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1.
BMC Health Serv Res ; 19(1): 967, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842870

RESUMO

BACKGROUND: Coverage is an important indicator to assess both the performance and effectiveness of public health programs. Recommended methods for coverage estimation for the treatment of severe acute malnutrition (SAM) can involve active and adaptive case finding (AACF), an informant-driven sampling procedure, for the identification of cases. However, as this procedure can yield a non-representative sample, exhaustive or near exhaustive case identification is needed for valid coverage estimation with AACF. Important uncertainty remains as to whether an adequate level of exhaustivity for valid coverage estimation can be ensured by AACF. METHODS: We assessed the sensitivity of AACF and a census method using a capture-recapture design in northwestern Nigeria. Program coverage was estimated for each case finding procedure. RESULTS: The sensitivity of AACF was 69.5% (95% CI: 59.8, 79.2) and 91.9% (95% CI: 85.1, 98.8) with census case finding. Program coverage was estimated to be 40.3% (95% CI 28.6, 52.0) using AACF, compared to 34.9% (95% CI 24.7, 45.2) using the census. Depending on the distribution of coverage among missed cases, AACF sensitivity of at least ≥70% was generally required for coverage estimation to remain within ±10% of the census estimate. CONCLUSION: Given the impact incomplete case finding and low sensitivity can have on coverage estimation in potentially non-representative samples, adequate attention and resources should be committed to ensure exhaustive or near exhaustive case finding. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03140904. Registered on May 3, 2017.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Programas de Rastreamento , Desnutrição Aguda Grave/diagnóstico , Pré-Escolar , Humanos , Lactente , Nigéria/epidemiologia , Prevalência , Amostragem , Desnutrição Aguda Grave/epidemiologia , Desnutrição Aguda Grave/terapia
2.
Bull World Health Organ ; 97(9): 597-604, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31474772

RESUMO

Objective: To improve the low coverage and performance of a programme on community-based management of acute malnutrition, implemented between October 2015 and April 2018 in Kupang district in rural Indonesia. Methods: To investigate why the coverage and performance were low in the first year of the programme, we conducted a semiquantitative evaluation between August and September 2016. We used the results from the evaluation to inform programme improvement, by developing and modifying community mobilization strategies. We employed a multipronged approach to improve community awareness on acute malnutrition and on community-based services for such condition. This approach involved workshops, focus discussion groups in the community and sensitization events at health posts that had issues with community engagement. Community health workers increased their efforts in active case finding by visiting households with children who had missed the community health post sessions. We measured the performance using three Sphere minimum standard performance indicators: proportion of children recovering (> 75%); defaulting (< 15%); and dying (<10%). Results: The community mobilization efforts increased the screening rate from 17% (564/3278) in October 2015 to 66% (6793/10 251) in March 2018. In 2017, the programme met the three performance indicators: 79% (256/326) of children recovered; 10% (34/326) defaulted; and less than 1% (2/326) died. Conclusion: In Indonesia, community mobilization is central for addressing severe acute malnutrition in children younger than five years. This strategy includes securing political leadership and effective messaging alongside locally tailored strategies and continuous ground-level support.


Assuntos
Serviços de Saúde Comunitária/métodos , Promoção da Saúde/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Desnutrição Aguda Grave/diagnóstico , Desnutrição Aguda Grave/epidemiologia , Pré-Escolar , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Pesquisa , População Rural
3.
BMC Res Notes ; 12(1): 409, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307556

RESUMO

OBJECTIVES: This study aimed to determine mortality rate, time to death and factors affecting the time to death among children with severe acute malnutrition admitted to therapeutic feeding unit of Felege Hiwot Referral Hospital, Bahirdar. RESULT: A total of 401 children with severe acute malnutrition who were admitted to therapeutic feeding units from September 2012 to January 2016 were included in the study. The incidence of death rate was 8.47% (95% CI 6.11%, 11.65%). The median time to death was 3 days (Inter Quartile Range of 4 days). Children's of age > 24 months (AHR = 0.27; 95% CI 0.1, 0.73), fully vaccinated status (AHR = 0.16; 95% CI 0.07, 0.36), HIV infection (AHR = 3.82; 95% CI 1.3, 11.15) and congestive heart failure (AHR = 6.98; 95% CI 2.42, 20.09) were significant predictors of mortality among children admitted for severe acute malnutrition.


