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Tadesse GA, Ferguson L, Robinson C, Kuria S, Wanyonyi H, Murage S, Mburu S, Dodhia R, Lavista Ferres JM, Dilkina B. Forecasting acute childhood malnutrition in Kenya using machine learning and diverse sets of indicators. PLoS One 2025; 20:e0322959. [PMID: 40367047 PMCID: PMC12077733 DOI: 10.1371/journal.pone.0322959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 03/31/2025] [Indexed: 05/16/2025] Open
Abstract
OBJECTIVES Malnutrition is a leading cause of morbidity and mortality for children under-5 globally. Low- and middle-income countries, such as Kenya, bear the greatest burden of malnutrition. The Kenyan government has been collecting clinical indicators, including on malnutrition, using District Health Information Software-2 (DHIS2) for over a decade. We aim to address the existing gap in decision-makers' ability to develop and utilize malnutrition forecasting capabilities for timely interventions. Specifically, our objectives include: develop a spatio-temporal machine learning model to forecast acute malnutrition among children in Kenya using DHIS2 data, enhance forecasting capability by integrating external complementary indicators, such as publicly available satellite imagery-driven signals, and forecast acute malnutrition at various stages and time horizons, including moderate, severe, and aggregated cases. METHODS We propose a framework to forecast malnutrition risk for each sub-county in Kenya based on clinical indicators and remote sensory data. To achieve this, we first aggregate clinical indicators and remotely sensed satellite data, specifically gross primary productivity measurements, to the sub-county level. We then label the rate of children diagnosed with acute malnutrition at the sub-county level using the standard Integrated Food Security Phase Classification for Acute Malnutrition. We then apply and compare several methods for forecasting malnutrition risk in Kenya using data collected from January 2019 to February 2024. As a baseline, we used a Window Average model, which captures the current practice at the Kenyan Ministry of Health. We also trained machine learning models, such as Logistic Regression and Gradient Boosting, to forecast acute malnutrition risk based on observed indicators from prior months. Different metrics, mainly Area Under Receiver Operating Characteristic Curve (AUC), were used to evaluate the forecasting performance by comparing their forecast values to known values on a hold-out test set. RESULTS We found that machine learning based models consistently outperform the Window Average baselines on forecasting sub-county malnutrition rates in Kenya. For example, the Gradient Boosting model achieves a mean AUC of 0.86 when forecasting with a 6-month time horizon, compared to an AUC of 0.73 achieved by the Window Average model. The Window Average method particularly fails to correctly forecast malnutrition in parts of West and Central Kenya where the acute malnutrition rate is variable over time and typically less than [Formula: see text]. We further found that machine learning models with satellite-based features alone also outperform Window Averaging baselines, while not needing clinical data at inference time. Finally, we found that recently observed outcomes and the remotely sensed data are key indicators. Our results demonstrate the ability of machine learning models to accurately forecast malnutrition in Kenya at a sub-county level from a variety of indicators. CONCLUSIONS To the best of the authors' knowledge, this work is the first to use clinical indicators collected via DHIS2 to forecast acute malnutrition in childhood at the sub-county level in Kenya. This work represents a foundational step in developing a broader childhood malnutrition forecasting framework, capable of monitoring malnutrition trends and identifying impending malnutrition peaks across more than 80 low- and middle-income countries collecting similar DHIS2 datasets.
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Affiliation(s)
| | - Laura Ferguson
- University of Southern California, Institute on Inequalities in Global Health, Los Angeles, California, United States of America
- Amref International University, Nairobi, Kenya
| | - Caleb Robinson
- Microsoft AI for Good Research Lab, Redmond, Washington, United States of America
| | | | | | - Samuel Murage
- Division of Nutrition and Dietetics, Ministry of Health, Nairobi, Kenya
| | | | - Rahul Dodhia
- Microsoft AI for Good Research Lab, Redmond, Washington, United States of America
| | | | - Bistra Dilkina
- University of Southern California, Center for AI in Society, Los Angeles, California, United States of America
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Mekonnen GB, Wondie WT, Legesse BT, Abera NM, Abuhay AG, Yirga GK, Demissie B, Engidaw MT. Recovery rate of sever acute malnutrition and its predictors among children admitted to therapeutic feeding unit in Northcentral Ethiopia. Sci Rep 2025; 15:14767. [PMID: 40295660 PMCID: PMC12037731 DOI: 10.1038/s41598-025-98582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 04/14/2025] [Indexed: 04/30/2025] Open
Abstract
Severe acute malnutrition (SAM) is the leading cause of hospital admissions and continues to be the leading cause of death in pediatric wards for children under five (25-30% of deaths), particularly in developing nations. Even if Ethiopia implements SAM treatment guidelines and protocols, the study area needs to have up-to-date data on the recovery rate. This study aimed to assess the recovery rate of severe acute malnutrition and its determinants among under-five children admitted to a therapeutic feeding unit. An institution-based retrospective follow-up study was conducted admitted severely malnourished children from January 1, 2021 to December 30, 2022 in Debre Tabor Comprehensive Specialized Hospital. Data from all 209 study participants were collected using SAM registration logbooks and medical record charts with structured questionnaires. Data were entered into Epi Info version 7 and exported into SPSS version 25 for further analysis. The Kaplan-Meier curve and life table were used to describe the variable. To identify predictors, a Cox proportional hazard analysis was computed. The hazard ratio with a 95% CI was calculated, and a P-value of ≤ 0.05 was considered to declare statistical significance. A review of 209 records of children diagnosed with severe acute malnutrition (SAM) was included in this study. Among these 75.1% recovered from SAM and the median survival time of recovery for children admitted in DTCSH was 15.42 days. Appetite status at admission and HIV status were significantly influenced recovery rates, with children showing poor appetite [Adjusted hazard ratio [AHR] 2.32, 95% CI 1.1-4.95] and HIV-positive status [AHR 2.55, 95% CI 1.001-6.5] at higher risk of delayed recovery rate. In this study, the overall nutritional recovery time was within an acceptable level of the Sphere standards. The main determinants of time to recovery in severely malnourished children were appetite status and HIV status during admission. Therefore, prompt checking of the appetite status of children and screening and intervention accordingly for their HIV status during admission are highly recommended for good nutritional recovery.
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Affiliation(s)
- Gebrehiwot Berie Mekonnen
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O Box: 272, Debre Tabor, Ethiopia.
| | - Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Bruck Tesfaye Legesse
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, Institutes of Health Science, Wollega University, Nekemte, Ethiopia
| | - Netsanet Melkamu Abera
- Department of Nursing, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Abere Gebru Abuhay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O Box: 272, Debre Tabor, Ethiopia
| | - Gebrie Kassaw Yirga
- Department of Adult Health Nursing, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Demissie
- Department of Environmental Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melaku Tadege Engidaw
- Social and Population Health Unit, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Public Health, School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, Australia
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Renzaho AMN, Jaiswal C, Chineka A, Aden MO, Dahir A, Kari HA, Karanja S, Fatuma A, Shire BA, Rahaman KS, Mohamed MI, Mohamed F, Bilal NK, Ocom G, Ayoya MA, Ndiaye B, Ategbo EA. Evaluating the Performance of Integrated Management of Acute Malnutrition Programs in Somalia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:378. [PMID: 40238406 PMCID: PMC11942193 DOI: 10.3390/ijerph22030378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 02/21/2025] [Accepted: 02/27/2025] [Indexed: 04/18/2025]
Abstract
Background: Globally, acute malnutrition remains a significant public health challenge. Severe acute malnutrition (SAM) is the most lethal type of acute malnutrition. This study aimed to produce pooled estimates of the effectiveness of integrated management of acute malnutrition (IMAM) programs in addressing SAM in Somalia. Methods: Medline, Embase, Cochrane, Web of Science, CINAHL, ProQuest, Google Scholar, eLENA, and the UNICEF website were searched with no language or date restrictions. Random effect models were used to estimate the pooled estimates of outpatient therapeutic program (OTP) and stabilization centres (SC) performance outcomes (I2 > 50%). Results: Of 186 identified studies, three included data from IMAM programs in Somalia but were excluded, as they had incomplete data. Included were seven datasets identified through the authors' list, which screened 36.34 million and admitted 2.31 million (6.35%) children aged 6-59 months. The pooled estimates of IMAM performance outcomes [%, (95% confidence interval)] for OTPs and SCs were, respectively, 2.45 (2.18, 2.56) and 4.11 (95%CI: 3.33, 4.90) for relapse, 95.39 (94.87, 95.90) and 80.81 (79.25, 82.37) for recovery, 0.18 (0.15, 0.21) and 1.73 (1.51, 1.95) for death, 2.57 (2.34, 2.79) and 2.75 (2.37, 3.12) for defaulter, 1.86 (1.55, 2.17), and 0.84 (0.66, 1.02) for non-recovery. Conclusions: OTP and SC performance outcomes in Somalia exceeded the Sphere Minimum Standards and compare favourably with results from the region. The adaptation of IMAM programs to meet multiple challenges in Somalia, supported by well-designed, coordinated, standardized, integrated, and harmonized implementation plans, is a strength.
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Affiliation(s)
- Andre M. N. Renzaho
- School of Medicine, Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571, Australia;
| | - Chandrakala Jaiswal
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Annastancia Chineka
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Musdafa Omar Aden
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Abdikadir Dahir
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Hanad Abdi Kari
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Simon Karanja
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Ajwang Fatuma
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Bashir Abdi Shire
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Kh Shafiur Rahaman
- School of Medicine, Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571, Australia;
| | - Mohamed Isse Mohamed
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Farhan Mohamed
- Somalian Ministry of Health, Corso Somalia, Mogadishu MC 13-1302, Somalia;
| | - Nejmudin Kedir Bilal
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Gabriel Ocom
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Mohamed Ag Ayoya
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
| | - Biram Ndiaye
- World Bank, 1818 H Street, Washington, DC 20433, USA;
| | - Eric Alain Ategbo
- UNICEF Somalia, API Compound, Nairobi P.O. Box 44145, Kenya; (C.J.); (M.O.A.); (A.D.); (H.A.K.); (S.K.); (A.F.); (B.A.S.); (M.I.M.); (N.K.B.); (G.O.); (M.A.A.); (E.A.A.)
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Workie HM, Sima BH, Bitew AA, Tigabu D. Time to recovery from severe acute malnutrition and predictors among children aged 6-59 months at public hospitals: retrospective follow-up study. Sci Rep 2025; 15:6513. [PMID: 39987123 PMCID: PMC11846952 DOI: 10.1038/s41598-025-90541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 02/13/2025] [Indexed: 02/24/2025] Open
Abstract
Severe acute malnutrition is a major cause of illness and death among children under the age of five in Ethiopia. However, there is limited evidence regarding the success of treatment and the length of hospital stays for children with severe acute malnutrition. The objective of this research was to assess the recovery period from severe acute malnutrition and determine potential predictors of recovery. A retrospective follow-up study was conducted. Children aged 6-59 months with severe acute malnutrition who had been treated at the therapeutic feeding unit were selected using a simple random sampling technique. The data was analyzed using Stata v14. Descriptive statistics were used to compute the nature of the variables. Kaplan-Meier with the log-rank test was used to test for the presence of differences in categorical variables. Model goodness of fit and assumptions were checked by the Cox-Snell residual and global tests, respectively. A p-value of 0.25 in the bivariable Cox regression analysis was used for the multivariable Cox regression analysis. Variables with p values less than 0.05 in the multivariable Cox regression were considered significant predictors of recovery time from severe acute malnutrition. In this study, the median recovery time was nine days, with an interquartile range of 7 to 11 days. The incidence rate of recovery was 11.24%. Children who had marasmus, pneumonia at admission, anemia at admission, had not been fully vaccinated, had not received vitamin A, and had not received plumpy'Nut had a statistically significant association with the time to recovery of severe acute malnutrition. Marasmus, pneumonia, and anemia at admission were the predictors that delayed the recovery time of children from their severe acute malnutrition. On the contrary, children who had been given vitamin A and plumpy nuts were the predictors that fastened recovery time. Therefore, special attention should be given to children who have marasmus, comorbidities like pneumonia, and anemia to shorten their recovery time from their severe acute malnutrition status.
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Affiliation(s)
- Hailemariam Mekonnen Workie
- College of Medicine and Health Science, School of Health Sciences, Department of Pediatrics and Child Health Nursing, Bahir Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Belay Hundera Sima
- GAMBY Medical and Business College, Textile Road, P.O. Box. 209, Bahir Dar, Ethiopia
| | | | - Dagnew Tigabu
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia.
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Wondmeneh TG, Giruma A. Time to Recovery From Severe Acute Malnutrition to Normal Nutritional Status and Its Predictors Among Children Aged 6-59 Months in North-East Ethiopia. MATERNAL & CHILD NUTRITION 2025:e13808. [PMID: 39956991 DOI: 10.1111/mcn.13808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 01/11/2025] [Accepted: 01/15/2025] [Indexed: 02/18/2025]
Abstract
Malnutrition is a major disease burden in developing countries, particularly in recurrently drought-affected areas. Despite the Ethiopian government's initiatives to set up stabilization centers in different hospitals to tackle severe acute malnutrition, there is limited data on the time to recover from severe acute malnutrition and its determinants among under-five children in northeast Ethiopia. The objective of the study is to determine time to recovery of under-five children from severe acute malnutrition to normal nutritional status and its predictors in northeast Ethiopia. A facility-based retrospective record review was carried out from March 1-20, 2023. The tools for the data extraction format were adapted from the national guidelines for the management protocol for severe acute malnutrition. The Kaplan-Meier survival curve was used to compare different categorical variables. The time-varying covariate Cox-proportional hazards regression model was fitted due to the violation of the Cox proportional hazard assumption (p = 0.007). A p-value < 0.05 was a cutoff point to declare statistical significance. In the final analysis, a total of 372 children aged 6-59 months with severe acute malnutrition were included, 58.1% of whom were recovered. The incidence rate of recovery from severe acute malnutrition was 4.43 per 100 child days. Children living in rural areas (AHR = 0.7, 95% CI: 0.5-0.94) and those without F-100 supplement (AHR = 0.85, 95% CI: 0.79-0.91) had a lower recovery rate from severe acute malnutrition. Children lacking IV antibiotics (AHR = 1.4, 95% CI: 1.03-2.0) and those HIV-free (AHR = 1.76, 95% CI: 1.1-3.3) were more likely to recover from severe acute malnutrition. The percentage of recovery in the study area was found to be lower than the sphere standard. F-100 supplements should be mandatory to improve and speed up the recovery rate. Special attention should be given to children from rural areas, those receiving IV antibiotics, and those living with HIV/AIDS.
