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Mao C, Shen Z, Long D, Liu M, Xu X, Gao X, Lin Y, Wang X. Epidemiological study of pediatric nutritional deficiencies: an analysis from the global burden of disease study 2019. Nutr J 2024; 23:44. [PMID: 38637763 PMCID: PMC11027389 DOI: 10.1186/s12937-024-00945-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/01/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Nutritional deficiencies (ND) continue to threaten the lives of millions of people around the world, with children being the worst hit. Nevertheless, no systematic study of the epidemiological features of child ND has been conducted so far. Therefore, we aimed to comprehensively assess the burden of pediatric ND. METHODS We analyzed data on pediatric ND between 1990 and 2019 from the Global Burden of Disease study (GBD) 2019 at the global, regional, and national levels. In addition, joinpoint regression models were used to assess temporal trends. RESULTS In 2019, the number of prevalent cases of childhood malnutrition increased to 435,071,628 globally. The global age-standardized incidence, prevalence, and DALY rates showed an increasing trend between 1990 and 2019. Meanwhile, the burden of child malnutrition was negatively correlated with sociodemographic index (SDI). Asia and Africa still carried the heaviest burden. The burden and trends of child malnutrition varied considerably across countries and regions. At the age level, we found that malnutrition was significantly more prevalent among children < 5 years of age. CONCLUSION Pediatric ND remains a major public health challenge, especially in areas with low SDI. Therefore, primary healthcare services in developing countries should be improved, and effective measures, such as enhanced pre-school education, strengthened nutritional support, and early and aggressive treatment, need to be developed.
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Affiliation(s)
- Chenhan Mao
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhuyang Shen
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Dan Long
- The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Min Liu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Xiaojin Xu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Xin Gao
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Yan Lin
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China.
| | - Xindong Wang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu, China.
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Rahman M, Naila NN, Islam MM, Mahfuz M, Alam A, Karmakar G, Ferdous AT, Siddique MAB, Mustaphi P, Ahmed T. Community perception and utilization of services for the severe wasted children aged 6-59 months in the Forcibly Displaced Myanmar Nationals and their nearest host communities in Bangladesh: a qualitative exploration. Front Nutr 2024; 11:1235436. [PMID: 38419844 PMCID: PMC10899428 DOI: 10.3389/fnut.2024.1235436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction There is a paucity of data on community perception and utilization of services for wasted children in Forcibly Displaced Myanmar Nationals (FDMN) and their nearest host communities. Methods We conducted a qualitative study to explore community perceptions and understand the utilization of services for severely wasted children among the FDMN and their nearest host communities in Teknaf, Cox's Bazar. We carried out 13 focus group discussions and 17 in-depth interviews with the caregivers of the children of 6-59 months, and 8 key informant interviews. Results Caregivers' perceived causes of severe wasting of their children included caregivers' inattention, unhygienic practices, and inappropriate feeding practices. However, the context and settings of the FDMN camps shaped perceptions of the FDMN communities. Caregivers in both the FDMN and host communities sought care from healthcare providers for their children with severe acute malnutrition (SAM) when they were noticed and encouraged by their neighbors or community outreach workers, and when their SAM children suffered from diseases such as diarrhea and fever. Some caregivers perceived ready-to-use therapeutic food (RUTF) as a food to be shared and so they fed it to their non-SAM children. Discussion Caregivers of the children having SAM with complications, in the FDMN and host communities, were reluctant to stay in stabilization centers or complex respectively, due to their households' chores and husbands' unwillingness to grant them to stay. The findings of this study are expected to be used to design interventions using locally produced RUTF for the management of SAM children in the FDMN, as well as to inform the health sector working on SAM child management in the host communities.
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Affiliation(s)
- Mahfuzur Rahman
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | | | | | | | - Aklima Alam
- Nutrition Research Division, icddr,b, Dhaka, Bangladesh
| | | | | | | | | | - Tahmeed Ahmed
- Nutrition Research Division, icddr,b, Dhaka, Bangladesh
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Chakraborty R, Joe W, ShankarMishra U, Rajpal S. Integrated child development service (ICDS) coverage among severe acute malnourished (SAM) children in India: A multilevel analysis based on national family health survey-5. PLoS One 2024; 19:e0294706. [PMID: 38330040 PMCID: PMC10852256 DOI: 10.1371/journal.pone.0294706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/25/2023] [Indexed: 02/10/2024] Open
Abstract
Severe acute malnutrition (SAM) can be fatal for children, and potentially limit their cognitive and physical growth. The last three National Family Health Survey (NFHS) in India shows an increase in the prevalence of SAM among under-five children. Given the specific mandates under ICDS (Integrated Child Development Service) for SAM children, it is important to validate the coverage efficiency of ICDS on SAM children. This paper examines a possible association between the coverage efficiency of ICDS on SAM children. The study further aims to identify the determinants of ICDS service utilization among SAM children. We used data from the fifth round of the National Family Health Survey. Descriptive statistics was used to estimate the SAM coverage under ICDS. Multilevel Logistic Regression was used to identify the determinants of ICDS service utilization among SAM children. The burden of SAM is higher among older children (3+ age). Coverage of ICDS was more among younger children and the poorest households in the rural areas. Results from multilevel logistic regression showed that age had a significant relationship with the outcome variable. SAM children living in the rural areas had a significantly higher odds of being covered under ICDS service (OR 1.57; CI: (1.35, 1.82)) than their urban counterparts. Pregnant and lactating mothers who received ICDS services were significant determinants of SAM coverage under ICDS. There is no evidence that ICDS is more efficient in identifying and covering SAM children than non-SAM children. Despite special provisioning in place for SAM children, coverage of different ICDS services was similar to that of non-SAM children, and were in fact lower than non-SAM children for some categories. The study suggests that improving coverage of ICDS services among pregnant and lactating mothers would increase the coverage of ICDS services among SAM children.
