Pediatr Gastroenterol Hepatol Nutr.  2019 May;22(3):242-248. 10.5223/pghn.2019.22.3.242.

Outcome of Children with Severe Acute Malnutrition and Diarrhea: a Cohort Study

• Bhatnagar
• Kumar R
• Dua R
• Basu S
• Kumar P

• KMID: 2444850
• DOI: http://doi.org/10.5223/pghn.2019.22.3.242

Abstract

PURPOSE
Severe acute malnutrition (SAM) is an important public health problem which contributes to significant number of under five deaths. Protocol based management significantly decreases risk of deaths in children with medical complications.
METHODS
Outcome of children aged 2 months-5 years admitted and fulfilling definition of SAM having diarrhea (group A) was compared to children with SAM having medical complications other than diarrhea (group B). Both groups were managed according to standard recommended protocols and monitored and followed up for 12 weeks after discharge.
RESULTS
The average weight gain, defaulter rate, primary failure, secondary relapse rate and readmission rate were similar in both groups. Length of stay in group A was three days longer (p-value=0.039). Discharge rate was comparable with overall 68% of children successfully discharged and 50% of children reaching weight/height >−2 standard deviation at follow-up of 12 weeks.
CONCLUSION
The current management protocol is equally effective for managing children with SAM having diarrhea. Good adherence to management protocol of dehydration and timely modification of therapeutic feeds in children with persistent diarrhea results in satisfactory weight gain.

Keyword

Malnutrition; Cachexia; Dehydration

MeSH Terms

Cachexia
Child*
Cohort Studies*
Dehydration
Diarrhea*
Follow-Up Studies
Humans
Length of Stay
Malnutrition
Public Health
Recurrence
Severe Acute Malnutrition*
Weight Gain

Figure

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  Fig. 1 Flow chart of inclusion of patients in the study. SAM: severe acute malnutrition, TORCH: toxoplasmosis, other (syphilis), rubella, cytomegalovirus, herpes simplex, GDD: Global developmental delay, GOI: Government of India.

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  Fig. 2 Clinical profile of patients included in study.

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  Fig. 3 Type of starter diet required during stabilization phase in group A: with diarrhea.

Reference

1. Ministry of Health and Social Welfare, Government of India. Operational guidelines on facility based management of children with severe acute malnutrition. New Delhi: Ministry of Health and Social Welfare, Government of India;2013.

2. International Institute for Population Sciences (IN). Indian fact sheet. National Family Health Survey (NFHS-4), 2015–16. Mumbai: International Institute for Population Sciences;2017. cited 2017 Mar 21. Available from: http://rchiips.org/nfhs/pdf/NFHS4/India.pdf.

3. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003; 361:2226–2234.

4. World Health Organization. Updates on management of severe acute malnutrition in infants and children: guideline. Geneva: World Health Organization;2013.

5. The Sphere Project. Humanitarian charter and minimum standards in humanitarian response: the Sphere handbook. 3rd ed. Northampton: Belmont Press Ltd.;2011.

6. Singh P, Kumar P, Rohatgi S, Basu S, Aneja S. Experience and outcome of children with severe acute malnutrition using locally prepared therapeutic diet. Indian J Pediatr. 2016; 83:3–8.

7. Mamidi RS, Kulkarni B, Radhakrishna KV, Shatrugna V. Hospital based nutrition rehabilitation of severely undernourished children using energy dense local foods. Indian Pediatr. 2010; 47:687–693.

8. Singh K, Badgaiyan N, Ranjan A, Dixit HO, Kaushik A, Kushwaha KP, et al. Management of children with severe acute malnutrition: experience of Nutrition Rehabilitation Centers in Uttar Pradesh, India. Indian Pediatr. 2014; 51:21–25.

9. Ahmed AU, Ahmed TU, Uddin MS, Chowdhury MH, Rahman MH, Hossain MI. Outcome of standardized case management of under-5 children with severe acute malnutrition in three hospitals of Dhaka City in Bangladesh. Bangladesh J Child Health. 2013; 37:5–13.

10. Irena AH, Mwambazi M, Mulenga V. Diarrhea is a major killer of children with severe acute malnutrition admitted to inpatient set-up in Lusaka, Zambia. Nutr J. 2011; 10:110.

11. Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E, Ignas J, et al. Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome. PLoS One. 2012; 7:e38321.

12. Hossain MI, Dodd NS, Ahmed T, Miah GM, Jamil KM, Nahar B, et al. Experience in managing severe malnutrition in a government tertiary treatment facility in Bangladesh. J Health Popul Nutr. 2009; 27:72–79.