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Affiliation(s)
- Temesgen Gebeyehu Wondmeneh
- Department of Public Health, College of Medical and Health Science, Samara University, North-East, Afar, Ethiopia
| | - Amarech Giruma
- Department of Public Health, College of Medical and Health Science, Samara University, North-East, Afar, Ethiopia
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Mudibo EO, Bogaert J, Tigoi C, Ngari MM, Singa BO, Lancioni CL, Diallo AH, Mbale E, Mupere E, Mukisa J, Thitiri J, Timbwa M, Omer E, Ngao N, Musyimi R, Kahindi E, Bamouni RM, Bandsma RHJ, Kelly P, Prendergast AJ, McGrath CJ, Tickell KD, Walson JL, Berkley JA, Njunge JM, Gonzales GB. Systemic biological mechanisms underpin poor post-discharge growth among severely wasted children with HIV. Nat Commun 2024; 15:10299. [PMID: 39604330 PMCID: PMC11603168 DOI: 10.1038/s41467-024-54717-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 11/19/2024] [Indexed: 11/29/2024] Open
Abstract
In sub-Saharan Africa, children with severe malnutrition (SM) and HIV have substantially worse outcomes than children with SM alone, facing higher mortality risk and impaired nutritional recovery post-hospitalisation. Biological mechanisms underpinning this risk remain incompletely understood. This case-control study nested within the CHAIN cohort in Kenya, Uganda, Malawi, and Burkina Faso examined effect of HIV on six months post-discharge growth among children with SM and those at risk of malnutrition, assessed proteomic signatures associated with HIV in these children, and investigated how these systemic processes impact post-discharge growth in children with SM. Using SomaScanTM assay, 7335 human plasma proteins were quantified. Linear mixed models identified HIV-associated biological processes and their associations with post-discharge growth. Using structural equation modelling, we examined directed paths explaining how HIV influences post-discharge growth. Here, we show that at baseline, HIV is associated with lower anthropometry. Additionally, HIV is associated with protein profiles indicating increased complement activation and decreased insulin-like growth factor signalling and bone mineralisation. HIV indirectly affects post-discharge growth by influencing baseline anthropometry and modulating proteins involved in bone mineralisation and humoral immune responses. These findings suggest specific biological pathways linking HIV to poor growth, offering insights for targeted interventions in this vulnerable population.
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Affiliation(s)
- Evans O Mudibo
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Jasper Bogaert
- Department of Data Analysis, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Caroline Tigoi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Moses M Ngari
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Benson O Singa
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Christina L Lancioni
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Abdoulaye Hama Diallo
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Department of Public Health, Centre Muraz Research Institute, Bobo-Dioulasso, Burkina Faso
| | - Emmie Mbale
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - John Mukisa
- Department of Immunology and Department of Molecular Biology Makerere University College of Health Sciences, Kampala, Uganda
| | - Johnstone Thitiri
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Molline Timbwa
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Elisha Omer
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Narshion Ngao
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Robert Musyimi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Eunice Kahindi
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | | | - Robert H J Bandsma
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Kelly
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Medicine, Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, UK
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Christine J McGrath
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kirkby D Tickell
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Judd L Walson
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Departments of International Health, Pediatrics and Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - James M Njunge
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.
| | - Gerard Bryan Gonzales
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
- The Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Ekeng B, Adedokun O, Otu V, Chukwuma S, Okah A, Asemota O, Eshiet U, Akpan U, Nwagboso R, Ebiekpi E, Umoren E, Usun E. The Spectrum of Pathogens Associated with Infections in African Children with Severe Acute Malnutrition: A Scoping Review. Trop Med Infect Dis 2024; 9:230. [PMID: 39453257 PMCID: PMC11510937 DOI: 10.3390/tropicalmed9100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 10/03/2024] [Accepted: 10/03/2024] [Indexed: 10/26/2024] Open
Abstract
Understanding the interplay between infections and severe acute malnutrition is critical in attaining good clinical outcomes when managing malnourished children. However, review studies describing the profile of the associated pathogens in the malnourished African paediatric population are sparse in the literature. We aimed to identify the spectrum of pathogens from studies reporting infections in severely malnourished African children, as well as the antibiotic resistance pattern and clinical outcomes. A systematic literature review of the PubMed database was conducted following PRISMA guidelines from January 2001 to June 2024. The search algorithm was ((marasmus) OR (kwashiorkor) OR (severe acute malnutrition) OR (protein energy malnutrition)) AND (Africa). For a more comprehensive retrieval, an additional search algorithm was deployed: ((HIV) OR (tuberculosis)) AND (severe acute malnutrition). We included 60 studies conducted between 2001 and 2024. Most of the studies were from East Africa (n = 45, 75%) and Southern Africa (n = 5, 8.3%). A total of 5845 pathogens were identified comprising 2007 viruses, 2275 bacteria, 1444 parasites, and 119 fungal pathogens. The predominant pathogens were HIV, Mycobacterium tuberculosis, and malaria parasites accounting for 33.8%, 30%, and 24.2% of pathogens identified. Antibiotic susceptibility testing was documented in only three studies. Fatality rates were reported in 45 studies and ranged from 2% to 56% regardless of the category of pathogen. This review affirms the deleterious effect of infections in malnourished patients and suggests a gross underdiagnosis as studies were found from only 17 (31.5%) African countries. Moreover, data on fungal infections in severely malnourished African children were nearly absent despite this population being at risk. Thus, there is an urgent need to prioritize research investigating African children with severe acute malnutrition for fungal infections besides other pathogens and improve the availability of diagnostic tools and the optimized usage of antibiotics through the implementation of antimicrobial stewardship programmes.
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Affiliation(s)
- Bassey Ekeng
- Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Olufunke Adedokun
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Vivien Otu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Stella Chukwuma
- Department of Medical Microbiology, College of Medicine, Enugu State University of Science and Technology, Enugu 400283, Nigeria
| | - Agatha Okah
- Department of Paediatrics, University Hospitals Coventry and Warwickshire, NHS Trust, Coventry CV2 2DX, UK
| | - Osamagbe Asemota
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Ubokobong Eshiet
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Usenobong Akpan
- Department of Paediatrics, University of Uyo Teaching Hospital, Uyo 520261, Nigeria
| | - Rosa Nwagboso
- Department of Family Medicine, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
| | - Eti Ebiekpi
- Department of Community Medicine, University of Uyo Teaching Hospital, Uyo 520261, Nigeria
| | - Emmanuella Umoren
- Department of Paediatrics, Leeds Teaching Hospital Trust, Leeds LS1 3EX, UK
| | - Edet Usun
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar 540271, Nigeria
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Liu Z, Duan Y, Yang L, Du J, Liu H. Global burden of childhood nutritional deficiencies, 1990-2019. Public Health 2024; 235:26-32. [PMID: 39038426 DOI: 10.1016/j.puhe.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES The aim of this study was to estimate the global burden, trends and health inequality of childhood nutritional deficiencies (CND) from 1990 to 2019. STUDY DESIGN This was an epidemiological study. METHODS Data were extracted from the 2019 Global Burden of Disease study. Estimates and 95% uncertainty intervals (UIs) for the rates and numbers were used to evaluate the global burden of CND. Temporal trends in the burden of CND were examined using Joinpoint analysis and average annual percentage changes. To assess health inequality, the slope index was used. RESULTS In 2019, 52 million new cases of CND and 105,000 deaths related to CND were recorded. Additionally, 435 million prevalence cases and 26 million disability-adjusted life years (DALYs) were recorded in the same year. From 1990 to 2019, the incidence rate of CND generally increased globally, except for the years 2010-2017; conversely, the prevalence, death and DALY rates exhibited decreasing trends over the study period. Half of the analysed regions and countries/territories demonstrated decreasing trends in the incidence, prevalence, death and DALY rates associated with CND. The incidence and prevalence of CND remained high in low-middle sociodemographic index (SDI) and low-SDI regions; however, they exhibited decreasing trends over the 30-year study period. The slope indexes showed that there were no significant changes in SDI-related inequality over 30 years. CONCLUSIONS Despite decreasing trends in the prevalence, death and DALY rates associated with CND over the three decades, the degree of inequality related to SDI in the burden of nutritional deficiencies has not shown a significant decline. In summary, CND remain a major public health burden in middle-SDI and low-SDI countries.
