.021], vomiting (AOR = 3.40, p < 0.0001), marasmus-kwashiorkor (AOR = 7.30, p = 0.005), lack of appetite (AOR = 56.10, p < 0.0001), cutaneous lesions (AOR = 5.50, p = 0.014), lethargy (AOR = 4.50, p = 0.001) and nasogastric rehydration (AOR = 6.50, p = 0.004). CONCLUSION: Practitioners in the northern region of Cameroon should address these locally identified mortality factors to intervene with, and hopefully prevent and adequately manage malnutrition and SAM in this and similar contexts.

Understanding risk factors for severe acute malnutrition among children during war conflict in yemen.

Severe acute malnutrition (SAM) is a major public health concern in Yemen, particularly in areas affected by ongoing conflict war. SAM is defined as a very low weight for height, by visible severe wasting, or by the presence of nutritional edema. The prevalence of SAM in Yemen has increased dramatically since the onset of the conflict. Prior studies have focused on evaluating prevalence, but this novel study aimed to assess the risk factors associated with SAM prevalence. Five thousand two hundred and seventeen patients of SAM admitted at 12 sentinel hospitals were enrolled, and data were collected and analyzed. Marasmus was the most common form. Numerous risk factors contribute to the high prevalence of SAM in Yemen, including food insecurity. The current conflict has hampered food production, distribution, and access. Awareness of risk factors can prevent SAM in the general population.

Treatment outcomes among children admitted stabilization centers in Eastern Ethiopia: retrospective study.

Background: There is improved access to Sever Acute Malnutrition management in Ethiopia; however, studies have revealed an alarming rate of defaulters' poor recovery and deaths, emphasizing the importance of researching to identify major causes. As a result, the goal of this research is to identify treatment outcome determinants and associated factors in severely malnourished children aged 6-59 months admitted to public hospitals in Eastern Ethiopia's stabilization centers. Methods: This study used an institutional-based retrospective cohort study design with 712 children aged 6 to 59 months. Data was gathered using a Sever Acute Malnutrition registration logbook and patient charts. Participants were chosen at random from their respective healthcare facilities based on population proportion. Epi-data was entered and analyzed using STATA version 14. To identify associated factors, the Cox proportional hazard Ratio was calculated, and a p-value of 0.05 at the 95% confidence interval was considered statistically significant. Results: This study revealed that only 70.65% (95% CI = 67.19, 73.88) of the children were cured while 17.84% defaulted from the management and 5.90% died. Children who did not have tuberculosis (AHR = 1.58, 95%CI:1.04, 2.40), anemia (AHR = 1.31, 95% CI:1.03, 1.68), Kwash dermatosis (AHR = 1.41, 95%CI:1.04, 1.91), or on NG-tube (AHR = 1.71, 95%CI:1.41, 2.08) were more likely to be cured from SAM. Conclusion: This study discovered that the cure rate is extremely low and the defaulter rate is extremely high. As a result, intervention modalities that address the identified factor are strongly recommended to accelerate the rate of recovery in Eastern Ethiopia.

Time to recovery from severe acute malnutrition and its predictors among under five children admitted to therapeutic feeding units of general and referral hospitals in Tigray, Ethiopia, 2020: a prospective cohort study.

BACKGROUND: Across the globe, an estimated 16 million children under the age of 5 are affected by severe acute malnutrition. Children with severe acute malnutrition are nine times more likely to die than well-nourished children. In Ethiopia, 7% of children under five are wasted, and 1% of these are severely wasted. A prolonged hospital stay increases the incidence of hospital-acquired infections. The aim of this study was to assess the time to recovery and its predictors among children 6-59 months old with severe acute malnutrition admitted to therapeutic feeding units of selected general and referral hospitals in Tigray, Ethiopia. METHODS: A prospective cohort study design was conducted among children aged 6-59 months admitted with severe acute malnutrition in selected hospitals in Tigray that have therapeutic feeding units. The data were cleaned, coded, entered into Epi-data Manager, and exported to STATA 14 for analysis. RESULT: Among 232 children followed in the study, 176 have recovered from severe acute malnutrition with a recovery rate of 54 per 1000 person-days observation and the median time to recovery was 16 days with an inter-quartile range of 8. In a multivariable Cox Regression, feeding plumpy nut [AHR 0.49 (95% CI 0.2717216-0.8893736)] and failing to gain 5 gr/kg/day for three successive days after feeding freely on F-100 [AHR 3.58 (95% CI 1.78837-7.160047)] were found to have an association with time to recovery. CONCLUSION: Despite the median time to recovery is shorter than what has been reported in a few studies, we can conclude that this could not let children avoid any possible hospital-acquired infections. The impact of staying in a hospital may also extend to the mother/caregiver in terms of the infection that they may acquire or the costs imposed on them.

