Background: Although risk factors for malnutrition have been identified earlier, individual factors potentially change in specific areas over time and a current characterization of risk factors provide the basis for preventative intervention strategies. No guidelines in relation to duration of micronutrient supplementation for treatment of SAM are available. Thus, the study was done to know the adequacy of dose of micronutrients that are presently being supplemented (WHO Protocols) for treating SAM. Methods: It is a case-control study involving 100 cases with severe acute malnutrition and 100 controls having normal nutrition status 6 months to 5 years of age. Detailed clinical data (using a predesigned questionnaire) and anthropometric measurements were recorded for analysis. Blood assay of Zinc, Magnesium and serum Proteins were done on the day of admission (day 1) and again after 2 weeks of treatment with nutritional supplementation (WHO protocols). Results: Out of 100 SAM Cases, 42% were from rural area whereas 76% of controls belonged to urban region (p value 0.03). Twenty-four (24%) mothers of SAM cases were Illiterate, whereas only 6 % of mothers in controls were illiterate. 57 % SAM cases were given breast feeding after 4 hours of life, where as 61% controls were given their first feed within 1 hour of birth with p value <0.01. Eighty-eight controls (88%) were given colostrum, whereas only 62 % SAM cases were given colostrum feeds with p value <0.01. Seventy controls (70%) were given exclusive breast feeding for 6 months whereas only 40% of cases (SAM) was given exclusive breast feeding till 6months of age (p value of <0.01). 57% of top fed cases were given over diluted feeds, only 27% of top fed controls were given over diluted feeds (p value 0.02). 53% of cases were bottle fed and 14% of controls were bottle fed with p value <0.01. Mean value of magnesium and zinc before supplementation was 2.4 mg/dl and 117 mcg/dl respectively with no significant rise after supplementation.
Conclusions:Here is a correlation of severe acute malnutrition with rural area, maternal Illiteracy and low socioeconomic status, deprivation of colostrums feeding, lack of exclusive breast feeding for 6 months, over dilution of top feeds and use of bottle feeding. There is no correlation between SAM and immunization status and demographic parameters like age, sex and religion. SAM is inversely related to duration of exclusive breast feeding. 23% of severely malnourished children had delay of developmental milestones. No significant rise of serum levels was seen with WHO recommended doses of micronutrient supplementation
Background: Pneumonia is one of the leading causes of mortality among under-five children contributing to 15% of deaths all over the world. More than 95% of all new cases of pneumonia in children less than 5 years occur in developing countries due to increased prevalence of under nutrition, inadequate coverage of vaccination, lack of exclusive breast feeding, illiteracy etc. Methods: A total 110 subjects with pneumonia aged 2 months to 5 years were included in the study. Pneumonia was diagnosed clinically and classified according to new guidelines of WHO. Nutrition history including breast feeding practices and immunization history was taken. Anthropometry recorded along with thorough clinical examination bacterial cultures of blood, sputum and nasopharyngeal aspirates were done. Chest X-ray was taken for all patients for confirmation. Results: Out of 110 total subjects, Sixty three cases (57.27%) belonged to the revised WHO classification of 'pneumonia' and 47 (42.72%) cases had 'severe pneumonia'. Ninety cases (81.81%) were less than 3 years of age. The percentage of severe pneumonia was higher in children less than 3 years of age with p value <0.05. No statistical correlation was found between gender and the severity of pneumonia. Out of total subjects, 64 cases were malnourished with weight for age <3 rd percentile. 25 cases belonged to IAP Grade I PEM, 30 cases to Grade II, 7 cases to Grade III and 2 Children belonged to grade IV PEM. There is no correlation between the degree of malnutrition and severity of pneumonia. Severe pneumonia was observed in higher proportion in children who were not exclusively breast fed with p value <0.05. Out of 83 fully vaccinated children, 26 (31.32%) cases had severe pneumonia whereas out of 27 cases of not fully vaccinated group, 21 (77.7%) had severe pneumonia with significant P value <0.05. Twenty six (23.63%) blood samples and 34 (30.9%) sputum/ nasopharyngeal aspirates yielded positive bacterial growth. Common organisms were Staphylococcus aureus (18), Klebsiella (18), CONS (4), Acinetobacter (4) Citrobacter (3), Pseudomonas (1), MRSA (1) and Streptococcus pneumoniae (1). Conclusions: Lack of exclusive breast feeding till 6 months of age, Failure of complete immunization coverage, Child malnutrition, Infancy and toddler age are the risk factors for 'severe pneumonia'. Staphylococcus aureus (18), Klebsiella (18), CoNS (4), Acinetobacter (4), Citrobacter (3) are the common organisms isolated from cultures of blood and sputum/naso pharyngeal aspirates.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.