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Affiliation(s)
- Zihao Liu
- School of Public Health, Bengbu Medical University, Donghai Avenue 2600, Bengbu, China.
| | - Ying Duan
- School of Public Health, Bengbu Medical University, Donghai Avenue 2600, Bengbu, China.
| | - Ling Yang
- School of Public Health, Bengbu Medical University, Donghai Avenue 2600, Bengbu, China.
| | - Jing Du
- School of Public Health, Bengbu Medical University, Donghai Avenue 2600, Bengbu, China.
| | - Huaqing Liu
- School of Public Health, Bengbu Medical University, Donghai Avenue 2600, Bengbu, China.
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Victor A, Antônio BC, Gotine ARM, Mahoche M, Pedro Xavier S, Silva Rodrigues OA, Ferreira AJF, Rondó PH. Predictors of nutritional recovery time in children aged 6-59 months with severe acute malnutrition in Sofala Province, Mozambique: survival analysis approach. J Public Health (Oxf) 2024; 46:305-314. [PMID: 38609179 DOI: 10.1093/pubmed/fdae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/11/2023] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Malnutrition is a public health problem that affects physical and psychosocial well-being. It manifests as a rapid deterioration in nutritional status and bilateral edema due to inadequate food intake or illness. METHODS This study is a retrospective cohort of 1208 children with severe acute malnutrition (SAM) in Sofala Province from 2018 to 2022. It includes hospitalized children aged 6-59 months with SAM and related complications. The dependent variable is recovery, and the independent variables include age, sex of the child, vomiting, dehydration, hypoglycemia, nutritional edema and anthropometry. Survival curves were plotted using the Kaplan-Meier method, and bivariable and multivariable Cox regression analyses were performed. RESULTS The crude analysis revealed significant factors for nutritional recovery in children with SAM, including age, weight, height, malaria, diarrhea and dehydration. Children under 24 months had a 28% lower likelihood of recovery. Weight below 6.16 kg decreased the likelihood by 2%, and height above 71.1 cm decreased it by 20%. Conversely, malaria, diarrhea and dehydration increased the likelihood of recovery. However, after adjustment, only diarrhea remained a significant predictor of nutritional recovery. CONCLUSION This study found that diarrhea is a predictor of nutritional recovery in children with SAM.
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Affiliation(s)
- Audêncio Victor
- School of Public Health, University of São Paulo (USP), Ave. Doutor Arnaldo, 715, 01246904, São Paulo, Brazil
- Department of Nutrition, Ministry of Health of Mozambique, Ave. Eduardo Mondlane 1008, Maputo, C.P. 264, Mozambique
| | - Bélio Castro Antônio
- Department of Nutrition, Ministry of Health of Mozambique, Ave. Eduardo Mondlane 1008, Maputo, C.P. 264, Mozambique
| | - Ana Raquel Manuel Gotine
- School of Public Health, University of São Paulo (USP), Ave. Doutor Arnaldo, 715, 01246904, São Paulo, Brazil
- Faculty of Health Sciences, Lúrio University, Bairro de Marrere, Rua No. 4250, CP 364, Nampula, Mozambique
| | - Manuel Mahoche
- School of Public Health, University of São Paulo (USP), Ave. Doutor Arnaldo, 715, 01246904, São Paulo, Brazil
| | - Sancho Pedro Xavier
- Institute of Collective Health, Federal University of Mato Grosso, Ave. Fernando Correia da Costa, nº 2367 - Bairro Boa Esperança, Cuiabá - MT - 78060-900, Brazil
| | - Osiyallê Akanni Silva Rodrigues
- Institute of Collective Health, Federal University of Bahia (UFBA), Basílio da Gama Street, Canela, Salvador - BA, 40110-040 Salvador, Bahia state, Brazil
| | - Andrêa J F Ferreira
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Building Tecnocentro, Rua Mundo, 121, Trobogy, Salvador, Bahia 41745-715 Brazil
- Center on Racism, Global Movements, and Population Health Equity, Drexel University Dornsife School of Public Health, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA
| | - Patrícia H Rondó
- School of Public Health, University of São Paulo (USP), Ave. Doutor Arnaldo, 715, 01246904, São Paulo, Brazil
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10
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Victor A, Antônio BC, Gotine ARM, Mahoche M, Pedro Xavier S, Silva Rodrigues OA, Ferreira AJF, Rondó PH. Predictors of nutritional recovery time in children aged 6–59 months with severe acute malnutrition in Sofala Province, Mozambique: survival analysis approach. J Public Health (Oxf) 2024; 46:305-314. [DOI: https:/doi.org/10.1093/pubmed/fdae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Abstract
Background
Malnutrition is a public health problem that affects physical and psychosocial well-being. It manifests as a rapid deterioration in nutritional status and bilateral edema due to inadequate food intake or illness.
Methods
This study is a retrospective cohort of 1208 children with severe acute malnutrition (SAM) in Sofala Province from 2018 to 2022. It includes hospitalized children aged 6–59 months with SAM and related complications. The dependent variable is recovery, and the independent variables include age, sex of the child, vomiting, dehydration, hypoglycemia, nutritional edema and anthropometry. Survival curves were plotted using the Kaplan–Meier method, and bivariable and multivariable Cox regression analyses were performed.
Results
The crude analysis revealed significant factors for nutritional recovery in children with SAM, including age, weight, height, malaria, diarrhea and dehydration. Children under 24 months had a 28% lower likelihood of recovery. Weight below 6.16 kg decreased the likelihood by 2%, and height above 71.1 cm decreased it by 20%. Conversely, malaria, diarrhea and dehydration increased the likelihood of recovery. However, after adjustment, only diarrhea remained a significant predictor of nutritional recovery.
Conclusion
This study found that diarrhea is a predictor of nutritional recovery in children with SAM.