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Affiliation(s)
- Ritankar Chakraborty
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - William Joe
- Population Research Centre, Institute of Economic Growth, Delhi University Enclave (North Campus), Delhi, India
| | - Udaya ShankarMishra
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Sunil Rajpal
- Department of Economics, FLAME University, Pune, Maharashtra, India
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Ahmed N, Umar F, Saleem F, Iqbal Q, Haider S, Bashaar M. Treatment Outcomes of Severe Acute Malnutrition and Its Determinants Among Paediatric Patients in Quetta City, Pakistan. J Multidiscip Healthc 2023; 16:2809-2821. [PMID: 37753341 PMCID: PMC10518357 DOI: 10.2147/jmdh.s428873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose Severe acute malnutrition (SAM) is the most prevalent reason for admission to a paediatric unit, and it is a leading cause of mortality in many countries, including Pakistan. This study aimed to assess treatment outcomes and associated factors among children aged 6-59 months with severe acute malnutrition. Patients and Methods A retrospective cohort study was conducted at the Outpatient Therapeutic Feeding Program Centre established at the Sheikh Khalifa bin Zayed Al Nahyan Medical Complex Quetta. Out of 225 patients' records, data from 182 (80.8%) records were analysed based on the inclusion criteria. The SAM logbook was used as a source of data. Predictors of treatment outcomes were identified by applying a regression model with p<0.05 taken as significant. Results One hundred and twenty (65.9%) of the children were diagnosed with SAM, while the remaining 34.1% had Moderate Acute Malnutrition. Ninety-five (52.2%) children were included in the marasmus, while 47.8% were included in the Kwashiorkor cohort. The recovery rate was 68.6%; 22.5% were non-responsive, 11% defaulted on the program, and 3.5% died during management. The multivariate logistic regression identified the presence of diarrhea and the use of amoxicillin as significant prognosticators of treatment outcomes. Consequently, the odds of recovery on SAM among children with diarrhea [AOR = 0.60, 95% CI: (0.35-0.75)] were lower than those without diarrhea. Likewise, children on PO amoxicillin had higher chances of recovery [AOR = 2.45, 95% CI: (2.21-4.68)]. Conclusion This study found that the recovery rate among children treated for SAM was poor based on the established Sphere Standard recommendation. In addition to community-based educational campaigns, capacity enhancement of OTP and frequent monitoring of services as well as program evaluation based on the management protocol is recommended to reduce the frequency of SAM among children.
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Affiliation(s)
- Nazir Ahmed
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Baluchistan, Pakistan
| | - Fehmida Umar
- Gynecology & Obstetrics Unit 1, Sandeman Provincial Hospital Quetta, Quetta, Baluchistan, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Baluchistan, Pakistan
| | - Qaiser Iqbal
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Baluchistan, Pakistan
| | - Sajjad Haider
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Baluchistan, Pakistan
| | - Mohammad Bashaar
- Research Services Division, SMART Afghan International Trainings & Consultancy, Kabul, Afghanistan
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Keshani P, Shahraki HR. Modeling trend changes in percent of under five-year-old children with malnutrition amongst 39 Asian countries from 1987 to 2016 via growth mixture model. BMC Nutr 2022; 8:38. [PMID: 35484594 PMCID: PMC9052463 DOI: 10.1186/s40795-022-00530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/14/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose Malnutrition is an important public health issue and the main cause of child morbidity and mortality, especially in developing countries. The present study aimed to model trend changes in percentage of the malnourished children under 5 among 39 Asian countries during 1987 to 2016. Methods Information about percentage of the malnourished under 5 years children based on under-weight (weight for age) malnutrition for 39 Asian countries were extracted from Gapminder web site during 1987 to 2016. To cluster Asian countries based on trend changes, Growth Mixture Model (GMM) was implemented. All the statistical analyses were performed in Mplus 7.4 software and P < 0.10 in likelihood ratio test (LRT) was considered as statistically significant. Results Based on P-value of LRT, the model with 3 clusters was selected. Although, cluster 3 with 9 countries had higher intercept in 1987 and the worst situation in malnutrition, they gained a sharp decrease (− 0.93) in percentage of malnourished children under five annually. The slope of − 0.64 for cluster 1 countries indicate a moderate decrease annually in percent of children with malnutrition. The other 20 countries with slope of − 0.29 in their linear trend belonged to cluster 2 which shows slow decrease in the percentage of children with malnutrition. Conclusion The investments in public health and education programs, as well as political commitment and government proper response in line with needs and demands are crucial to promote food security, nourishing diets and improving child nutrition. Certainly, most of them are still a long way from eradicating malnutrition.
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Affiliation(s)
- Parisa Keshani
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Raeisi Shahraki
- Department of Epidemiology and Biostatistics, Faculty of Health, Shahrekord University of Medical Sciences, Rahmatieh Educational Complex, Shahrekord, Iran.
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Karim MR, Al Mamun ASM, Rana MM, Mahumud RA, Shoma NN, Dutt D, Bharati P, Hossain MG. Acute malnutrition and its determinants of preschool children in Bangladesh: gender differentiation. BMC Pediatr 2021; 21:573. [PMID: 34903193 PMCID: PMC8667456 DOI: 10.1186/s12887-021-03033-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/22/2021] [Indexed: 01/26/2023] Open
Abstract
Background Children acute malnutrition (AM) is a global public health concern, especially in low and middle income countries. AM is associated with multiple physiological vulnerabilities, including immune dysfunction, enteric barrier disruption, gut microbiome dysbiosis, and essential nutrient deficits. This study aimed to determine the prevalence of AM and its associated factors among preschool children in Rajshahi district, Bangladesh. Methods This cross-sectional study was conducted from October to December, 2016. Children acute malnutrition was assessed using mid-upper arm circumference. Multiple binary logistic regression analyses were employed to determine the associated factors after adjusting the effect of independent factors of children AM. Result The prevalence of AM amongst preschool children was 8.7%, among them 2.2 and 6.5% were severe acute malnutrition and moderate acute malnutrition, respectively. Z-proportional test demonstrated that the difference in AM between girls (11.6) and boys (5.9%) was significant (p < 0.05). Children AM was associated with being: (i) children aged 6–23 months (aOR = 2.29, 95% CI: 1.20–4.37; p < 0.05), (ii) early childbearing mothers’ (age < 20 years) children (aOR = 3.06, 95% CI: 1.08–8.66; p < 0.05), (iii) children living in poor family (aOR = 3.08, 95% CI: 1.11–8.12; p < 0.05), (iv) children living in unhygienic latrine households (aOR = 2.81, 95% CI: 1.52–5.09; p < 0.01), (v) Hindu or other religion children (aOR = 0.42, 95% CI: 0.19–0.92; p < 0.05). Conclusion The prevalence of AM was high among these preschool children. Some modifiable factors were associated with AM of preschool children. Interventions addressing social mobilization and food security could be an effective way to prevent acute malnutrition among children in Bangladesh.