Assuntos
Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Desnutrição Aguda Grave/mortalidade , Desnutrição Aguda Grave/terapia , Pré-Escolar , Comorbidade , Etiópia/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Desnutrição Aguda Grave/epidemiologia , Taxa de Sobrevida
4.
EBioMedicine ; 45: 464-472, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31255658

RESUMO

BACKGROUND: More children are now surviving severe acute malnutrition (SAM), but evidence suggests that early-life malnutrition is associated with increased risk of long-term cardio-metabolic disorders. To better understand potential mechanisms, we studied the metabolite profiles of children seven years after treatment for SAM. METHODS: We followed-up children (n = 352) treated for SAM in 2006-2007, at Queen Elizabeth Central Hospital, in Malawi. Using nuclear magnetic resonance spectroscopy, tandem mass spectrometry and enzyme-linked immunosorbent assay, we measured circulating metabolites in fasting blood in a subset of SAM survivors (n = 69, 9·6 ±â€¯1·6 years), siblings (n = 44, 10·5 ±â€¯2·7 years), and age and sex-matched community controls (n = 37, 9·4 ±â€¯1·8 years). Data were analysed using univariate and sparse partial least square (sPLS) methods. Differences associated with SAM survival, oedema status, and anthropometry were tested, adjusting for age, sex, HIV, and wealth index. FINDINGS: Based on 194 measured metabolites, the profiles of SAM survivors were similar to those of siblings and community controls. IGF1, creatinine, and FGF21, had loading values >0·3 and ranked stably in the top 10 distinguishing metabolites, but did not differ between SAM survivors and controls with univariate analysis. Current stunting was associated with IGF1 (ß = 15·2, SE = 3·5, partial R2 = 12%, p < 0·0001) and this relationship could be influenced by early childhood SAM (ß = 17·4, SE = 7·7, partial R2 = 2·8%, p = 0·025). No metabolites were associated with oedema status, duration of hospital stay, anthropometry measured during hospitalization, nor with changes in anthropometry since hospitalization. INTERPRETATION: In this group of survivors, SAM was not associated with longer-term global metabolic changes 7 years after treatment. However, SAM may influence the relationship between current stunting and IGF1. Further risk markers for NCDs in SAM survivors may only be revealed by direct metabolic challenge or later in life.


Assuntos
Metabolômica , Desnutrição Aguda Grave/sangue , Desnutrição Aguda Grave/epidemiologia , Adolescente , Adulto , Antropometria/métodos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hospitalização , Humanos , Lactente , Malaui/epidemiologia , Masculino , Desnutrição Aguda Grave/fisiopatologia , Adulto Jovem
5.
EBioMedicine ; 45: 456-463, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31229436

RESUMO

BACKGROUND: Children with severe acute malnutrition (SAM), with or without diarrhoea, often have enteropathy, but there are few molecular data to guide development of new therapies. We set out to determine whether SAM enteropathy is characterised by specific transcriptional changes which might improve understanding or help identify new treatments. METHODS: We collected intestinal biopsies from children with SAM and persistent diarrhoea. mRNA was extracted from biopsies, sequenced, and subjected to a progressive set of complementary analytical approaches: NOIseq, Gene Set Enrichment Analysis (GSEA), and correlation analysis of phenotypic data with gene expression. FINDINGS: Transcriptomic profiles were generated for biopsy sets from 27 children of both sexes, under 2 years of age, of whom one-third were HIV-infected. NOIseq analysis, constructed from phenotypic group extremes, revealed 66 differentially expressed genes (DEGs) out of 21,386 mapped to the reference genome. These DEGs include genes for mucins and mucus integrity, antimicrobial defence, nutrient absorption, C-X-C chemokines, proteases and anti-proteases. Phenotype - expression correlation analysis identified 1221 genes related to villus height, including increased cell cycling gene expression in more severe enteropathy. Amino acid transporters and ZIP zinc transporters were specifically increased in severe enteropathy, but transcripts for xenobiotic metabolising enzymes were reduced. INTERPRETATION: Transcriptomic analysis of this rare collection of intestinal biopsies identified multiple novel elements of pathology, including specific alterations in nutrient transporters. Changes in xenobiotic metabolism in the gut may alter drug disposition. Both NOIseq and GSEA identified gene clusters similar to those differentially expressed in pediatric Crohn's disease but to a much lesser degree than those identified in coeliac disease. FUND: Bill & Melinda Gates Foundation OPP1066118. The funding agency had no role in study design, data collection, data analysis, interpretation, or writing of the report.


Assuntos
Diarreia/genética , Enteropatias/genética , Desnutrição Aguda Grave/genética , Transcriptoma/genética , Biópsia , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/patologia , Feminino , Perfilação da Expressão Gênica , Humanos , Lactente , Enteropatias/epidemiologia , Enteropatias/patologia , Mucosa Intestinal/metabolismo , Masculino , Análise de Sequência de RNA , Desnutrição Aguda Grave/epidemiologia , Desnutrição Aguda Grave/patologia , Zâmbia/epidemiologia
6.
Indian Pediatr ; 56(4): 287-293, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31064896

