Malnutrition among under-five children in Democratic Republic of the Congo: A plague of the health system

Locally Prepared Therapeutic Food for Treatment of Severely Underweight Children in Rural India: An Interventional Prospective Controlled Community-Based Study with Long Follow-Up:-'SAMMAN' Trial

BACKGROUND

Severely underweight (SUW) children contribute significantly to under-five mortality and morbidity. There are WHO guidelines for the management of severe acute malnutrition but no specific guidelines for SUW management.

OBJECTIVE

The objectives were to achieve a recovery rate of 30% at 90 days of treatment for severe underweight (SUW) children aged 6-60 months, compare changes in weight-for-age Z (WAZ) scores, growth patterns, and case fatality rates between intervention and reference arms (RA), and reduce the prevalence of SUW in the intervention arm (IA). The target of a 30% recovery rate was achievable and significant based on our past research conducted in similar settings.

METHODS

Design: A prospective controlled community-based, longitudinal, two arms (IA, RA), intervention study with long follow-up was conducted between January 2011 and October 2023.

SETTING

Primary care for participants from 14 villages in rural Melghat, India.

PARTICIPANTS

The study participants included SUW children aged 6-60 months and age-matched (±2 weeks) normal controls. The SAMMAN (Acronym for SAM-Management) intervention was comprised of local therapeutic food-micronutrient (LTF-MN) therapy for 90 days, intensive behavior change communication, infection treatment, and quarterly anthropometric records. SUW recovery, growth patterns, case fatality rate, prevalence at 90 days of therapy and at 60 months of age, and survival until early adolescence were assessed. ANCOVA analysis was used to obtain changes in Z-scores.

RESULTS

In the IA, the recovery rate was 36.8% at 90 days and 78.2% at 60 months of age. The mean difference in change in WAZ scores between the intervention arm and the reference arm was statistically significant (p < 0.0001). Growth patterns were similar between the two arms up to early adolescence. The SUW case fatality rate was significantly lower in the IA (0.9%) as compared to 4.62% in the RA at 60 months (p = 0.022). The reduction in SUW prevalence in intervention villages was higher than in the control villages (p < 0.001). The cost of management per SUW child was 3888 INR (47 USD) less than RUTF.

CONCLUSION

The SAMMAN intervention is safe and cost-effective for significantly improving WAZ scores, sustainable, and hence replicable in resource-limited areas.

Epidemiology and clinical characteristics of acute malnutrition among under-5 children attending a rural hospital in the Democratic Republic of Congo: a cross-sectional study

Background

Malnutrition, a public health problem in a low-income country such as the Democratic Republic of Congo (DR Congo), is a major killer among children under 5 who are most at risk of acute malnutrition. This study aims to describe the epidemiological and clinical characteristics of acute malnutrition in children under 5 years old.

Methods

The authors conducted a retrospective and descriptive cross-sectional study on children under 5 with acute malnutrition from April 2022 to April 2023. A total of 287 malnourished children were consulted, hospitalized in a rural hospital, and registered for participation in this study.

Results

Two hundred eighty-seven (25%) children were victims of acute malnutrition. The age group between 13 and 24 months is the most affected by acute malnutrition with 30%. The male-to-female(M/F) sex ratio was 1.17. Kwashiorkor is the most common form of acute malnutrition with 171 (59.6%) cases. Abdominal bloating, weight loss as well as diarrhea and vomiting were the more frequent clinical signs. Shock is the most complication of acute malnutrition. Therapeutic milk (Food 75 and Food 100) was the most effective in management. Twenty-nine (10.1%) other children died from acute malnutrition and 258 (89.9%) children progressed to full recovery.

Conclusion

Acute malnutrition in children remains a public health problem worldwide and particularly in low-income countries such as DR Congo. It is associated with multiple physiological vulnerabilities and has many short- and long-term complications in children who have suffered from it.

Protecting the health of the most vulnerable in the overlooked Democratic Republic of Congo crisis

Background and Aim

The Democratic Republic of Congo (DRC) is facing a humanitarian crisis due to prolonged conflicts, human rights abuses, and gender-based violence. This perspective article aims to discuss the challenges faced by vulnerable populations in the DRC, including the impact of interventions and broader humanitarian strategies.

Methods

A search on Google Scholar was carried out to identify relevant journal articles. Additionally, relevant reports and data on the DR Congo crisis were sourced from the websites of international and humanitarian organizations including the United Nations High Commissioner for Refugees, World Health Organization, United Nations Office for the Coordination of Humanitarian Affairs, and the Norwegian Refugee Council.

Results

The crisis has led to 6.1 million displaced individuals and 1 million seeking asylum in neighboring countries. Insecurity and displacement further exacerbate the crisis, exacerbating health issues and malnutrition, particularly among women and children. The deterioration of water, sanitation, and hygiene infrastructure in the region facilitates the spread of infectious diseases. The UN has appealed for $8.3 billion in humanitarian assistance in West and Central Africa, including DRC. However, more attention and efforts are needed to curb the menace of the conflict.

Conclusions

Addressing root causes like political volatility, economic disparity, and social unrest is crucial for sustained health protection. Tailoring humanitarian assistance to the context of conflict is essential, prioritizing mental health support and psychosocial services. Improving access to healthcare is crucial. Addressing food insecurity is essential, involving targeted food assistance programs, improving agricultural practices, and establishing income-generating activities. Sustaining international assistance and investments are needed to address the health needs of the most vulnerable populations.