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Affiliation(s)
- Audêncio Victor
- School of Public Health, University of São Paulo (USP) , Ave. Doutor Arnaldo, 715, 01246904, São Paulo , Brazil
- Department of Nutrition, Ministry of Health of Mozambique , Ave. Eduardo Mondlane 1008, Maputo, C.P. 264 , Mozambique
| | - Bélio Castro Antônio
- Department of Nutrition, Ministry of Health of Mozambique , Ave. Eduardo Mondlane 1008, Maputo, C.P. 264 , Mozambique
| | - Ana Raquel Manuel Gotine
- School of Public Health, University of São Paulo (USP) , Ave. Doutor Arnaldo, 715, 01246904, São Paulo , Brazil
- Faculty of Health Sciences, Lúrio University , Bairro de Marrere, Rua No. 4250, CP 364, Nampula , Mozambique
| | - Manuel Mahoche
- School of Public Health, University of São Paulo (USP) , Ave. Doutor Arnaldo, 715, 01246904, São Paulo , Brazil
| | - Sancho Pedro Xavier
- Institute of Collective Health, Federal University of Mato Grosso , Ave. Fernando Correia da Costa, nº 2367 - Bairro Boa Esperança, Cuiabá - MT - 78060-900 , Brazil
| | - Osiyallê Akanni Silva Rodrigues
- Institute of Collective Health, Federal University of Bahia (UFBA) , Basílio da Gama Street, Canela, Salvador - BA, 40110-040 Salvador, Bahia state , Brazil
| | - Andrêa J F Ferreira
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Building Tecnocentro, Rua Mundo, 121, Trobogy, Salvador, Bahia 41745-715 Brazil
- Center on Racism , Global Movements, and Population Health Equity, , Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104 , USA
- Drexel University Dornsife School of Public Health , Global Movements, and Population Health Equity, , Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104 , USA
| | - Patrícia H Rondó
- School of Public Health, University of São Paulo (USP) , Ave. Doutor Arnaldo, 715, 01246904, São Paulo , Brazil
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11
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Feleke FW, Masresha SA, Mulaw GF. Time to recovery and its predictors among children aged 6-59 months having uncomplicated severe acute malnutrition attending an outpatient therapeutic program in Northeast Ethiopia: prospective cohort study. Front Nutr 2024; 11:1407931. [PMID: 39171110 PMCID: PMC11337616 DOI: 10.3389/fnut.2024.1407931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/15/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction There are insufficient data regarding the variables influencing recovery times, despite the accessible outpatient therapy program (OTP) bringing services for treating severe acute malnutrition (SAM) closer to the community. Therefore, this study aimed to identify the factors influencing the recovery duration in children with uncomplicated SAM between the ages of 6 and 59 months who were attending an OTP in North Wollo, northern Ethiopia. Methods From February 2021 to July 2021, 356 children, ages 6-59 months, enrolled in a facility-based prospective cohort study. An interviewer administered a semi-structured questionnaire once a week to acquire anthropometric measures. The data were imported into Stata version 14.2 for analysis from EPI data entry version 4.6.06. The time to recovery for each attribute was determined using a log-rank test, a survival curve, and a Kaplan-Meier estimate of the median time to recovery. The Cox Proportional-Hazards Model was used to identify independent predictors of recovery time; statistical significance was indicated at 95% CI and a p-value of 0.05. Results With a recovery rate of 74.7%, the median recovery period was 56 days. Frequency of growth monitoring and promotion (GMP) service utilization [AHR = 1.622 (95% CI: 1.052-2.130)], cough [AHR = 0.385 (95% CI: 0.176-0.843)], maternal delivery at health center [AHR = 1.448 (95% CI: 1.023-2.050)], and maternal literacy [AHR = 1.445 (95% CI: 1.019-2.058)] were determinants of time to recovery. Conclusion The median recovery period was 56 days with a recovery rate of 74.7%. Regular utilization of GMP services, maternal delivery at the health center, and cough at admission were independent predictors for this study. As a result, there should be a greater emphasis on the importance of girls' (future mothers') education and nutrition counseling, particularly the integration of GMP service components into institutional delivery/for girls/women who have received little education on how to improve time to recovery and the success of the OTP.
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12
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Nanga DC, Carboo JA, Chatenga H, Nienaber A, Conradie C, Lombard M, Dolman‐Macleod RC. Micronutrient supplementation practices in relation to the World Health Organisation 2013 guidelines on management of severe acute malnutrition. MATERNAL & CHILD NUTRITION 2024; 20:e13636. [PMID: 38456385 PMCID: PMC11168367 DOI: 10.1111/mcn.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/09/2024]
Abstract
In 2013, the World Health Organisation (WHO) updated the recommendations for micronutrient deficiency correction in hospitalised under-5 children with complicated severe acute malnutrition (SAM). This study aimed to describe the micronutrient deficiency correction practices in relation to WHO 2013 recommendations. Data from medical records of under-5 children admitted for SAM management at two hospitals in South Africa and three tertiary hospitals in Ghana were extracted. Micronutrient correction practices were compared to the WHO 2013 recommendations by considering the dosage, timing of micronutrient supplementation (vitamin A, iron and folic acid) and therapeutic feeds administered. In total, 723 medical records were included. Nearly half (48.3%) of the children received at least one of the studied micronutrients as a supplement. Vitamin A was supplemented in 27.4% of the children, while iron and folic acid were supplemented in 9.5% and 34.9%, respectively. Among the children who received vitamin A, 60.1% received the first dose on Day 1 of admission. Also, 46.4% of the iron-supplemented children received iron within the first week of admission. Vitamin A, iron and folic acid were administered within the dose range of 100,000-180,000 IU, 3.1-7.7 mg per kg per day, and 3-5 mg per day, respectively. Additionally, 71.7% of the children reportedly received therapeutic feeds that met WHO recommendations. The micronutrient deficiency correction practices regarding dose and timing differed from the 2013 WHO guidelines. Qualitative studies investigating the reasons for the disparities are recommended.
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Affiliation(s)
- Doris Cement Nanga
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
- Department of Human Nutrition and Health, Faculty of Food and Human ScienceLilongwe University of Agriculture and Natural ResourcesLilongweMalawi
| | - Janet A. Carboo
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
| | - Humphrey Chatenga
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
- Department of Human Nutrition and Health, Faculty of Food and Human ScienceLilongwe University of Agriculture and Natural ResourcesLilongweMalawi
| | - Arista Nienaber
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
| | - Cornelia Conradie
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
| | - Martani Lombard
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
| | - Robin Claire Dolman‐Macleod
- Centre of Excellence for Nutrition (CEN), Faculty of Health ScienceNorth‐West UniversityPotchefstroomSouth Africa
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Bahwere P, Funnell G, Qarizada AN, Woodhead S, Bengnwi W, Le MT. Effectiveness of a nonweight-based daily dosage of ready-to-use therapeutic food in children suffering from uncomplicated severe acute malnutrition: A nonrandomized, noninferiority analysis of programme data in Afghanistan. MATERNAL & CHILD NUTRITION 2024; 20:e13641. [PMID: 38627974 PMCID: PMC11168373 DOI: 10.1111/mcn.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/02/2024] [Accepted: 02/27/2024] [Indexed: 06/13/2024]
Abstract
Severe acute malnutrition (SAM) remains a major global public health problem. SAM cases are treated using ready-to-use therapeutic food (RUTF) at a dosage of ∼200 kcal/kg/day per the standard treatment protocol (STD). Emerging evidence on simplifications to the standard protocol, which among other adaptations, includes reducing the daily RUTF dosage, indicates that it is effective and safe for treating children with SAM. In response to a foreseen stock shortage of RUTF, the government of Afghanistan endorsed the temporary use of a modified treatment protocol in which the daily RUTF dosage was prescribed at 1000 kcal/day (irrespective of body weight) until the child achieved moderate acute malnutrition status (weight-for-height z-score ≥ -3 or mid-upper arm circumference [MUAC] ≥ 115 mm), at which point 500 kcal/day was prescribed until cured (modified treatment protocol [MTP]). In this paper, we report the results of this nonweight-based daily RUTF dosage experience. Data of 2042 children with SAM, treated using either the STD protocol (n = 269) or the MTP protocol (n = 1773) from August 2019 to March 2021 in five provinces, were analyzed. The per-protocol analyses confirmed noninferiority of MTP protocol when compared to STD protocol for recovery rate [93.3% vs. 90.2%; ∆ (95% confidence interval, CI) = 3.1 (-0.9; 7.2) %] and length-of-stay [82.6 vs. 75.6 days; ∆ (95% CI) = 6.9 (3.3; 10.5) days], considering the margin of noninferiority of -10% and +14 days, respectively. Weight gain velocity was smaller in the MTP protocol group than in the STD protocol group [3.7 (1.7) vs. 5.2 (2.9) g/kg/day; ∆ (95% CI) = -1.5 (-1.8, -1.2); p < 0.001]. The STD group had a significantly higher mean than the MTP group for absolute MUAC gain [∆ (95% CI) = 1.7 (1.0; 2.3) mm; p < 0.001] and the MUAC velocity [∆ (95% CI) = 0.29 (0.20; 0.37) mm/week; p < 0.001]. Our results confirm the noninferiority of a nonweight-based daily dosage and support the endorsement of this modification as an alternative to the standard protocol in resource-constrained contexts.