RESUMO

OBJECTIVE: To compare efficacy of indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy) with Standard Nutrition Therapy in children with Severe acute malnutrition. DESIGN: Two facility-based and two community-based models: (i) Open prospective randomized controlled trial comparing Indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy) with Standard Nutrition Therapy; (ii) Only Indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy); (iii) Doorstep Child Care Centre; and (iv) Community-based Management of Acute Malnutrition. SETTING: (i) Urban Health Center, Dharavi, Mumbai; (ii) Two day care centers of Non-governmental Organization SNEHA - Mumbai; (iii) Urban slums, M East and L Ward, Mumbai. PARTICIPANTS: 1105 children aged 6-60 months in community or hospital inpatient/ outpatient department diagnosed as Severe Acute Malnutrition by WHO definition. INTERVENTION: All subjects received either Indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy) or Standard Nutrition Therapy (protein calorie rich diet) for eight weeks and followed up for next four months. MAIN OUTCOME MEASURES: Mean rate of weight gain (g/kg/day), target weight, change in nutritional status. RESULTS: Rate of weight gain was higher (P<0.05) at 2 weeks on indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy) (5.63 g/kg/day) as compared to Standard Nutrition Therapy (3.43 g/kg/day). 61.2% subjects achieved target weight compared to 47.7% controls. At 8 weeks, 82.8% subjects recovered from Severe Acute Malnutrition compared to 19.3% controls (P<0.005). The results obtained in community were comparable to facility-based indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy). The morbidity was less in study group at follow-up. CONCLUSIONS: Indigenous Ready-to-use Therapeutic Food (Medical Nutrition Therapy) appeared to be superior to Standard Nutrition Therapy in promoting weight gain in children with Severe Acute Malnutrition.


Assuntos
Fast Foods , Alimentos Formulados , Desnutrição Aguda Grave/dietoterapia , Desnutrição Aguda Grave/epidemiologia , Ganho de Peso/fisiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estado Nutricional
7.
Ital J Pediatr ; 45(1): 46, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971316

RESUMO

BACKGROUND: Despite improving access to Severe Acute Malnutrition (SAM) management, information on the quality of the service, as measured by timely recovery, is scare. This study is designed to assess treatment outcomes and factors affecting time-to-recovery from SAM in children 6-59 months admitted to a stabilizing center in Hawassa University Comprehensive Specialized Hospital (HU-CSH), Southern Ethiopia. METHODS: Institutional-based retrospective cohort study was conducted on 420 randomly selected children aged 6-59 months. The children were managed at the hospital from July, 2015 to June, 2017. Pre-tested structured questionnaire was used to extract data from medical records. Data were analyzed using Kaplan Meir (KM) curve, Log rank test and Cox-Proportional hazards model. The outputs of the bivariable and multivariable Cox model are presented using Adjusted Hazard Ratio (AHR) with the respective 95% Confidence Intervals (CIs). RESULTS: After a maximum of 59 days treatment 69.3% of the children recovered and 10.8% died. The mean (±SD) weight gain rates was 12.7 (±8.9) g/kg/days. The overall incidence density rate of recovery was 3.8 per 100 person-days. The overall median (IQR) time of recovery was 17(10, 24) days. F-100 intake (AHR = 0.502, 95%, CI: 0.29-0.86), Tuberculosis infection (AHR = 1.38, 95% CI: 1.00-1.91) and provision of special medication (IV fluid, IV antibiotic and blood transfusion) (AHR = 0.72, 95% CI: 0.52-0.99) at admission were found to be significant predictors of time-to-recovery from SAM. CONCLUSION: The overall recovery from complicated SAM children admitted at HU-CSH after a maximum of 59 days treatment was low (69.4%) and a very high proportion of children (10.8%) end up in death. Therefore, HU-CSH should give special focus for those children present with medical comorbidities during admission.


Assuntos
Hospitalização , Desnutrição Aguda Grave/epidemiologia , Desnutrição Aguda Grave/terapia , Antibacterianos/uso terapêutico , Transfusão de Sangue/estatística & dados numéricos , Pré-Escolar , Estudos de Coortes , Etiópia/epidemiologia , Feminino , Hidratação , Alimentos Fortificados , Humanos , Lactente , Masculino , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Tuberculose/epidemiologia , Ganho de Peso
8.
BMC Infect Dis ; 19(1): 121, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30727974