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Affiliation(s)
- Md Reazul Karim
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | | | - Md Masud Rana
- DASCOH Foundation, Lutheren Mission Complex, Dingadoba, Rajpara, Rajshahi, 6201, Bangladesh
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Nurun Naher Shoma
- DASCOH Foundation, Lutheren Mission Complex, Dingadoba, Rajpara, Rajshahi, 6201, Bangladesh
| | - Dhiman Dutt
- Swiss Red Cross, House# 35, Road # 117, Gulshan-1, Dhaka, 1212, Bangladesh
| | - Premananda Bharati
- Biological Anthropology, Indian Statistical Institute, 203 BT Road, Kolkata, West Bengal, 700 108, India
| | - Md Golam Hossain
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
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Saleem J, Zakar R, Bukhari GMJ, Naz M, Mushtaq F, Fischer F. Effectiveness of Ready-to-Use Therapeutic Food in Improving the Developmental Potential and Weight of Children Aged under Five with Severe Acute Malnourishment in Pakistan: A Pretest-Posttest Study. Int J Environ Res Public Health 2021; 18:ijerph18179060. [PMID: 34501649 PMCID: PMC8430796 DOI: 10.3390/ijerph18179060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022]
Abstract
The objective of this study was to assess whether the standard therapy of ready-to-use therapeutic food in the treatment of uncomplicated severe acute malnutrition (SAM) is effective in improving developmental potential and weight gain in children aged under five years. A multicenter pretest-posttest study was conducted among 91 children aged under five with uncomplicated SAM in Pakistan. Study participants completed their eight weeks’ therapy of ready-to-use therapeutic food according to the World Health Organization’s (WHO) standard guidelines. The study outcome was the proportion of children with improved developmental potential in all domains in comparison with the pretreatment status and children gaining >15% of their baseline weight; mean weight-for-height/length z-score after completing eight weeks’ therapy of ready-to-use therapeutic food. The Denver Development Screening Tool II was used for developmental screening. Significant changes (p < 0.05) were observed for developmental status milestones in terms of gross motor, fine motor, and personal/social milestones, as well as language and global development milestones. There was a strong positive correlation (r = 0.961) between initial weight and weight at the last visit (p < 0.001). Ready-to-use therapeutic food is effective in improving development potential as well as promoting weight gain in children aged under five with uncomplicated SAM if provided according to WHO guidelines.
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Affiliation(s)
- Javeria Saleem
- Department of Public Health, University of the Punjab, Lahore 54590, Pakistan; (J.S.); (R.Z.)
| | - Rubeena Zakar
- Department of Public Health, University of the Punjab, Lahore 54590, Pakistan; (J.S.); (R.Z.)
| | - Gul Mehar Javaid Bukhari
- Department of Community Medicine, Federal Medical and Dental College, Islamabad 44000, Pakistan;
| | - Mahwish Naz
- Department of Primary and Secondary Health, Government of Punjab, Lahore 54000, Pakistan;
| | - Faisal Mushtaq
- Department of Biostatistics, Institute of Public Health, Lahore 54000, Pakistan;
| | - Florian Fischer
- Institute of Public Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, 88250 Weingarten, Germany
- Correspondence:
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Shahid S, Mahesar M, Rahim A, Sadiq Y. Experience of using home-based fortified diet in rehabilitation of malnourished children at Indus Hospital, Karachi, Pakistan: an institution based retrospective chart review study. BMC Nutr 2021; 7:49. [PMID: 34384500 PMCID: PMC8361784 DOI: 10.1186/s40795-021-00455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 07/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background Globally, it is estimated that 50 million children under five are wasted. National nutrition survey-2018 has shown that 23.3 and 45.5% of children are wasted and stunted in Pakistan. Many studies have shown that hospital-based management of malnutrition is not practical due to high cost and iatrogenic infections and currently WHO recommends community-based management of malnutrition with provision of therapeutic food. There is limited evidence of community rehabilitation of malnourished children by using home fortified diet in Pakistan. This study explores use of energy dense, home fortified diet in achieving weight gain of malnourished children in Karachi. Methods A descriptive, retrospective chart review of pediatric patients (aged 6 month–5 years) seen in Indus Hospital between January 2017 to June 2018 was conducted. A pre-designed data abstraction form was used to record detailed information about demographic characteristics, feeding, anthropometric, micronutrient, and nutritional details at enrollment and on follow-up. Results A total of 361 patients were included in the final analysis. The median age (IQR) of children was 15 (14) months. Forty eight percent (n = 172) children had diarrhea and 54% (n = 195) children had respiratory tract infection. The median length of stay in the program was 28 days. The median (IQR) for average weight gain was 4.8 (0–10.3) g/Kg/day, 64.6% (n = 226) children defaulted, 29% (n = 102) were cured and 3% (n = 10) died. Conclusion This study showed adequate weight gain and recovery in malnourished children by using home fortified diet in real life situations without using therapeutic food or monetary support. Home fortified diets may serve as effective strategy in community-based rehabilitation of malnourished children.
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Affiliation(s)
- Saba Shahid
- Department of Pediatrics, The Indus Hospital, Karachi City, Pakistan.
| | - Marvi Mahesar
- Indus Hospital Research Center, The Indus Hospital, Karachi City, Pakistan
| | - Anum Rahim
- Indus Hospital Research Center, The Indus Hospital, Karachi City, Pakistan
| | - Yumna Sadiq
- Nutrition and Food Services Department, The Indus Hospital, Karachi City, Pakistan
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Hussain I, Habib A, Ariff S, Khan GN, Rizvi A, Channar S, Hussain A, Fazal S, Kumar D, Alvarez JL, Guerrero S, Grant A, Soofi SB. Effectiveness of management of severe acute malnutrition (SAM) through community health workers as compared to a traditional facility-based model: a cluster randomized controlled trial. Eur J Nutr 2021; 60:3853-60. [PMID: 33880645 DOI: 10.1007/s00394-021-02550-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We compared the impact of management of severe acute malnutrition (SAM) by lady health workers (LHWs) at a community level with the standard CMAM program provided at the health facility. METHODS A two-arm cluster randomised controlled trial was conducted in a rural district in sindh Pakistan. The primary outcome was recovery from SAM and secondary outcomes were relapse, defaulter and mortality rate. RESULTS A total of 829 children were recruited in the trial (430 in intervention and 399 in control groups). No significant difference was noted in recovery rate between the intervention and control groups (79.2% vs 85.6%, p = 0.276). Similarly, no significant differences were noted in relapse (p = 0.757), weight gain (p = 0.609), deaths (p = 0.775) and defaulter rate (p = 0.324) across the groups. Compliance of RUTF was significantly higher in the control group (93%) than in the intervention group (87%), p < 0.000. CONCLUSION Our results showed no impact of SAM treatment on performance indicators of CMAM (recovery, relapse, death and default) between the standard CMAM programme performed at the health facility by the government and NGO staff and the programme performed at health house level by the LHWs in Pakistan. We recommend further robust trials in other settings to confirm our results.