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Affiliation(s)
- Paluku Bahwere
- Center for Epidemiology, Biostatistics and Clinical Research (CR2), School of Public HealthUniversité Libre de BruxellesBrusselsBelgium
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14
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Tesfay W, Abay M, Teklehaimanot BF, Gebremedhin A. Stabilizing time and its predictors among 1-59 months old children managed for severe acute malnutrition during the humanitarian crisis in Tigray regional state of Ethiopia, 2023: a prospective cohort study. BMC Pediatr 2024; 24:221. [PMID: 38561711 PMCID: PMC10983702 DOI: 10.1186/s12887-024-04711-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Higher rate of acute malnutrition is observed in emergencies compared to non-emergency settings and severe acute malnutrition upsurges alarmingly and become deadly in humanitarian crises due to lack of food, lack of quality water supply and insufficient healthcare. Research is one learning tool by identifying strength and areas of improvement. However, little is known about outcomes of therapeutic feeding programmes in comparison with the standard indicators set in humanitarian setting. METHODS Health facility based prospective cohort study was conducted using routinely collected programme data of children hospitalized to the inpatient therapeutic feeding center in suhul general hospital from January 1st, 2023 to June 30, 2023. Data was collected using a form developed relating to the federal ministry of health standard management protocols for severe acute malnutrition then it was cleaned, coded and entered to EpiData version 4.2.0 and then exported to SPSS version 25 for analysis. RESULTS From 184 children, 96.2% were stabilized while the remaining 3.8% were censored with overall median stabilizing time of 8 days. Weight gain was used as one of the discharging criteria for infants less than six months and their mean weight gain found to be 12.89 g per kilogram daily. Appetite test (AHR = 0.338; 95% CI: 0.221-0.518), blood transfusion (AHR = 5.825; 95% CI: 2.568-13.211), IV fluid resuscitation (AHR = 2.017; 95% CI: 1.094-3.717), IV antibiotics (AHR = 2.288; 95% CI: 1.164-4.500) and NG tube feeding (AHR = 1.485; 95% CI: 1.065-2.071) were identified as significant predictors of stabilizing time. CONCLUSION All the outcome indicators for stabilization center are consistent with the SPHERE association set of standards during humanitarian intervention. The hospital and other concerned humanitarian organizations should focus on sustaining these achievements as suhul hospital is the main treatment center for children suffering from severe acute malnutrition in the northwest zone of Tigray regional state. Further pre-post experimental studies which compare the stabilizing time before and after crisis are recommended.
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Affiliation(s)
- Wagnew Tesfay
- Medical Teams International (MTI), Shire Field Office, Nutrition Supervisor, Shire, Ethiopia.
| | - Mebrahtu Abay
- College of Health Sciences, Aksum University, Aksum, Ethiopia
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15
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Mercedes RA, Kasbaum MA, George PE, Tumweheire EG, Scheurer ME, Nabukeera-Barungi N. Nutritional Recovery of Children With HIV and Severe Acute Malnutrition Attending an Outpatient Therapeutic Care Program. J Acquir Immune Defic Syndr 2023; 94:66-72. [PMID: 37314836 DOI: 10.1097/qai.0000000000003222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/03/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite significant morbidity and mortality from HIV and severe acute malnutrition (SAM) among children in sub-Saharan Africa, research is lacking in these children. We describe the proportion of children living with HIV with SAM achieving recovery, the factors associated with recovery, and time to recovery in an outpatient therapeutic care program. SETTING AND METHODS This is a retrospective observational study of children with SAM and HIV on antiretroviral therapy (6 months-15 years), enrolled in outpatient therapeutic care from 2015 to 2017 at a pediatric HIV clinic in Kampala, Uganda. SAM diagnosis and recovery by 120 days after enrollment were determined per World Health Organization guidelines. Cox-proportional hazards models were used to determine predictors of recovery. RESULTS Data from 166 patients were analyzed (mean age 5.4 years, SD 4.7). Outcomes showed 36.1% recovered, 15.6% were lost to follow-up, 2.4% died, and 45.8% failed. Average time to recovery was 59.9 days (SD 27.8). Patients 5 years or older were less likely to recover (crude hazard ratio [CHR] = 0.33, 95% CI: 0.18 to 0.58). In multivariate analysis, febrile patients were less likely to recover (adjusted hazard ratio = 0.53, 95% CI: 0.12 to 0.65). Patients with CD4 count of 200 or less at enrollment were less likely to recover (CHR = 0.46, 95% CI: 0.22 to 0.96). CONCLUSIONS Despite treatment with antiretroviral therapy for children living with HIV, we observed poor rates of recovery from SAM, below the international target of >75%. Moreover, patients 5 years and older, fever, or low CD4 at diagnosis of SAM may require more intense therapy or closer monitoring than their counterparts.
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Affiliation(s)
| | - Marie A Kasbaum
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Paul E George
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Currently, Department of Pediatrics, Emory University, Atlanta, GA
| | - Enid G Tumweheire
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda; and
| | | | - Nicolette Nabukeera-Barungi
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda; and
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Ahmed JA, Yusuf N, Wilfong T, Tukeni KN, Berhanu H, Roba KT. Treatment outcomes among children admitted stabilization centers in Eastern Ethiopia: retrospective study. Front Public Health 2023; 11:1165858. [PMID: 37533525 PMCID: PMC10392950 DOI: 10.3389/fpubh.2023.1165858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND There is improved access to Sever Acute Malnutrition management in Ethiopia; however, studies have revealed an alarming rate of defaulters' poor recovery and deaths, emphasizing the importance of researching to identify major causes. As a result, the goal of this research is to identify treatment outcome determinants and associated factors in severely malnourished children aged 6-59 months admitted to public hospitals in Eastern Ethiopia's stabilization centers. METHODS This study used an institutional-based retrospective cohort study design with 712 children aged 6 to 59 months. Data was gathered using a Sever Acute Malnutrition registration logbook and patient charts. Participants were chosen at random from their respective healthcare facilities based on population proportion. Epi-data was entered and analyzed using STATA version 14. To identify associated factors, the Cox proportional hazard Ratio was calculated, and a p-value of 0.05 at the 95% confidence interval was considered statistically significant. RESULTS This study revealed that only 70.65% (95% CI = 67.19, 73.88) of the children were cured while 17.84% defaulted from the management and 5.90% died. Children who did not have tuberculosis (AHR = 1.58, 95%CI:1.04, 2.40), anemia (AHR = 1.31, 95% CI:1.03, 1.68), Kwash dermatosis (AHR = 1.41, 95%CI:1.04, 1.91), or on NG-tube (AHR = 1.71, 95%CI:1.41, 2.08) were more likely to be cured from SAM. CONCLUSION This study discovered that the cure rate is extremely low and the defaulter rate is extremely high. As a result, intervention modalities that address the identified factor are strongly recommended to accelerate the rate of recovery in Eastern Ethiopia.