RESUMO

BACKGROUND: Soil-transmitted helminthic (STH) infections are common in Sub-Saharan Africa. One method used for control of these helminths is mass anti-helminthic administration in populations at risk of STH infections. In this regard, empiric treatment of children with Severe Acute Malnutrition (SAM) for STH infection is practiced in this region. It is however unclear if children with SAM suffer more from STH infection than healthy children. The objective of this study was to compare prevalence and intensity of STH infection between pre-school aged children with SAM and healthy children. METHODS: We approached 1114 pre-school aged children attending care in two health facilities in Kano, Nigeria to partake in this study. Of this number, we recruited 620 (55.7%) children, comprising 310 well-nourished children from well-baby clinics and 310 children with SAM from Community Management for Acute Malnutrition (CMAM) centres in these facilities. We assessed their nutritional status using World Health Organisation (WHO) growth charts and collected stool samples which we analysed using Formal-Ether Concentration technique to identify STH infection and Stoll's technique to assess intensities of STH infection. We fitted a logistic regression model to determine if there was any association between nutrition status and helminthic infection, adjusting for the confounding effects of socio-economic status and age. We compared intensity of STH infection (measured as eggs per gram of faeces) between both nutrition groups using the independent t-test. RESULTS: Overall STH prevalence in our population was low (2.7%) and we found no significant association between nutritional status and presence of STH infection (OR = 1.10, 95% CI 0.38 to 3.21). Majority of our study participants had either low or moderate (94.2%) and there was no statistically significant difference between intensity of STH infection (t value = - 1.52, P value = 0.13) in children with SAM and those who were well-nourished. CONCLUSIONS: The overall STH prevalence among pre-school children was low in Kano and we did not find prevalence and intensity of STH infection to differ significantly between preschool children with SAM and well-nourished children. Our findings confirm the WHO recommendation that at low levels of prevalence and intensity, interventions to control STH are unnecessary.


Assuntos
Helmintíase/epidemiologia , Helmintíase/transmissão , Desnutrição Aguda Grave/parasitologia , Animais , Estudos Transversais , Fezes/parasitologia , Feminino , Helmintos/isolamento & purificação , Humanos , Lactente , Masculino , Nigéria/epidemiologia , Estado Nutricional , Prevalência , Desnutrição Aguda Grave/epidemiologia , Fatores Socioeconômicos , Solo/parasitologia
9.
Arch Dis Child ; 104(3): 229-235, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30266874

RESUMO

BACKGROUND: Stunting is the most common manifestation of childhood undernutrition worldwide. Children presenting with severe acute malnutrition (SAM) are often also severely stunted. We evaluated linear growth and its determinants after medically complicated SAM. METHODS: We performed secondary analysis of clinical trial data (NCT00934492) from HIV-uninfected Kenyan children aged 2-59 months hospitalised with SAM. Outcome was change in height/length-for-age z-score (HAZ) between enrolment and 12 months later. Exposures were demographic, clinical, anthropometric characteristics and illness episodes during follow-up. RESULTS: Among 1169 children with HAZ values at month 12 (66% of those in original trial), median (IQR) age 11 (7-17) months and mean (SD) HAZ -2.87 (1.6) at enrolment, there was no change in mean HAZ between enrolment and month 12: -0.006Z (95% CI -0.07 to 0.05Z). While 262 (23%) children experienced minimal HAZ change (within ±0.25 HAZ), 472 (40%) lost >0.25 and 435 (37%) gained >0.25 HAZ. After adjusting for regression to the mean, inpatient or outpatient episodes of diarrhoea and inpatient severe pneumonia during follow-up were associated with HAZ loss. Premature birth and not being cared by the biological parent were associated with HAZ gain. Increases in mid-upper arm circumference and weight-for-age were associated with HAZ gain and protected against HAZ loss. Increase in weight-for-height was not associated with HAZ gain but protected against HAZ loss. No threshold of weight gain preceding linear catch-up growth was observed. CONCLUSIONS: Interventions to improve dietary quality and prevent illness over a longer period may provide opportunities to improve linear growth.


Assuntos
Transtornos do Crescimento/etiologia , Transtornos da Nutrição do Lactente/complicações , Desnutrição Aguda Grave/complicações , Estatura/fisiologia , Pré-Escolar , Método Duplo-Cego , Feminino , Seguimentos , Crescimento/fisiologia , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Transtornos da Nutrição do Lactente/epidemiologia , Quênia , Masculino , Desnutrição Aguda Grave/epidemiologia
10.
Matern Child Nutr ; 15(2): e12702, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30246929

RESUMO

The objectives of most treatment programs for severe acute malnutrition (SAM) in children focus on initial recovery only, leaving post-discharge outcomes, such as relapse, poorly understood and undefined. This study aimed to systematically review current literature and conduct secondary data analyses of studies that captured relapse rates, up to 18-month post-discharge, in children following recovery from SAM treatment. The literature search (including PubMed and Google Scholar) built upon two recent reviews to identify a variety of up-to-date published studies and grey literature. This search yielded 26 articles and programme reports that provided information on relapse. The proportion of children who relapsed after SAM treatment varied greatly from 0% to 37% across varying lengths of time following discharge. The lack of a standard definition of relapse limited comparability even among the few studies that have quantified post-discharge relapse. Inconsistent treatment protocols and poor adherence to protocols likely add to the wide range of relapse reported. Secondary analysis of a database from Malawi found no significant association between potential individual risk factors at admission and discharge, except being an orphan, which resulted in five times greater odds of relapse at 6 months post-discharge (95% CI [1.7, 12.4], P = 0.003). The development of a standard definition of relapse is needed for programme implementers and researchers. This will allow for assessment of programme quality regarding sustained recovery and better understanding of the contribution of relapse to local and global burden of SAM.