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Dahal K, Yadav DK, Baral D, Yadav BK. Determinants of severe acute malnutrition among under 5 children in Satar community of Jhapa, Nepal. PLoS One 2021; 16:e0245151. [PMID: 33534789 PMCID: PMC7857586 DOI: 10.1371/journal.pone.0245151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 12/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background Severe acute malnutrition (SAM) is the most extreme and visible form of undernutrition plagued by chronic poverty, household food insecurity, lack of education. One of the indigenous and marginalized community of Nepal, Satar/Santhal has often been neglected and is devoid of good education and are economically deprived. This predisposes under 5 children of Satar into malnutrition. The study aims to assess determinants of SAM among children under 5 years of age in Satar community of Jhapa district, Nepal. Material & methods A community based matched case control study was carried from September 2019 to February 2020 among under five children of Satar community residing in Jhapa district. Multistage random sampling technique was used to select 50 cases and 100 controls in the ratio of 1:2. Information was collected through personal interview with the parents and anthropometric measurement of the children was measured. Bivariate and multivariate conditional logistic regression analysis was used to explore the determinants of severe acute malnutrition. Results A total of 664 children between the age group of 6–59 months were screened for SAM. The prevalence of SAM was found 7.53%. Factors like, low economic status, birth interval less than 2 years, frequency of breast feeding <8 times/day and household food insecurity were found to be significant determinants of SAM. Multivariate logistic regression documented low economic status (AOR: 11.14, 95% CI 1.42 to 87.46); and frequency of breast feeding <8 times/day (AOR: 2.09, 95% CI 1.00 to 4.37) as determinants of SAM. Conclusion Low economic status and frequency of breast feeding less than 8times/day were major determinants of SAM among children under 5yrs of age. Ending malnutrition will require greater efforts and integrated approaches to eradicate extreme poverty. Multi-sector approaches have been conducting for SAM in Nepal but there are no specific approaches for marginalized community.
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Affiliation(s)
- Kajol Dahal
- School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
- * E-mail:
| | - Deepak Kumar Yadav
- Faculty of School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Dharanidhar Baral
- Faculty of School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Birendra Kumar Yadav
- Faculty of School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
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Annan RA, Aduku LNE, Kyei-Boateng S, Yuen HM, Pickup T, Pulman A, Monroy-Valle M, Ashworth A, Jackson AA, Choi S. Implementing effective eLearning for scaling up global capacity building: findings from the malnutrition elearning course evaluation in Ghana. Glob Health Action 2020; 13:1831794. [PMID: 33086945 PMCID: PMC7595220 DOI: 10.1080/16549716.2020.1831794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/29/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Global demand for capacity building has increased interest for eLearning. As eLearning resources become more common, effective implementation is required to scale up utilization in Low- and Middle-Income Countries (LMICs). OBJECTIVE This paper describes the process of implementing a malnutrition eLearning course, effectiveness of course delivery models devised, factors affecting course completion, and cost comparison between the models and face-to-face training at healthcare and academic institutions in Ghana. METHODS Four delivery models: Mobile Training Centre (MTC), Online Delivery (OD), Institutional Computer Workstation (ICW) and Mixed Delivery (MD) - a combination of OD and ICW - were determined. Participants were enabled to access the course using one of the four models where contextually appropriate. Pre and post-assessments and questionnaires were administered to compare participants' course completion status and knowledge gain between delivery models. The effect of access to computer and Internet at home and relevance of course to job and academic progression on course completion were further investigated. Comparison of delivery model costs against face-to-face training was also undertaken. RESULTS Of 7 academic and 9 healthcare institutions involving 915 people, 9 used MTC (34.8%), 3 OD (18.8%), 3 ICW (34.2%) and 1 MD (12.2%). Course completion was higher among institutions where the course was relevant to job or implemented as part of required curriculum activities. Knowledge gain was significant among most participants, but higher among those who found the course relevant to job or academic progression. The implementation costs per participant for training with MTC were £51.0, OD £2.2, ICW £1.2 and MD £1.1, compared with a face-to-face training estimate of £105.0 (1 GHS = 0.14 GBP). CONCLUSION The malnutrition eLearning course makes global capacity building in malnutrition management achievable. Adopting contextually appropriate delivery models and ensuring training is relevant to job/academic progression can enhance eLearning effectiveness in LMICs.
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Affiliation(s)
- Reginald Adjetey Annan
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), PMB University Post Office, Kumasi, Ghana
| | - Linda Nana Esi Aduku
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), PMB University Post Office, Kumasi, Ghana
| | - Samuel Kyei-Boateng
- Department of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology (KNUST), PMB University Post Office, Kumasi, Ghana
| | - Ho Ming Yuen
- Faculty of Medicine, University of Southampton, Level B, South Academic Block, Southampton General Hospital, Southampton, UK
| | - Trevor Pickup
- Faculty of Medicine, University of Southampton, Level B, South Academic Block, Southampton General Hospital, Southampton, UK
| | - Andy Pulman
- Faculty of Medicine, University of Southampton, Level B, South Academic Block, Southampton General Hospital, Southampton, UK
| | - Michele Monroy-Valle
- Facultad de Ciencias de la Salud, Universidad Rafael Landívar, Ciudad de Guatemala, Guatemala
| | - Ann Ashworth
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Alan A. Jackson
- Faculty of Medicine, University of Southampton, Level B, South Academic Block, Southampton General Hospital, Southampton, UK
| | - Sunhea Choi
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
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Kim C, Mansoor GF, Paya PM, Ludin MH, Ahrar MJ, Mashal MO, Todd CS. Multisector nutrition gains amidst evidence scarcity: scoping review of policies, data and interventions to reduce child stunting in Afghanistan. Health Res Policy Syst 2020; 18:65. [PMID: 32527267 PMCID: PMC7291673 DOI: 10.1186/s12961-020-00569-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 05/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background Child health indicators have substantially improved across the last decade, yet Afghanistan has among the highest child stunting and malnutrition rates in Asia. Multisectoral approaches were recently introduced but evidence for this approach to improve support for and implementation of child nutrition programmes is limited compared to other countries. Methods We reviewed policy and programme data to identify best practices and gaps surrounding child malnutrition in Afghanistan. We conducted a scoping review using broad search categories and approaches, including database and website searches, reference hand-searches, purposive policy and programme document request, and key informant interviews. Inclusion and exclusion criteria were developed iteratively, with abstracts and documents assessed against the final criteria. We abstracted documents systematically and summarised and synthesised content to generate the main findings. Results We included 18 policies and strategies, 45 data sources and reports, and 20 intervention evaluations. Movement towards multisectoral efforts to address malnutrition at the policy level has started; however, integrated nutrition-specific and nutrition-sensitive interventions are not yet uniformly delivered at the community level. Many data sources capturing nutrition, food security and WASH (water, sanitation and hygiene) indicators are available but indicator definitions are not standardised and there are few longitudinal nutrition surveys. Political will to improve household nutrition status has shown increased government and donor investments in nutrition-sensitive and nutrition-specific programmes through combined small- and large-scale interventions between 2004 and 2013; however, evidence for interventions that effectively decrease stunting prevalence is limited. Conclusions This review shows a breadth of nutrition programme, policy and data in Afghanistan. Multisector approaches faced challenges of reaching sufficient coverage as they often included a package of food security, livelihoods and health interventions but were each implemented independently. Further implementation evidence is needed to aid policy and programmes on effective integration of nutrition, food security and WASH in Afghanistan.