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Affiliation(s)
| | - Newas Yusuf
- School of Public Health, Haramaya University, Harar, Ethiopia
| | - Tara Wilfong
- College of Health Sciences, School of Public Health, Haramaya University, Harar, Ethiopia
| | | | - Hiwot Berhanu
- School of Public Health, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- College of Health Sciences, School of Public Health, Haramaya University, Harar, Ethiopia
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Mokori A, Ndungutse AH, Amongin D, Agabiirwe CN, Byabasheija R, Draru J. Use of collaborative learning approach for increased cure rate among children aged 6-59 months with severe wasting in Karamoja, Uganda. BMJ Open Qual 2023; 12:bmjoq-2022-001941. [PMID: 36764732 PMCID: PMC9923296 DOI: 10.1136/bmjoq-2022-001941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND At 10%, Karamoja region has the highest rate of child wasting in Uganda. The region has 126 outpatient therapeutic care (OTC) sites for managing children with severe acute malnutrition. LOCAL PROBLEM Cure rate (CR) in OTC in Karamoja remains below the international standard of over 75%. The study aimed at increasing the CR in 10 OTC sites in Karamoja, from 74.1% to >75% in 13 months. METHODS The study commenced in July 2018, up to September 2019, in purposively selected health facilities in six districts in Karamoja. Quality improvement (QI) methods per the Ministry of Health QI Framework were applied. QI teams (QITs) tracked the outcome of the tested changes for 13 months. χ2 tests were used to assess the intrafacility and interdistrict association in CR. INTERVENTION Institute for Health Improvement (IHI) (2003) improvement model was applied in this collaborative. QITs conducted root cause analysis of CR gaps, which guided them in the development of improvement aims, changes and indicators. QITs used plan-do-study-act cycles to test and adopt the feasible changes. RESULTS CR increased from 74.1% to 78.6%, with an overall average of 80% within 13 months. Abim district had the highest CR (83.3%) and Kaabong district the lowest (75.2%). Health centre II (84.0%) had the highest CR. Assigning village health teams to follow up caregivers of children in OTC with missed appointments, allocation of village health teams and local leaders to monitor the administration of ready-to-use therapeutic food to children, and screening and treating comorbidities among children in OTC increased CR. CONCLUSIONS QI methods focusing on collaborative learning increased CR among children in OTC in Karamoja. Sustaining the gains requires district health offices, partners and health facility management's commitment to institutionalise the QI collaborative learning approaches.
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Affiliation(s)
| | | | | | | | | | - Joyce Draru
- Nursing, Arua Regional Referral Hospital, Arua, West Nile, Uganda
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18
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Tsegaye A, Lencha B, Kumsa K. Predictors of time to recovery from uncomplicated severe acute malnutrition among 6-59 months children treated in out patient treatment in health posts of Nagele Arsi district: a retrospective cohort study. BMC Pediatr 2022; 22:712. [PMID: 36514008 PMCID: PMC9746122 DOI: 10.1186/s12887-022-03767-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Access to outpatient therapeutic feeding programs (OTP) for all children who have uncomplicated severe acute malnutrition (SAM) remains a global public health priority. Identifying predictors that determine time-to-recovery from severe acute malnutrition optimize therapeutic success. However, reliable evidence on the determinants of time to recovery at health posts was not available in Nagele Arsi district of South Ethiopia. OBJECTIVE This study was aimed to identify determinants of time-to-recovery from uncomplicated SAM among children aged (6-59) months treated at an OTP in health posts of Nagele Arsi district, Southern Ethiopia. METHODS Institutional based retrospective cohort study was conducted among 357 children treated in Negele Arsi district from July1, 2018 to June 30, 2020. The children were selected using simple random sampling from 20 health posts. SAM treatment outcomes were compared against international SPHERE standards. The average time-to-recovery was estimated using Kaplan-Meier survival curve and the independent predictors of time to recovery were determined using multivariable Cox-proportional hazard model. The strength of the association was done using adjusted hazard ratio (AHR) with 95% confidence intervals. Statistical significance was declared at p value < 0.05. The results were presented by text, tables and figures. RESULT A total of 284 (79.6%) children recovered during follow up. The mean weight gain for recovered children was 4.7 + 2.4 g/kg/day. The median time-to-recovery was 44 days 95% CI (42.7-45.3). Children who received Amoxicillin, AHR =2.574, 95% CI (1.879-3.525); de-wormed, AHR = 1.519, 95% CI (1.137-2.031); received Vitamin A, AHR = 2.518, 95% CI, (1.921-3.301) and new admissions, AHR = 1.823, 95%CI, (1.224-2.715) were more likely to recover. However, those who admitted with non-edema, AHR = 0.256, 95% CI, (0.189-0.346); had cough at admission, AHR = 0.513, 95 CI, (0.366-0.719) and had diarrhea at admission AHR = 0.5, 95% CI, 0.5 (0.350-0.712) were less likely to recover. CONCLUSION AND RECOMMENDATION The recovery rate was within the acceptable ranges of International Sphere Standards. Those children who had cough and diarrhea should be given due attention from health extension workers and program planners. Appropriate provision of routine medication and timely intervention of co-morbidity are needed to increase chance of early recovery.
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Affiliation(s)
| | - Bikila Lencha
- Department of Public Health, Madda Walabu University, Shashemene, Oromia Ethiopia
| | - Kebede Kumsa
- Department of Public Health, Madda Walabu University, Shashemene, Oromia Ethiopia
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19
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Arredondo-Hernandez R, Siebe C, Castillo-Rojas G, Ponce de León S, López-Vidal Y. The synergistic interaction of systemic inflammation, dysbiosis and antimicrobial resistance promotes growth restriction in children with acute severe malnutrition: An emphasis on Escherichia coli. FRONTIERS IN ANTIBIOTICS 2022; 1:1001717. [PMID: 39816412 PMCID: PMC11732057 DOI: 10.3389/frabi.2022.1001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/05/2022] [Indexed: 01/18/2025]
Abstract
A healthy development is denied to millions of children worldwide as harsh life conditions manifest themselves in an altered inflammation-prone microbiome crosstalk environment. Keynote of this tragedy is that insufficient nutritious amino acid blocks lipids-intake to sustain diverse microbiota, and promotes the generalist strategy followed by Escherichia coli -besides other proteobacteria- of shifting gut metabolism, subverting the site specificity of first immune reaction. Furthermore, it could be hypothesized that selective success lies in their ability to induce inflammation, since this phenomenon also fuels horizontal gene transfer (HGT). In this review, we dilucidate how immune mechanisms of environmental enteric dysfunction affect overgrowth restriction, infectious morbidity rate, and acquired lifelong risks among severe acute malnourished children. Also, despite acknowledging complexities of antimicrobial resistant enrichment, we explore and speculate over the links between virulence regulation and HGT as an indissociable part in the quest for new inflammatory niches by open genome bacteria, particularly when both collide in the most vulnerable.