Single parenthood and depression: A thorough review of current understanding

BACKGROUND

Single parenthood is becoming increasingly common in today's society for various reasons such as divorce, the death of a spouse, or the choice of parenthood. Regrettably, there seems to be no significant concern among world leaders regarding depression arising from single parenting.

AIM

This article aimed to explore the prevalence of depression in single parents, the factors contributing to it, and its effects on their physical and emotional well-being. Additionally, it aims to investigate the long-lasting effects of depression in single parents, effective therapeutic approaches to tackle these issues and offer proactive suggestions for relevant global stakeholders.

METHODOLOGY

A selection of studies was identified through electronic databases such as PubMed, Embase, and PsycINFO databases. The search strategy encompassed terms related to single parenthood, depression, mental health, prevalence, risk factors, and treatment modalities. Included studies comprised of peer-reviewed research articles, systematic reviews, meta-analyses, and observational studies published in English.

RESULT

Today, there is a growing prevalence of single parenthood due to a range of factors, including divorce, the loss of a partner, and intentional decisions regarding single parenthood. However, this transition comes with challenges, including the risk of developing depression. Depression is a serious mental health condition affecting many individuals worldwide. Raising a child alone increases the likelihood of developing depression for the parent due to the increased burden and responsibilities. Such parents tend to have low self-esteem, suicide/suicide attempts, and so forth and children born by those parents are vulnerable to depression, physical abuse, infections, etc.

CONCLUSION

Future research should focus on identifying effective interventions for treating depression among single parents and improving the availability of mental health facilities for this vulnerable population, especially in places with a high prevalence of depression. Mental health physicians in collaboration with obstetricians and gynecologists across the globe should offer counseling and mediation services during pre-conception care visits for both single and partnered parents.

Nutritional Status Link with Polioseronegativity Among Children from Poliomyelitis Transmission High-Risk Area of the Democratic Republic of the Congo (DRC)

Background

Malnutrition is identified as a risk-factor for insufficient polioseroconversion in the context of a vaccine-derived polio virus (VDPV) outbreak prone region. To assess the prevalence of malnutrition and its link to poliovirus insufficient immunity, a cross-sectional household survey was conducted in the regions of Haut- Lomami and Tanganyika, DRC.

Methods

In March 2018, we included 968 healthy children aged 6 to 59 months from eight out of 27 districts. Selection of study locations within these districts was done using a stratified random sampling method, where villages were chosen based on habitat characteristics identified from satellite images. Consent was obtained verbally in the preferred language of the participant (French or Swahili) by interviewers who received specific training for this task. Furthermore, participants contributed a dried blood spot sample, collected via finger prick. To assess malnutrition, we measured height and weight, applying WHO criteria to determine rates of underweight, wasting, and stunting. The assessment of immunity to poliovirus types 1, 2, and 3 through the detection of neutralizing antibodies was carried out at the CDC in Atlanta, USA.

Results

Of the study population, we found 24.7% underweight, 54.8% stunted, and 15.4% wasted. With IC95%, underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.96; [1.52-2.54]) were significantly associated with seronegativity to polioserotype 1. Underweight (OR=1.64; [1.20-2.24]) and the non-administration of vitamin A (OR=1.55; [1.20-2.01]) were significantly associated with seronegativity to polioserotype 2. Underweight (OR=1.50; [1.11-2.03]), and the non-administration of vitamin A (OR=1.80. [1.38-2.35]) were significantly associated with seronegativity to polioserotype 3. Underweight (OR=1.68; IC95% [1.10-2.57]) and the non-administration of vitamin A (OR=1.82; IC95% [1.30-2.55]) were significantly associated with seronegativity to all polioserotypes.

Conclusion

This study reveals a significant association between underweight and polioseronegativity in children. In order to reduce vaccine failures in high-risk areas, an integrated approach by vaccination and nutrition programs should be adopted.

Prediction Model with Validation for Polioseronegativity in Malnourished Children from Poliomyelitis Transmission High-Risk Area of the Democratic Republic of the Congo (DRC)

Background

Malnutrition is identified as a risk factor for insufficient polio seroconversion in the context of a vaccine-derived poliovirus (VDPV) outbreak-prone region. In the Democratic Republic of Congo (DRC), underweight decreased from 31% (in 2001) to 26% (in 2018). Since 2004, VDPV serotype 2 outbreaks (cVDPV2) have been documented and were geographically limited around the Haut-Lomami and Tanganyika Provinces.

Methods

To develop and validate a predictive model for poliomyelitis vaccine response in malnourished infants, a cross-sectional household study was carried out in the Haut-Lomami and Tanganyika provinces. Healthy children aged 6 to 59 months (n=968) were enrolled from eight health zones (HZ) out of 27, in March 2018. We performed a bivariate and multivariate logistics analysis. Final models were selected using a stepwise Wald method, and variables were selected based on the criterion p < 0.05. The association between nutritional variables, explaining polio seronegativity for the three serotypes, was assessed using the receiver operating characteristic curve (ROC curve).

Results

Factors significantly associated with seronegativity to the three polio serotypes were underweight, non-administration of vitamin A, and the age group of 12 to 59 months. The sensitivity was 10.5%, and its specificity was 96.4% while the positive predictive values (PPV) and negative (PNV) were 62.7% and 65.3%, respectively. We found a convergence of the curves of the initial sample and two split samples. Based on the comparison of the overlapping confidence intervals of the ROC curve, we concluded that our prediction model is valid.

Conclusion

This study proposed the first tool which variables are easy to collect by any health worker in charge of vaccination or in charge of nutrition. It will bring on top, the collaboration between the Immunization and the Nutritional programs in DRC integration policy, and its replicability in other low- and middle-income countries with endemic poliovirus.