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Affiliation(s)
- Christine Kim
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Ghulam Farooq Mansoor
- FHI 360/Integrated Hygiene, Sanitation, and Nutrition (IHSAN) project, Kabul, Afghanistan
| | - Pir Mohammad Paya
- FHI 360/Integrated Hygiene, Sanitation, and Nutrition (IHSAN) project, Kabul, Afghanistan
| | - Mohammad Homayoun Ludin
- Public Nutrition Directorate, Ministry of Public Health, Islamic Republic of Afghanistan, Kabul, Afghanistan
| | - Mohammad Javed Ahrar
- Rural Water Supply and Irrigation Programme (RuWATSIP) Department, Ministry of Rural Rehabilitation and Development (MRRD), Islamic Republic of Afghanistan, Kabul, Afghanistan
| | - Mohammad Omar Mashal
- FHI 360/Integrated Hygiene, Sanitation, and Nutrition (IHSAN) project, Kabul, Afghanistan
| | - Catherine S Todd
- Division of Reproductive, Maternal, Newborn, and Child Health, Global Health, Population and Nutrition Department, Durham, North, Carolina, United States of America
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Mutunga M, Frison S, Rava M, Bahwere P. The Forgotten Agenda of Wasting in Southeast Asia: Burden, Determinants and Overlap with Stunting: A Review of Nationally Representative Cross-Sectional Demographic and Health Surveys in Six Countries. Nutrients 2020; 12:nu12020559. [PMID: 32093376 PMCID: PMC7071426 DOI: 10.3390/nu12020559] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 12/11/2022] Open
Abstract
Childhood wasting is among the most prevalent forms of undernutrition globally. The Southeast Asia region is home to many wasted children, but wasting is not recognized as a public health problem and its epidemiology is yet to be fully examined. This analysis aimed to determine the burden of wasting, its predictors, and the level of wasting and stunting concurrence. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in six countries in the region were analyzed. The pooled weighted prevalence for wasting and concurrent wasting and stunting among children 0–59 months in the six countries was 8.9%, 95% CI (8.0–9.9) and 1.6%, 95% CI (1.5–1.8), respectively. This prevalence is approximately 12-fold higher than the 0.7% prevalence of high-income countries; and translated into an absolute number of 1,088,747 children affected by wasting and 272,563 concurrent wasting and stunting. Wasting prevalence was 50 percent higher in the 0–23-month age group. Predictors for wasting included source of drinking water, wealth index, urban residence, child’s age and history of illness and mother’s body mass index. In conclusion, our analysis showed that wasting is a serious public health problem in the region that should be addressed urgently using both preventive and curative approaches.
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Affiliation(s)
- Mueni Mutunga
- United Nations Children’s Fund (UNICEF) East Asia Pacific Regional Office, Bangkok 10200, Thailand
- Correspondence:
| | - Severine Frison
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7HT, UK;
| | - Matteo Rava
- Bergen Center for Ethics and Priority Setting (BCEPS), University of Bergen, 5009 Bergen, Norway;
| | - Paluku Bahwere
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de santé publique, Université Libre de Bruxelles, 1080 Brussels, Belgium;
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Dalglish SL, Seni Badou M, Sirat A, Abdullahi O, Adalbert MFE, Biotteau M, Goldsmith A, Kozuki N. Combined protocol for severe and moderate acute malnutrition in emergencies: Stakeholders perspectives in four countries. Matern Child Nutr 2019; 16:e12920. [PMID: 31773867 PMCID: PMC7083443 DOI: 10.1111/mcn.12920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/07/2019] [Accepted: 11/11/2019] [Indexed: 12/29/2022]
Abstract
Each year, acute malnutrition affects an estimated 52 million children under 5 years of age. Current global treatment protocols divide treatment of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) despite malnutrition being a spectrum disease. A proposed Combined Protocol provides for (a) treatment of MAM and SAM at the same location; (b) diagnosis using middle‐upper‐arm circumference (MUAC) and oedema only; (c) treatment using a single product, ready‐to‐use‐therapeutic food (RUTF), and (d) a simplified dosage schedule for RUTF. This study examines stakeholders' knowledge of and opinions on the Combined Protocol in Niger, Nigeria, Somalia, and South Sudan. Data collection included a document review followed by in‐depth interviews with 50 respondents from government, implementing partners, and multilateral agencies, plus 11 global and regional stakeholders. Data were analysed iteratively using thematic content analysis. We find that acute malnutrition protocols in these countries have not been substantially modified to include components of the Combined Protocol, although aspects were accepted for use in emergencies. Respondents generally agreed that MAM and SAM treatment should be provided in the same location, however they said MUAC and oedema‐only diagnosis, although more field‐ready than other diagnostic measures, did not necessarily catch all malnourished children and may not be appropriate for “tall and slim” morphologies. Similarly, using only RUTF presented inherent logistical advantages, but respondents worried about pipeline issues. Respondents did not express strong opinions about simplified dosage schedules. Stakeholders interviewed indicated more evidence is needed on the operational implications and effectiveness of the Combined Protocol in different contexts.