Assuntos
Desnutrição Aguda Grave/epidemiologia , África/epidemiologia , Ásia/epidemiologia , Pré-Escolar , Humanos , Lactente , Recidiva , Índias Ocidentais/epidemiologia
11.
BMC Res Notes ; 11(1): 870, 2018 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-30522517

RESUMO

OBJECTIVES: Severe acute malnutrition (SAM) has been considered as the complex nutritional problem within developing countries. Alleviating its occurrence also exists in an anxiety. A series of studies were conducted to disclose evidences and documented by here author. Moreover key messages were abstracted with this review easing access of texts. RESULTS: Due to pitiable sanitary practices 30% of cow milk had massive bacterial isolates like Escherichia coli; while usage of raw milk has been common do. Besides the mean severe household food insecurity was 6.5% and practice of family planning was 30%; whilst family size subsists as predictor for household food insecurity. The habits of exclusive breastfeeding, timely initiation of complementary feeding and apt complementary feeding were 78%, 34% and 11%, respectively with awareness as predictor. On the other hand SAM has been recognized as problem in children and treated mainly in outpatient therapeutic program by curative foods. Yet the provided foods were shared due to severe household food insecurity causing SAM recovery rate intolerable. So children get severely underfed by multidimensional determinants and need multifaceted strategies starting from awareness creation and alleviating household food insecurity.


Assuntos
Desnutrição Aguda Grave/epidemiologia , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Etiópia/epidemiologia , Humanos
12.
Nutr J ; 17(1): 116, 2018 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563516

RESUMO

BACKGROUND: In spite of the availability of guidelines for the management of severe acute malnutrition (SAM) in Ethiopia, high comorbidity and poor treatment outcomes are still observed in therapeutic feeding centers among under -five children with SAM. The aim of this study was to assess comorbidity, treatment outcomes and factors affecting the recovery rate of children aged 1-59 months with SAM admitted into Therapeutic Feeding Centers (TFCs). METHODS: A total of 413 records of children with SAM admitted in three selected hospitals from July 2013 to July 2015 G.C were retrospectively reviewed. Descriptive analysis was used to compare performance indicator values with SPHERE project reference standards (the minimum standard to be attained during nutritional therapy). Cox-proportional hazard regression analysis was performed to estimate the predictors of recovery rate at p-value < 0.05. RESULT: The mean age of children was 16 months (95% CI, 15.0, 17.0). Out of 413 children with SAM, 231 (55.9%) recovered, 24 (5.8%) died and 16.3% were defaulted from TFCs. The mean weight gain (in gram per weight of kilogram per day) for recovered children was 15.61 g/kg/day (95% CI, 14.15, 17.07). The overall median recovery time for these children was 12 days (95% CI, 11.22, 12.78). Moreover, most (77.5%) of children admitted with SAM were marasmic followed by Kwash (16%). Pneumonia (54.8%), diarrhea (41.8%) and rickets (21.4%) were co-morbidities which affected SAM children. A child being admitted at Mehal Meda Hospital (Adjusted Hazard Ratio (AHR) = 2.01; 95% CI: 1.34, 2.91), edematous form of malnutrition (AHR = 0.59; 95% CI: 0.39, 0.90) and being a child infected with pneumonia (AHR = 0.71; 95% CI: 0.51, 0.98) were predictors of nutritional recovery rate. CONCLUSION: Under five pneumonia, diarrhea and rickets were co-morbidities that should be prevented. Recovery rate was poor when compared to SPHERE project reference value (which is > 75%). Predictors, namely presence of pneumonia and edematous form of malnutrition reduced nutritional recovery rate. Whereas, being admitted at Mehal Meda Hospital improved recovery rate. Therefore, hospitals should work in collaboration with health extension workers to prevent co-morbidities and strengthen screening and referral of malnutrition cases at community level. Moreover, Zonal Health Department and District Health Offices should facilitate experience sharing among health facilities.