Rate, risk factors and estimations of time to develop severe acute malnutrition after children receiving antiretroviral therapy at selected health facilities in northwest Ethiopia.

Severe acute malnutrition (SAM) affects up to 50 % of children with HIV, especially those who reside in resource-constrained healthcare setting like Ethiopia. During subsequent follow-up of children factors related to incidence of SAM after antiretroviral therapy (ART) is set on, however, there is no prior evidence. An institution-based retrospective cohort study was employed among 721 HIV-positive children from 1 January to 30 December 2021. Data were entered using Epi-Data version 3.1 and exported to STATA version 14 for analysis. Bi-variable and multivariable Cox-proportional hazard models were employed at 95 % confidence intervals to identify significant predictors for SAM. According to this result, the overall mean (±sd) age of the participants was found to be 9⋅83 (±3⋅3) years. At the end of the follow-up period, 103 (14⋅29 %) children developed SAM with a median time of 30⋅3 (13⋅4) months after ART initiation. The overall incidence density of SAM was found to be 5⋅64 per 100 child (95 % CI 4⋅68, 6⋅94). Children with CD4 counts below the threshold [AHR 2⋅6 (95 % CI 1⋅2, 2⋅9, P = 0⋅01)], disclosed HIV status [AHR 1⋅9 (95 % CI 1⋅4, 3⋅39, P = 0⋅03)] and Hgb level ≤10 mg/dl [AHR 1⋅8 (95 % CI 1⋅2, 2⋅9, P = 0⋅03)] were significant predictors for SAM. Significant predictors of acute malnutrition were having a CD4 count below the threshold, children who had previously reported their HIV status, and having haemoglobin <10 mg/dl. To ensure better health outcomes, healthcare practitioners should improve earlier nutritional screening and consistent counselling at each session of care.

Inflammation: the driver of poor outcomes among children with severe acute malnutrition?

Severe acute malnutrition (SAM) is the most life-threatening form of undernutrition and underlies at least 10% of all deaths among children younger than 5 years in low-income countries. SAM is a complex, multisystem disease, with physiological perturbations observed in conjunction with the loss of lean mass, including structural and functional changes in many organ systems. Despite the high mortality burden, predominantly due to infections, the underlying pathogenic pathways remain poorly understood. Intestinal and systemic inflammation is heightened in children with SAM. Chronic inflammation and its consequent immunomodulation may explain the increased morbidity and mortality from infections in children with SAM, both during hospitalization and in the longer term after discharge. Recognition of the role of inflammation in SAM is critical in considering new therapeutic targets in this disease, which has not seen a transformational approach to treatment for several decades. This review highlights the central role of inflammation in the wide-ranging pathophysiology of SAM, as well as identifying potential interventions that have biological plausibility based on evidence from other inflammatory syndromes.

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.

Factors associated with acute malnutrition among children aged 6-59 months in Haiti, Burkina Faso and Madagascar: A pooled analysis.

BACKGROUND: Acute malnutrition is one of the main causes of morbidity and mortality among children under 5 years worldwide, and Action Contre la Faim (ACF) aims to address its causes and consequences. To better tailor humanitarian programs, ACF conducts standardized contextual studies called Link NCAs (Nutrition Causal Analysis), to identify factors associated with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Data from three Link NCAs performed in 2018 and 2019 in Haiti, Burkina Faso and Madagascar were used to explore the prevalence of malnutrition by different indicators and associated risk factors among children aged 6-59 months. METHODS: Cross-sectional data, collected via household surveys applying two-stage cluster sampling, were pooled to build a sample of 1,356 children. Recommended anthropometric thresholds were used to define SAM (Weight-for-Height Z-score (WHZ) <-3 or Mid-upper Arm Circumference (MUAC) <115 mm and/or presence oedema), MAM (-3≤WHZ<-2 or 115≤MUAC<125 mm) and global acute malnutrition GAM (SAM or MAM) among children. Multivariate analyses for each anthropometric indicator were performed using logistic mixed models and adjusting for potential confounders. RESULTS: The prevalence of acute malnutrition was the highest in Madagascar. The risk of having GAM and MAM varied across countries, while the risk of having SAM varied across clusters. Being male, suffering from diarrhea, and having unwashed face and hands, were significantly associated with GAM by WHZ with adjusted odds ratio of 1.9 [95%Confidence interval (CI):1.1-3.2], 1.7 (95%CI: 1.0-3.1) and 1.9 (95%CI: 1.0-3.6) respectively. These factors were also associated with MAM by WHZ. None of the studied factors was significantly associated with SAM, which could be due to a small sample size. CONCLUSION: These results obtained from a large sample contribute to the evidence of the factors associated with undernutrition in children aged 6-59 months. Further research with larger sample sizes is needed to confirm these results.