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Affiliation(s)
- Sarah L Dalglish
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Amin Sirat
- Nutrition Department, International Rescue Committee, Maiduguri, Nigeria
| | - Omar Abdullahi
- Nutrition Department, International Rescue Committee, Mogadishu, Somalia
| | | | - Marie Biotteau
- Nutrition Department, International Rescue Committee, Bamako, Mali
| | - Amelia Goldsmith
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Naoko Kozuki
- Nutrition Department, International Rescue Committee, Washington, DC, USA
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Abstract
Background Child malnutrition still remains a major cause of childhood morbidity and mortality in Bangladesh. This study aims to determine the prevalence and identify the associated risk factors of child malnutrition in Bangladesh using multilevel logistic regression model on data from the Bangladesh Demographic and Health Survey (BDHS), 2014. Methods A total sample of 6965 children aged 0–59 months was extracted from BDHS 2014. We performed descriptive analysis and multilevel generalized linear regression analysis with clustered data structure. Results Our findings show that among children the prevalence of moderate and severe values was respectively: 25 and 12% for stunting; 11 and 3.1% for wasting; 25 and 7.9% for underweight. The probability of stunting increased with age, with highest rate among children aged 36–47 months, which was significantly higher than children aged less than 6 months (OR = 6.71, 95% CI = 4.46, 10.10). Female children are found to be 11% less likely to be stunted than male children (OR = 0.89, 95% CI = 0.78, 1.02). Children with birth interval less than 24 months were significantly more likely to be stunted than children of first birth by 36% (OR = 1.36, 95% CI = 1.11, 1.67). Mothers with a normal BMI were 16% less likely to have children with stunting compared to mothers who are underweight (OR = 0.84, 95% CI = 0.76, 0.93). Other factors which were associated with a higher risk of stunting included parents with lower educational levels, children from the poorest wealth index, and mothers aged less than 20 years as first birth. Conclusion Government and non-government organization should generate effective program to aware women of reproductive age about adverse effect of short birth interval, and to aware parents about standard height and weight according to age and gender of children. Overall, necessary steps may be taken to make people educated and to reduce household wealth inequality to improve nutritional status of children.
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Affiliation(s)
- Papia Sultana
- 1Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | | | - Jahanara Akter
- Global Public Health Research Foundation, Dhaka, Bangladesh
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Aguayo VM, Badgaiyan N, Qadir SS, Bugti AN, Alam MM, Nishtar N, Galvin M. Community management of acute malnutrition (CMAM) programme in Pakistan effectively treats children with uncomplicated severe wasting. Matern Child Nutr 2019; 14 Suppl 4:e12623. [PMID: 30499254 PMCID: PMC6866122 DOI: 10.1111/mcn.12623] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Víctor M Aguayo
- Programme Division, United Nations Children's Fund (UNICEF), New York, NY, USA
| | - Nina Badgaiyan
- UNICEF, Regional Office for South Asia, Kathmandu, Nepal
| | | | - Ali Nasir Bugti
- Nutrition Program, Department of Health, Government of Balochistan, Quetta, Pakistan
| | | | - Noureen Nishtar
- Action Contre la Faim (ACF) International, Country Office for Pakistan, Islamabad, Pakistan
| | - Melanie Galvin
- UNICEF, Country Office for Pakistan, Islamabad, Pakistan
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17
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Saleem J, Zakar R, Zakar MZ, Belay M, Rowe M, Timms PM, Scragg R, Martineau AR. High-dose vitamin D3 in the treatment of severe acute malnutrition: a multicenter double-blind randomized controlled trial. Am J Clin Nutr 2019; 107:725-733. [PMID: 29722846 DOI: 10.1093/ajcn/nqy027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/01/2018] [Indexed: 12/26/2022] Open
Abstract
Background Vitamin D deficiency is common in children with severe acute malnutrition, in whom it is associated with severe wasting. Ready-to-use therapeutic food (the standard treatment) contains modest amounts of vitamin D that do not reliably correct deficiency. Objective The aim of this study was to determine whether high-dose oral vitamin D3 enhances weight gain and development in children with uncomplicated severe acute malnutrition. Design We conducted a randomized placebo-controlled trial of high-dose vitamin D3 supplementation in children aged 6-58 mo with uncomplicated severe acute malnutrition in Pakistan. Participants were randomly assigned to receive 2 oral doses of 200,000 IU vitamin D3 or placebo at 2 and 4 wk after starting ready-to-use therapeutic food. The primary outcome was the proportion of participants gaining >15% of baseline weight at 8 wk after starting ready-to-use therapeutic food (the end of the study). Secondary outcomes were mean weight-for-height or -length z score and the proportion of participants with delayed development at the end of the study (assessed with the Denver Development Screening Tool II), adjusted for baseline values. Results Of the 194 randomly assigned children who started the study, 185 completed the follow-up and were included in the analysis (93 assigned to intervention, 92 to control). High-dose vitamin D3 did not influence the proportion of children gaining >15% of baseline weight at the end of the study (RR: 1.04; 95% CI: 0.94,1.15, P = 0.47), but it did increase the weight-for-height or -length z score (adjusted mean difference: 1.07; 95% CI: 0.49,1.65, P < 0.001) and reduce the proportion of participants with delayed global development [adjusted RR (aRR): 0.49; 95% CI: 0.31, 0.77, P = 0.002], delayed gross motor development (aRR: 0.29; 95% CI: 0.13, 0.64, P = 0.002), delayed fine motor development (aRR: 0.59; 95% CI: 0.38, 0.91, P = 0.018), and delayed language development (aRR: 0.57; 95% CI: 0.34, 0.96, P = 0.036). Conclusions High-dose vitamin D3 improved the mean weight-for-height or -length z score and developmental indexes in children receiving standard therapy for uncomplicated severe acute malnutrition in Pakistan. This trial was registered at clinicaltrials.gov as NCT03170479.