Assuntos
Diarreia/epidemiologia , Hospitalização , Pneumonia/epidemiologia , Raquitismo/epidemiologia , Desnutrição Aguda Grave/epidemiologia , Desnutrição Aguda Grave/terapia , Pré-Escolar , Comorbidade , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Ganho de Peso
13.
Matern Child Nutr ; 14 Suppl 4: e12623, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30499254

RESUMO

Severe wasting is the most widespread form of severe acute malnutrition, affecting an estimated 17 million children globally. This analysis assesses the effectiveness of Pakistan's community management of acute malnutrition (CMAM) programme. We conducted a retrospective case series analysis of 32,458 children aged 6-59 months who were admitted to the programme with a mid-upper arm circumference (MUAC) < 115 mm (January 1-December 31, 2014). We found that at admission, 59.6% of the children were girls and 87.4% were in the age group 6-23 months old. While in the programme, 120 children (0.4%) died, 3,456 (10.6%) defaulted, and 28,882 (89.0%) were discharged after a mean length of stay of 69.3 ± 25.7 days. Children's mean weight gain while in the programme was 3.2 ± 2.7 g/kg body weight/day. At discharge, 28,499 children (98.7% of discharged) had recovered (MUAC ≥ 125 mm). The odds of death were significantly higher among children with weight-for-height (WHZ) < -3 and/or height-for-age (HAZ) < -2 at admission. The odds of recovery on the basis of MUAC ≥125 mm were higher among children with HAZ ≥ -2 at admission. The odds of recovery on the basis of WHZ ≥ -2 were significantly higher among children with WHZ ≥ -3 and/or HAZ < -2 at admission. Pakistan's CMAM programme is effective in achieving good survival and recovery rates. Population-level impact could be increased by giving priority to children 6-23 months old and children with multiple anthropometric failure and by scaling up CMAM in the provinces and areas where the risk, prevalence, and/or burden of severe acute malnutrition is highest.


Assuntos
Serviços de Saúde Comunitária , Desnutrição Aguda Grave , Síndrome de Emaciação , Antropometria , Peso Corporal , Criança , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Paquistão/epidemiologia , Estudos Retrospectivos , Desnutrição Aguda Grave/diagnóstico , Desnutrição Aguda Grave/epidemiologia , Desnutrição Aguda Grave/terapia , Síndrome de Emaciação/diagnóstico , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/terapia
14.
PLoS One ; 13(11): e0205688, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30412636

RESUMO

Children in slums are at high risk of acute malnutrition and death. Cost-effectiveness of community-based management of severe acute malnutrition programmes has been demonstrated previously, but there is limited evidence in the context of urban slums where programme cost structure is likely to vary tremendously. This study assessed the cost-utility of adding a community based prevention and treatment for acute malnutrition intervention to Government of India Integrated Child Development Services (ICDS) standard care for children in Mumbai slums. The intervention is delivered by community health workers in collaboration with ICDS Anganwadi community health workers. The analysis used a decision tree model to compare the costs and effects of the two options: standard ICDS services with the intervention and prevention versus standard ICDS services alone. The model used outcome and cost data from the Society for Nutrition, Education & Health Action's Child Health and Nutrition programme in Mumbai slums, which delivered services to 12,362 children over one year from 2013 to 2014. An activity-based cost model was used, with calculated costs based on programme financial records and key informant interviews. Cost data were coupled with programme effectiveness data to estimate disability adjusted life years (DALYs) averted. The community based prevention and treatment programme averted 15,016 DALYs (95% Uncertainty Interval [UI]: 12,246-17,843) at an estimated cost of $23 per DALY averted (95%UI:19-28) and was thus highly cost-effective. This study shows that ICDS Anganwadi community health workers can work efficiently with community health workers to increase the prevention and treatment coverage in slums in India and can lead to policy recommendations at the state, and potentially the national level, to promote such programmes in Indian slums as a cost-effective approach to tackling moderate and severe acute malnutrition.


Assuntos
Serviços de Saúde Comunitária/economia , Análise Custo-Benefício/economia , Avaliação de Programas e Projetos de Saúde/economia , Desnutrição Aguda Grave/epidemiologia , Idoso , Criança , Pré-Escolar , Agentes Comunitários de Saúde/economia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Áreas de Pobreza , Desnutrição Aguda Grave/prevenção & controle
15.
BMC Pediatr ; 18(1): 289, 2018 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-30176822

RESUMO

BACKGROUND: Depression is the leading cause of disease-related disability in women and adversely affects the health and well-being of mothers and their children. Studies have shown maternal depression as a risk factor for poor infant growth. Little is known about the situation in Sub-Saharan Africa. The aim of our study was to examine the association between maternal depression and severe acute malnutrition in Kenyan children aged 6-60 months. METHODS: A matched case-control study was conducted in general paediatric wards at the Kenyatta National Hospital. The cases were children admitted with severe acute malnutrition as determined by WHO criteria. The controls were age and sex-matched children with normal weight admitted in the same wards with acute ailments. Mothers of the cases and controls were assessed for depression using the PHQ-9 questionnaire. Child anthropometric and maternal demographic data were captured. Logistic regression analyses were used to compare the odds of maternal depression in cases and controls, taking into account other factors associated with child malnutrition status. RESULTS: The prevalence of moderate to severe depression among mothers of malnourished children was high (64.1%) compared to mothers of normal weight children (5.1%). In multivariate analyses, the odds of maternal depression was markedly higher in cases than in controls (adjusted OR = 53.5, 95% CI = 8.5-338.3), as was the odds of having very low income (adjusted OR = 77.6 95% CI = 5.8-1033.2). CONCLUSIONS: Kenyan mothers whose children are hospitalized with malnutrition were shown in this study to carry a significant mental health burden. We strongly recommend formation of self-help groups that offer social support, counseling, strategies to address food insecurity, and economic empowerment skills for mothers of children hospitalized for malnourishment.