Severe acute malnutrition outcomes for children of South African compared to foreign-born parents admitted to a rural regional hospital in South Africa: a retrospective cohort study.

BACKGROUND: Children of foreign-born parents with vulnerable legal status, limited economic rights and exclusion from national social interventions may be at higher risk for severe acute malnutrition (SAM). We evaluated the relationship between parent status (foreign-born vs. South African) and outcomes for children with SAM admitted to a rural regional hospital in the Western Cape, South Africa. METHODS: A retrospective cohort study was conducted including children <5 years admitted to Worcester Provincial Hospital during 2015-17 with SAM (WHO weight-for-height Z score <-3, presence of nutritional oedema, mid-upper-arm-circumference of <11.5 cm or visible severe wasting). Exposures, including parent status, and outcomes including in-hospital death were determined from hospital and regional dietician records. RESULTS: Of 95 children included, 31 (33%) were of foreign-born and 64 (67%) of South African parents. Median (interquartile range) age at admission was 12 (8-18) vs. 10 (8-13) months in children of South African vs. foreign-born parents with no difference in preterm birth, concurrent illnesses or admission duration. Age, HIV status and breastfeeding practices were no different in foreign-born compared to South African mothers. In-hospital deaths occurred in 3/64 (5%) and 6/31 (19%) children of South African vs. foreign-born parents (p = 0.01). Children of foreign-born compared to South African parents had an odds ratio of 4.88 (95% CI 1.13-21.06) for in-hospital SAM-associated mortality. CONCLUSION: In this rural setting, 33% of children admitted with SAM were of foreign-born parents and experienced in-hospital SAM-associated mortality at least four times higher than children of South African parents. This illustrates the extreme vulnerability of these children.

In some contexts children of foreign-born parents may experience vulnerable legal status putting them at higher risk for food insecurity and severe malnutrition in their early years of life, compared to children of native-born parents. In a rural region of the Western Cape of South Africa, we observed that children of foreign-born parents were four times more likely to die of malnutrition than children of South African parents. This was so even though these children did not display other expected risk factors for malnutrition such as being born preterm, not breastfeeding or being HIV-exposed. To achieve the Sustainable Developmental Goals, policy makers and healthcare systems will need to cater for all children in the country, including asylum seekers and children of foreign-born parents. The South African Constitution and Refugee Act are in support of this. However, the findings of this study illustrate the extent of vulnerability of children living in South Africa born to foreign-born parents and calls for an evaluation of the services made available to support their health and well-being.

Incidence and predictors of attrition rate after children started inpatient treatments for complicated severe acute malnutrition in North West Ethiopia.

BACKGROUND: Retaining children for inpatient treatment of complicated severe acute malnutrition (SAM) is a growing challenge until achieved the reference weight of a child. In Ethiopia, there is limited information regarding the time to be lost from the stabilizing centers after initiation of treatment. Thus, this study aimed to identify incidence and predictors of attrition for children suffering from SAM after started inpatient treatment in North West Ethiopia. METHODS: A retrospective cohort study was conducted among under-five children admitted and started inpatient treatment for complicated SAM from 2015/2016 to 2020/2021. Data were entered using Epi-data version 4.2 and then exported to STATA (SE) version R-14 software for further analysis. The analysis was computed using Cox proportional hazard regression model after checking all proportional hazard assumptions. Covariates having < 0.2 of P values in the bi-variable analysis were candidates transferred to the multivariable Cox proportional hazard regression model. Finally, a statistical significance was declared at a P value of < 0.05. RESULT: Overall, 760 files of under-five children were analyzed with a mean (± SD) age of participants 27.8 (± 16.5) months. About 6944 child-days of treatment observation were recorded with the crude incidence of attrition rate of 9.7% (95% CI 7.9-12.6). The overall median time of attrition and half-life time S(t1/2) of survival rates was determined as 14 (IQR = ± 7) days and 91.6% (95% CI 88.2-93.1), respectively. The attrition rate was significantly associated with cases living in rural residents (AHR = 6.03; 95% CI 2.2; 25.2), being re-admitted SAM cases (AHR = 2.99; 95% CI 1.62; 5.5), and caregivers did not have formal education (AHR = :5.6, 95% CI 2.7; 11.7) were all independent predictors for attrition from inpatient treatment. CONCLUSIONS: Nearly one in every ten severely acute malnourished under-five children defaulted at the end of treatment observation with a median time of 14 (IQR = ± 7) days. Living in a rural residence, being re-admitted cases, caregivers who did not have a formal education were significantly associated with the attrition rate. Hence, it is crucial to detect and control the identified causes of defaulting from treatment observation promptly. Furthermore, serious counseling during admission and nutritional provision strategies are essential for virtuous treatment outcomes.