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Affiliation(s)
- Javeria Saleem
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan.,Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Rubeena Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Muhammad Z Zakar
- Department of Public Health, Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
| | - Mulugeta Belay
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Marion Rowe
- Department of Clinical Biochemistry, Homerton University Hospital, London, United Kingdom
| | - Peter M Timms
- Department of Clinical Biochemistry, Homerton University Hospital, London, United Kingdom
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Adrian R Martineau
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Chanani S, Waingankar A, Shah More N, Pantvaidya S, Fernandez A, Jayaraman A. Effectiveness of NGO-government partnership to prevent and treat child wasting in urban India. Matern Child Nutr 2019; 15 Suppl 1:e12706. [PMID: 30748121 DOI: 10.1111/mcn.12706] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 02/06/2023]
Abstract
This study reviews the performance of a community-based nutrition programme in preventing and treating wasting without complications among children under age three in urban informal settlements of India. Implemented by a non-profit organization, with national (Integrated Child Development Services [ICDS]) and city-level (Municipal Corporation of Greater Mumbai [MCGM]) government partners, the programme screened 7,759 children between May 2014 and April 2015. During this period, the programme admitted 705 moderately wasted and 189 severely wasted children into the treatment group and 6,820 not wasted children into the prevention group. Both prevention and treatment groups received growth monitoring, referrals to public health facilities, and home-based counselling (if <6 months) by community health workers. Treatment groups received additional home-based counselling and access to medical screenings. Severely wasted children also received access to ready-to-use therapeutic food. The study assessed default rates, wasting status, and average weight gain 3 months after admission. Factors associated with growth faltering in the prevention group were explored using logistic regression. Default rates for the severely wasted, moderately wasted, and prevention group were 12.7%, 20.4%, and 22.1%, respectively. Recovery rate was 42.4% for the severely wasted and 61.3% for the moderately wasted. For the moderately wasted, mean weight gain was 2.1 g/kg/day, 95% confidence interval (CI) [1.6, 2.6], and 4.5 g/kg/day for the severely wasted, 95% CI [3.1, 5.9]. Among prevention group children, 3.6% faltered into wasting-3.2% into moderate and 0.4% into severe. The paper gives insights into ways in which ICDS and MCGM can successfully integrate large-scale community-based acute malnutrition programming.
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Affiliation(s)
- Sheila Chanani
- Society for Nutrition, Education and Health Action, Mumbai, India
| | | | - Neena Shah More
- Society for Nutrition, Education and Health Action, Mumbai, India
| | | | - Armida Fernandez
- Society for Nutrition, Education and Health Action, Mumbai, India
| | - Anuja Jayaraman
- Society for Nutrition, Education and Health Action, Mumbai, India
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Asim M, Nawaz Y. Child Malnutrition in Pakistan: Evidence from Literature. Children (Basel) 2018; 5:E60. [PMID: 29734703 PMCID: PMC5977042 DOI: 10.3390/children5050060] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/16/2018] [Accepted: 04/23/2018] [Indexed: 12/30/2022]
Abstract
Pakistan has one of the highest prevalences of child malnutrition as compared to other developing countries. This narrative review was accomplished to examine the published empirical literature on children’s nutritional status in Pakistan. The objectives of this review were to know about the methodological approaches used in previous studies, to assess the overall situation of childhood malnutrition, and to identify the areas that have not yet been studied. This study was carried out to collect and synthesize the relevant data from previously published papers through different scholarly database search engines. The most relevant and current published papers between 2000⁻2016 were included in this study. The research papers that contain the data related to child malnutrition in Pakistan were assessed. A total of 28 articles was reviewed and almost similar methodologies were used in all of them. Most of the researchers conducted the cross sectional quantitative and descriptive studies, through structured interviews for identifying the causes of child malnutrition. Only one study used the mix method technique for acquiring data from the respondents. For the assessment of malnutrition among children, out of 28 papers, 20 used the World Health Organization (WHO) weight for age, age for height, and height for weight Z-score method. Early marriages, large family size, high fertility rates with a lack of birth spacing, low income, the lack of breast feeding, and exclusive breastfeeding were found to be the themes that repeatedly emerged in the reviewed literature. There is a dire need of qualitative and mixed method researches to understand and have an insight into the underlying factors of child malnutrition in Pakistan.
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Affiliation(s)
- Muhammad Asim
- Population Research Center, University of Texas, Austin, TX 78712, USA.
- Department of Sociology, University of Sargodha, Sargodha, Punjab 40100, Pakistan.
| | - Yasir Nawaz
- Department of Sociology, University of Sargodha, Sargodha, Punjab 40100, Pakistan.
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Abstract
Good genes, good food, good friends. That is what parents hope will sustain and nurture the harmonious growth of their children. The impact of the genetic background and nutrition on postnatal growth has been in the spot light for long, but the good friends have come to the scene only recently. Among the good friends perhaps the most crucial ones are those that we are carrying within ourselves. They comprise the trillions of microbes that collectively constitute each individual's intestinal microbiota. Indeed, recent epidemiological and field studies in humans, supported by extensive experimental data on animal models, demonstrate a clear role of the intestinal microbiota on their host's juvenile growth, especially under suboptimal nutrient conditions. Genuinely integrative approaches applicable to invertebrate and vertebrate systems combine tools from genetics, developmental biology, microbiology, nutrition, and physiology to reveal how gut microbiota affects growth both positively and negatively, in healthy and pathological conditions. It appears that certain natural or engineered gut microbiota communities can positively impact insulin/IGF-1 and steroid hormone signaling, thus contributing to the host juvenile development and maturation.
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Affiliation(s)
- Martin Schwarzer
- Institut de Génomique Fonctionnelle de Lyon (IGFL), Université de Lyon, Ecole Normale Supérieure de Lyon, CNRS UMR 5242, Université Claude Bernard Lyon 1, 69364, Lyon Cedex 07, France.
- Laboratory of Gnotobiology, Institute of Microbiology of the Czech Academy of Sciences, Nový Hrádek, Czech Republic.
| | - Maura Strigini
- INSERM, U1059, Sainbiose, Université de Lyon, Université Jean Monnet, Faculté de Médecine, Campus Santé Innovation, 42023, Saint-Étienne, France.
| | - François Leulier
- Institut de Génomique Fonctionnelle de Lyon (IGFL), Université de Lyon, Ecole Normale Supérieure de Lyon, CNRS UMR 5242, Université Claude Bernard Lyon 1, 69364, Lyon Cedex 07, France
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Abstract
Over the past two decades, increasing efforts have been made to find suitable nutritional products for managing particularly moderate forms of malnutrition following acute phase treatment, including the adoption of ready-to-use therapeutic foods. The challenge in meeting nutrient needs of normal growing young children and other vulnerable population groups with scant food supply has led us to explore the use of local, traditional and culturally adaptable food-based complementary foods employing the food multimix (FMM) concept. The present paper examined FMM as a concept to demonstrate how locally available composite complementary recipes were used to create highly nutritious recipes at low cost and improve nutrition among vulnerable individuals. The method employed a food-to-food fortification approach for recipe development making use of the ‘nutrient strengths’ of candidate ingredients. A range of different food recipes had been developed using a stepwise approach and combinations of foods from different populations and communities and packaged as 100 g recipe powders. Proximate and micronutrient analyses have been undertaken, optimised and the nutrient compositions compared with reference nutrient intakes for target groups. Examples of recipes and their nutrient profiles had been highlighted for different formulations showing different ingredients. Theoretical nutrient values were translated into practice based on data from intervention studies. The FMM approach using locally available food has held promise, and published evidence did indicate that the concept can contribute significantly to long-term food-based solutions to meeting nutrient needs of vulnerable groups in poor communities.