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Affiliation(s)
- Rene Arredondo-Hernandez
- Laboratorio de Microbioma, División de Investigación y División de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Christina Siebe
- Instituto de Geología, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Gonzalo Castillo-Rojas
- Programa de Inmunología Molecular Microbiana, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Samuel Ponce de León
- Laboratorio de Microbioma, División de Investigación y División de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Yolanda López-Vidal
- Programa de Inmunología Molecular Microbiana, Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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20
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Tsegaye AT, Pavlinac PB, Turyagyenda L, Diallo AH, Gnoumou BS, Bamouni RM, Voskuijl WP, van den Heuvel M, Mbale E, Lancioni CL, Mupere E, Mukisa J, Lwanga C, Atuhairwe M, Chisti MJ, Ahmed T, Shahid AS, Saleem AF, Kazi Z, Singa BO, Amam P, Masheti M, Berkley JA, Walson JL, Tickell KD. The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6-23 Months in Sub-Saharan Africa and South Asia. Nutrients 2022; 14:3481. [PMID: 36079736 PMCID: PMC9460249 DOI: 10.3390/nu14173481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6−23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.
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Affiliation(s)
| | | | | | - Abdoulaye H. Diallo
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina Faso
| | - Blaise S. Gnoumou
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina Faso
| | - Roseline M. Bamouni
- Department of Public Health, University Joseph Ki-Zerbo, Ouagadougou 03BP7021, Burkina Faso
| | - Wieger P. Voskuijl
- Amsterdam UMC, University of Amsterdam, Amsterdam Centre for Global Child Health & Emma Children’s Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Meta van den Heuvel
- Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Emmie Mbale
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 265, Malawi
| | - Christina L. Lancioni
- Department of Pediatrics, Oregon Health and Science University, Portland, OR 97239, USA
| | - Ezekiel Mupere
- Uganda-CWRU Research Collaboration, Kampala P.O. Box 663, Uganda
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda
| | - John Mukisa
- Uganda-CWRU Research Collaboration, Kampala P.O. Box 663, Uganda
| | | | | | - Mohammod J. Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Abu S.M.S.B. Shahid
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka 1212, Bangladesh
| | - Ali F. Saleem
- Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Zaubina Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | | | - Pholona Amam
- Kenya Medical Research Institute, Nairobi 54840, Kenya
| | - Mary Masheti
- Kenya Medical Research Institute, Nairobi 54840, Kenya
| | - James A. Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi 80108, Kenya
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi 184742, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Judd L. Walson
- Departments of Global Health, University of Washington, Seattle, WA 98195, USA
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi 184742, Kenya
| | - Kirkby D. Tickell
- Departments of Global Health, University of Washington, Seattle, WA 98195, USA
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21
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Owusu SM, Chen J, Merz E, Fu C. Progressing towards nutritional health in Sub‐Saharan Africa: An econometric analysis of the effect of sustainable food production on malnutrition. Int J Health Plann Manage 2022; 37:2266-2283. [DOI: 10.1002/hpm.3468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/05/2022] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Jianlin Chen
- School of Business Jinggangshan University Ji'an Jiangxi China
| | - Ellen Merz
- School of Business Jinggangshan University Ji'an Jiangxi China
| | - Chuanbo Fu
- School of Business Jinggangshan University Ji'an Jiangxi China
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22
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O’Brien KS, Sié A, Dah C, Ourohiré M, Ouedraogo M, Boudo V, Arzika A, Lebas E, Nyatigo F, Godwin W, Kelly JD, Arnold BF, Oldenburg CE. Comparing Azithromycin to Amoxicillin in the Management of Uncomplicated Severe Acute Malnutrition in Burkina Faso: A Pilot Randomized Trial. Am J Trop Med Hyg 2022; 106:930-938. [PMID: 35008055 PMCID: PMC8922483 DOI: 10.4269/ajtmh.21-1023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/12/2021] [Indexed: 11/07/2022] Open
Abstract
Azithromycin is a promising alternative to amoxicillin in the management of uncomplicated severe acute malnutrition (SAM) as it can be administered as a single dose and has efficacy against several pathogens causing infectious disease and mortality in children under 5. In this pilot trial, we aimed to establish the feasibility of a larger randomized controlled trial and provide preliminary evidence comparing the effect of azithromycin to amoxicillin on weight gain in children with uncomplicated SAM. We enrolled children 6-59 months old with uncomplicated SAM at six healthcare centers in Burkina Faso. Participants were randomized to a single dose of azithromycin or a 7-day course of amoxicillin and followed weekly until nutritional recovery and again at 8 weeks. Apart from antibiotics, participants received standard of care, which includes ready-to-use therapeutic food. Primary feasibility outcomes included enrollment potential, refusals, and loss to follow-up. The primary clinical outcome was weight gain (g/kg/day) over 8 weeks. Outcome assessors were masked. Between June and October 2020, 312 children were screened, 301 were enrolled with zero refusals, and 282 (93.6%) completed the 8-week visit. Average weight gain was 2.5 g/kg/day (standard deviation [SD] 2.0) in the azithromycin group and 2.6 (SD 1.7) in the amoxicillin group (mean difference -0.1, 95% CI -0.5 to 0.3, P = 0.63). Fewer adverse events were reported in the azithromycin group (risk ratio 0.50, 95% CI 0.31-0.82, P = 0.006). With strong enrollment and follow-up, a fully powered trial in this setting is feasible.
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Affiliation(s)
- Kieran S. O’Brien
- Francis I Proctor Foundation, University of California, San Francisco, California
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | - Valentin Boudo
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Ahmed Arzika
- Centre de Recherche et Interventions en Santé Publique, Niamey, Niger
| | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, California
| | - Fanice Nyatigo
- Francis I Proctor Foundation, University of California, San Francisco, California
| | - William Godwin
- Francis I Proctor Foundation, University of California, San Francisco, California
| | - J. Daniel Kelly
- Francis I Proctor Foundation, University of California, San Francisco, California
| | - Benjamin F. Arnold
- Francis I Proctor Foundation, University of California, San Francisco, California;,Department of Ophthalmology, University of California, San Francisco, California
| | - Catherine E. Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, California;,Department of Ophthalmology, University of California, San Francisco, California;,Department of Epidemiology & Biostatistics, University of California, San Francisco, California,Address correspondence to Catherine E. Oldenburg, Francis I. Proctor Foundation, University of California, San Francisco, 490 Illinois St., 2nd floor, San Francisco, CA 94158. E-mail:
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23
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Govender I, Rangiah S, Kaswa R, Nzaumvila D. Malnutrition in children under the age of 5 years in a primary health care setting. S Afr Fam Pract (2004) 2021; 63:e1-e6. [PMID: 34677078 PMCID: PMC8517826 DOI: 10.4102/safp.v63i1.5337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 02/03/2023] Open
Abstract
In this study, we outlined the types of malnutrition amongst children, the causes of malnutrition intervention at the primary health care level and some recommendations to alleviate childhood malnutrition in South Africa.
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Affiliation(s)
- Indiran Govender
- Department of Family Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa.
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