Time to readmission and associated factors after post treatment discharge of severe acute malnourished under-five children in Pawe General Hospital.

BACKGROUND: Relapse or repeated episodes is the admission of a child with the diagnosis of severe acute malnutrition (SAM) after being discharged to a status of treated and cured from a stabilizing center. A child may experience more than one episode of SAM depending on the improvement of the underlying comorbidity. Thus, this study aimed to estimate the time to readmission of SAM and associated factors for under-five children in North West Ethiopia. METHODS: An institution-based retrospective cohort study was employed in 760 files of under-five children spanning from 2014/15 to 2019/20. The data extraction tool was developed from SAM treatment guidelines and medical history sheets. Epi Data version 3.2 and STATA version 14 were used for data entry and final analysis, respectively. After checking all assumptions, the multivariable Cox Proportional Hazard model was fitted to the isolated independent predictors for time to readmission. A categorical variable with p < 0.05 was considered a risk factor for the relapse of SAM. RESULT: The mean (± SD) age of participant children was 27.8 (± 16.5) months with mean (± SD) time to relapse of SAM cases were 30.4(± 21.39) weeks posttreatment discharge. The overall incidence density rate of relapse was determined as 10.8% (95% CI 8.3; 12.6). The average time (± SD) for treatment recovery from the first admission of the SAM case was 28.8(± 18.7) days. Time of readmission was significantly associated with living in rural resident (AHR 5⋅3 = 95% CI, 2⋅95, 13⋅87, p = 0.021), having HIV infection (AHR6⋅8 = 95%CI; 4.1-11.9 p = 0.001), and first admission with edema (AHR = 3.5 = 95% CI; 1.92, 6.2, p = 0.018). CONCLUSION: Nearly one in every ten severely acute malnourished under-five children relapsed within a mean time to relapse 30.4(± 21.39) weeks posttreatment discharge. Time to relapse was significantly associated with being a rural resident for children, having edema during the first admission, and being HIV-infected cases. A protocol ought to be drafted for extending Supplementary Nutrition in Acute Malnutrition management program following discharge is highly needed.

Nutritional and health status of a cohort of school-age children born to mothers treated for severe acute malnutrition in their childhood in The Democratic Republic of Congo.

BACKGROUND: Malnutrition is a public health problem, but outside the theoretical framework, little is known about the concrete intergenerational effects of malnutrition. OBJECTIVE: The objective of this study is to compare the nutritional status and health indicators of school children born to mothers who were treated for severe acute malnutrition (SAM). METHODOLOGY: The study took place in Miti-Murhesa health zone in the Democratic Republic of Congo. This is a cohort study assessing the nutritional and health status of school children born to mothers who had been treated for SAM, based on WHZ or edema, in Lwiro hospital between 1988-2002 compared to children born to mothers who were not exposed to SAM. Stunting and thinness were evaluated by Height for Age Z-score (HAZ) and Body Mass Index by Age criteria (BMIAZ) respectively. On admission, blood samples were taken to assess anemia, HIV serology, hemogram and others biological indicators. Stool's examinations were conducted by using Olympus optical microscope. Parametric and non-parametric tests were applied to compare the different variables in two groups. RESULTS: We identified 106 children aged 5-16 years (103 exposed and 58 unexposed) and we received 83.5% and 91.4% children respectively for anthropometric parameters. The mean of age was 7.9 ± 2.4 year in exposed group and 7.4 ± 2.1 year in unexposed group (p = 0.26). The prevalence of stunting was 68.3% in the exposed group and 67.3% in the unexposed group (p = 0.90). The prevalence of thinness was 12.8% in the exposed group and 9.6% in the unexposed group (p = 0.57). The biological profile (glycemia, urea, creatinine and hemogram) and the prevalence of intestinal parasites were similar in the two groups. CONCLUSION: In this sample, in a malnutrition-endemic area, there was no statistically significant difference in nutrition and health indicators between school children born to mothers exposed to SAM and their community controls.