A study of clinical profile and outcome of SAM children admitted in nutritional rehabilitation centre, Patna Medical College and Hospital, Patna, Bihar, India

Abstract

Background: Severe Acute malnutrition (SAM) with severe wasting remains a major killer of children. In Bihar 48% of children are stunted, 21 % are wasted and 7% are severely wasted. Even during the first six months of life, 31% are wasted. Under nutrition generally decreases with the increasing mother’s schooling, better nutritional status of the mother. Stunting and under nutrition are higher in rural areas than in urban areas.Methods: It is a hospital based observational study done between June 2017 to December 2017. A total of 55 SAM patients with medical complications in the age group of 6 months to 60 months admitted in Nutritional Rehabilitation center (NRC), Department of Pediatrics, Patna Medical College, Patna were included in the study. Socio-Economic profile, effectiveness of NRC in treating SAM children, and effect of timely initiation of complementary feed on nutritional status of children were assessed.Results: A total of 55 children were admitted in the NRC of PMCH, Patna during the period of June 2017 to Dec 2017. 56.4% were males and 43.6% were females. 36% o were in the age group of 12months to 24months. 78% belonged to below poverty line. Major medical complications were anemia (53%), LRTI (33%) and acute gastroenteritis (29%). Immunisation was complete in only 45%. In only 53% babies Complimentary feeding was initiated after 6 months of age. 67% of the mothers of SAM children were illiterate. 95% children were discharged after gaining proper weight. Defaulter rate was 4% and death rate was 2%. 78% of the admitted children showed good weight gain i.e.>10 gm/kg/day, whereas in 15% children weight gain was in the range of 5-10 gm/kg/day.Conclusions: Many factors such as literacy, income, age of marriage and sanitation facility indirectly or directly influence the nutritional status of children. NRCs provide life-saving care for children with SAM as demonstrated by the high recovery rate (95%).

Length of stay to recover from severe acute malnutrition and associated factors among under-five years children admitted to public hospitals in Aksum, Ethiopia

“…The overall rate of recovery from SAM was found to be 56%, that is consistent with findings from Debrebrhan University that revealed 55.9% rate of recovery [37]. It is significantly higher than that of Ayder hospital (11) other similar studies from Bahirdar [13,35], Ghana [20] and Yemen [36].…”

“…It is similar with the findings of two studies done in Ethiopia [25,26] and one conducted in Nigeria [40]. But the mortality rate is greater than that of some studies done in Ethiopia [11,13,35], India [37,38], Ghana [20] and Yemen [36]. This could be due to lack of close follow up of patients with strict adherence to the national or international SAM management protocols and socioeconomic differences in the different areas.…”

“…It is significantly higher than that of Ayder hospital (11) other similar studies from Bahirdar [ 13 , 35 ], Ghana [ 20 ] and Yemen [ 36 ]. Nevertheless, it is by greater margin below the minimum international standards [ 15 ], in comparison with other study findings in Ethiopia [ 1 , 8 , 24 , 25 , 27 – 32 ] and similar reports from India, Malawi and Uganda [ 34 , 37 – 39 ] as well. This might be due to the relatively higher rate of transfer out to nearby health facility, which probably would be to prevent patient overload since one of the study area (AKU-CSH) is the only referral hospital in this particular study area.…”

“…It is also lower than several studies conducted in the Ethiopia [1,8,11,24,32] and that of Yemen [36]. However, the median LOS is higher than some study reports from some parts of Ethiopia [25,26,33], Ghana [20] and India [37]. This could be due to the differences in underlying co-morbidities, caring practice of healthcare providers, health facility set up and variation in socioeconomic status of the population in these different study areas.…”