Assuntos
Depressão/diagnóstico , Mães/psicologia , Desnutrição Aguda Grave/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Depressão/epidemiologia , Feminino , Hospitalização , Humanos , Renda , Lactente , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pobreza , Adulto Jovem
16.
PLoS One ; 13(8): e0202053, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30161151

RESUMO

BACKGROUND: Severe acute malnutrition (SAM) is a major global health problem affecting some 16.9 million children under five. Little is known about what happens to children 6-24 months post-discharge as this window often falls through the gap between studies on SFPs and those focusing on longer-term effects. METHODS: A protocol was registered on PROSPERO (PROSPERO 2017:CRD42017065650). Embase, Global Health and MEDLINE In-Process and Non-Indexed Citations were systematically searched with terms related to SAM, nutritional intervention and follow-up between June and August 2017. Studies were selected if they included children who experienced an episode of SAM, received a therapeutic feeding intervention, were discharged as cured and presented any outcome from follow-up between 6-24 months later. RESULTS: 3,691 articles were retrieved from the search, 55 full-texts were screened and seven met the inclusion criteria. Loss-to-follow-up, mortality, relapse, morbidity and anthropometry were outcomes reported. Between 0.0% and 45.1% of cohorts were lost-to-follow-up. Of those discharged as nutritionally cured, mortality ranged from 0.06% to 10.4% at an average of 12 months post-discharge. Relapse was inconsistently defined, measured, and reported, ranging from 0% to 6.3%. Two studies reported improved weight-for-height z-scores, whilst three studies that reported height-for-age z-scores found either limited or no improvement. CONCLUSIONS: Overall, there is a scarcity of studies that follow-up children 6-24 months post-discharge from SAM treatment. Limited data that exists suggest that children may exhibit sustained vulnerability even after achieving nutritional cure, including heightened mortality and morbidity risk and persistent stunting. Prospective cohort studies assessing a wider range of outcomes in children post-SAM treatment are a priority, as are intervention studies exploring how to improve post-SAM outcomes and identify high-risk children.


Assuntos
Transtornos da Nutrição Infantil/epidemiologia , Transtornos da Nutrição do Lactente/epidemiologia , Alta do Paciente , Desnutrição Aguda Grave/epidemiologia , Transtornos da Nutrição Infantil/mortalidade , Transtornos da Nutrição Infantil/terapia , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Transtornos da Nutrição do Lactente/mortalidade , Transtornos da Nutrição do Lactente/terapia , Masculino , Morbidade , Recidiva , Desnutrição Aguda Grave/mortalidade , Desnutrição Aguda Grave/terapia
17.
Int Health ; 10(6): 405-411, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29986102

RESUMO

Background: Mortality of children with severe acute malnutrition (SAM) is a devastating problem in Ethiopia. This study estimated the pooled case fatality ratio of SAM among children <5 y of age and its association with comorbidity. Methods: An electronic search was carried out using the database of MEDLINE/PubMed through the HINARI Programme, Google Scholar and Google for grey literature. A random effects model was used to estimate the pooled case fatality ratio of SAM and the hazard ratio (HR) of human immunodeficiency virus (HIV)/tuberculosis (TB) comorbidity using Stata/SE version 14. Results: A total of 13 studies were included in the meta-analysis. The overall case fatality ratio of SAM among children <5 y of age in Ethiopia was 11.3% (95% confidence interval [CI] 8.8-13.7) with the I2 heterogeneity test (I2=89.5%). Furthermore, the HR of SAM children was 3.4 (95% CI 1.91-6.06) in HIV and 2.08 (95% CI 1.2-3.61) in TB comorbidity as compared with their counterparts without comorbidity. Conclusions: In the aggregate, the pooled case fatality ratio was unacceptably high in Ethiopia. The case fatality ratio of SAM children is higher in HIV and TB comorbidity. Therefore, escalation of the existing nutritional strategies and early case detection of comorbidity are strongly recommended to mitigate the case fatality ratio of SAM.