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Kabir A, Maitrot MRL. Factors influencing feeding practices of extreme poor infants and young children in families of working mothers in Dhaka slums: A qualitative study. PLoS One 2017; 12:e0172119. [PMID: 28207894 PMCID: PMC5312963 DOI: 10.1371/journal.pone.0172119] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background Nutritional status differs between infants and young children living in slum and non-slum conditions—infants and young children living in City Corporation slums are likely to have worse nutritional status compared to those from non-slums. Furthermore, families in slums tend to engage female labor in cash-earning activities as a survival strategy; hence, a higher percentage of mothers stay at work. However, little is known about feeding practices for infants and young children in families with working mothers in slums. This study aims to understand the factors that determine feeding practices for infants and young children living in families with working mothers in Dhaka slums. Methods This study adopted a qualitative approach. Sixteen In-depth Interviews, five Key Informant Interviews, and Focused Group Discussions were conducted with family members, community leaders, and program staff. Method triangulation and thematic analyses were conducted. Results Feeding practices for infants and young children in families with working mothers are broadly determined by mothers’ occupation, basis civic facilities, and limited family buying capacity. Although mothers have good nutritional knowledge, they negotiate between work and feeding their infants and young children. Household composition, access to cooking facilities, and poverty level were also found to be significant determining factors. Conclusion The results suggest a trade-off between mothers’ work and childcare. The absence of alternative care support in homes and/or work places along with societal factors outweighs full benefits of project interventions. Improving alternative childcare support could reduce the burden of feeding practice experienced by working mothers and may improve nutritional outcomes.
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Bhandari N, Mohan SB, Bose A, Iyengar SD, Taneja S, Mazumder S, Pricilla RA, Iyengar K, Sachdev HS, Mohan VR, Suhalka V, Yoshida S, Martines J, Bahl R. Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition: a randomised trial in India. BMJ Glob Health 2016; 1:e000144. [PMID: 28588982 PMCID: PMC5321385 DOI: 10.1136/bmjgh-2016-000144] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the efficacy of ready-to-use therapeutic food (RUTF), centrally produced RUTF (RUTF-C) or locally prepared RUTF (RUTF-L) for home-based management of uncomplicated severe acute malnutrition (SAM) compared with micronutrient-enriched (augmented) energy-dense home-prepared foods (A-HPF, the comparison group). METHODS In an individually randomised multicentre trial, we enrolled 906 children aged 6-59 months with uncomplicated SAM. The children enrolled were randomised to receive RUTF-C, RUTF-L or A-HPF. We provided foods, counselling and feeding support until recovery or 16 weeks, whichever was earlier and measured outcomes weekly (treatment phase). We subsequently facilitated access to government nutrition services and measured outcomes once 16 weeks later (sustenance phase). The primary outcome was recovery during treatment phase (weight-for-height ≥-2 SD and absence of oedema of feet). RESULTS Recovery rates with RUTF-L, RUTF-C and A-HPF were 56.9%, 47.5% and 42.8%, respectively. The adjusted OR was 1.71 (95% CI 1.20 to 2.43; p=0.003) for RUTF-L and 1.28 (95% CI 0.90 to 1.82; p=0.164) for RUTF-C compared with A-HPF. Weight gain in the RUTF-L group was higher than in the A-HPF group (adjusted difference 0.90 g/kg/day, 95% CI 0.30 to 1.50; p=0.003). Time to recovery was shorter in both RUTF groups. Morbidity was high and similar across groups. At the end of the study, the proportion of children with weight-for-height Z-score (WHZ) >-2 was similar (adjusted OR 1.12, 95% CI 0.74 to 1.95; p=0.464), higher for moderate malnutrition (WHZ<-2 and ≥-3; adjusted OR 1.46, 95% CI 1.02 to 2.08; p=0.039), and lower for those with SAM (adjusted OR 0.58, 95% CI 0.40 to 0.85; p=0.005) in the RUTF-L when compared with the A-HPF group. CONCLUSIONS This first randomised trial comparing options for home management of uncomplicated SAM confirms that RUTF-L is more efficacious than A-HPF at home. Recovery rates were lower than in African studies, despite longer treatment and greater support for feeding. TRIAL REGISTRATION NUMBER NCT01705769; Pre-results.
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Affiliation(s)
- Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Anuradha Bose
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Sharad D Iyengar
- Action Research and Training for Health, Udaipur, Rajasthan, India
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Kirti Iyengar
- Action Research and Training for Health, Udaipur, Rajasthan, India
| | | | | | - Virendra Suhalka
- Action Research and Training for Health, Udaipur, Rajasthan, India
| | - Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Jose Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
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Abstract
Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environmental enteropathy, poor complementary feeding practices, and chronic and acute infections, contribute to the development of SAM. Careful anthropometry is key to making an accurate diagnosis of SAM and can be performed by village health workers or even laypeople in rural areas. The majority of children can be treated at home with ready-to-use therapeutic food under the community-based management of acute malnutrition model with recovery rates of approximately 90% under optimal conditions. A small percentage of children, often those with HIV, tuberculosis or other comorbidities, will still require inpatient therapy using fortified milk-based foods.
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Affiliation(s)
- Indi Trehan
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA Department of Paediatrics and Child Health, University of Malawi, Blantyre, Malawi
| | - Mark J Manary
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA Department of Community Health, University of Malawi, Blantyre, Malawi Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA
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Legido A. Letter to the editor. Semin Pediatr Neurol 2015; 22:73. [PMID: 25976263 DOI: 10.1016/j.spen.2015.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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