Assuntos
Infecções por HIV/epidemiologia , Pacientes Internados/estatística & dados numéricos , Desnutrição Aguda Grave/epidemiologia , Tuberculose/epidemiologia , Pré-Escolar , Comorbidade , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Masculino
18.
Nutrients ; 10(6)2018 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-29921769

RESUMO

Malnutrition remains a serious health problem in Cambodia with over 10% of children less than five years of age suffering from acute malnutrition. In addition to the presence of nutritional edema, two indicators are recommended by the World Health Organization for the diagnosis of acute malnutrition: weight-for-height Z-scores (WHZ; with acute malnutrition defined as WHZ < −2 Z-score) and mid-upper arm circumference (MUAC, with acute malnutrition defined as MUAC < 12.5 cm). Earlier, we showed that WHZ and MUAC identified different subgroups of children with acute malnutrition. To explore factors associated with both indicators of acute malnutrition, we analyzed baseline data from a longitudinal study in three provinces in Cambodia: Phnom Penh (capital, urban environment), Kratie (rural province), and Ratanakiri (hilly, rural province). Data was available for 4381 children below 30 months of age. Malnutrition rates were higher in the two rural provinces than in the capital. Although both MUAC and WHZ showed gender bias, with MUAC identifying more girls, and WHZ identifying more boys with acute malnutrition, the gender effect was strongest for MUAC. The gender bias of MUAC diminished with older age, but remained significant up to 30 months of age. Only using both MUAC and WHZ as indicators resulted in gender neutral identification of acute malnutrition. WHZ alone always identified more children with acute malnutrition than MUAC alone. In Phnom Penh, MUAC alone identified only 11% with acute malnutrition in addition to WHZ. To conclude, both MUAC and WHZ showed gender bias in this cohort of Cambodian children. In Cambodia, implementation of a MUAC-only or a WHZ-only program for the identification of acute malnutrition would be unethical as it will lead to many children remaining undiagnosed.


Assuntos
Braço/anatomia & histologia , Estatura , Peso Corporal , Transtornos da Nutrição Infantil/diagnóstico , Desnutrição Aguda Grave/diagnóstico , Camboja , Criança , Transtornos da Nutrição Infantil/epidemiologia , Feminino , Humanos , Lactente , Masculino , Avaliação Nutricional , Desnutrição Aguda Grave/epidemiologia , Fatores Sexuais
19.
Public Health Nutr ; 21(12): 2193-2199, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29615143

RESUMO

OBJECTIVE: Millions of children suffer from severe acute malnutrition (SAM) in low- and middle- income countries. Much is known about the effectiveness of community treatment programmes (CMAM) but little is known about post-discharge outcomes after successful treatment. The present study aimed to evaluate post-discharge outcomes of children cured of SAM. DESIGN: Prospective, observational cohort study. Children with SAM who were discharged as cured were followed monthly for 6 months or until they experienced relapse to SAM. 'Cure' was defined as a child achieving a mid-upper arm circumference (MUAC) of ≥115 mm with ≥15 % weight gain after loss of oedema. Relapse was defined as a child with MUAC<115 mm and/or oedema at any monthly visit. SETTING: Save the Children CMAM programme in Swabi, Pakistan, from January 2012 to December 2014. SUBJECTS: Children aged 6-59 months (n 117) discharged as cured from the CMAM programme were eligible for the study and followed for 6 months. RESULTS: One hundred children (92·6 %) remained free of SAM, eight (7·4 %) relapsed to SAM, nine (8·3 %) were lost to follow-up and none died. Most relapses occurred within 3 months of discharge (mean time to relapse 73·4 (sd 36·2) d). At enrolment, 90 % had moderate acute malnutrition (MAM) and 10 % were not malnourished. By the end of 6 months, 35 % persisted with MAM and the remaining were not malnourished. CONCLUSIONS: In rural Pakistan, fewer than 10 % of children cured of SAM relapsed. The first 3 months is the most vulnerable time.


Assuntos
Desnutrição Aguda Grave/epidemiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Paquistão/epidemiologia , Estudos Prospectivos , Recidiva , Desnutrição Aguda Grave/terapia , Resultado do Tratamento
20.
Indian Pediatr ; 55(2): 131-133, 2018 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-29503269

RESUMO

OBJECTIVE: This cross sectional study was done to assess the developmental status in children (6-30 mo old) with severe acute malutrition (SAM). METHODS: Study subjects were enrolled from children in SAM therapeutic unit, and controls were selected from well-baby clinic of the institute. Neurodevelopment of both groups was assessed using the Developmental assessment scale of Indian infants (DASII). Developmental quotient (DQ) ≤70 was considered delayed. RESULTS: Mean (SE) motor DQ 59.04 (0.74) and mental DQ 62.1 (0.57) was lower in SAM as compared to controls (both P<0.0001). Clusters of early age were normal but clusters with items of later infancy were delayed. CONCLUSION: Children with SAM show significant delay in development, and motor DQ is affected more than mental DQ.


Assuntos
Deficiências do Desenvolvimento , Desnutrição Aguda Grave , Pré-Escolar , Comorbidade , Estudos Transversais , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/fisiopatologia , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Desnutrição Aguda Grave/complicações , Desnutrição Aguda Grave/epidemiologia , Desnutrição Aguda Grave/fisiopatologia
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