Classification of Infantile Malnutrition

Walker, A

doi:10.1016/s0140-6736(70)92834-5

Cited by 37 publications

(8 citation statements)

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“…Severe malnutrition was defined as weight-for-age or weight-for-height z score <-3 of the median of the National Center for Health Statistics (NCHS) ( 19 ). We have also included the children with marasmus, or kwashiorkor, or marasmic-kwashiorkor defined according to the Wellcome classification ( 20 ). Acute pneumonia was defined as the radiological evidence of lobar or patchy consolidation ( 6 ) and/or clinical evidence of severe/very severe pneumonia according to the WHO criteria of acute respiratory infection ( 21 ).…”

Section: Methodsmentioning

confidence: 99%

Pulmonary Tuberculosis in Severely-malnourished or HIV-infected Children with Pneumonia: A Review

Chisti

Ahmed

Pietroni

et al. 2013

J Health Popul Nutr

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Presentation of pulmonary tuberculosis (PTB) as acute pneumonia in severely-malnourished and HIV-positive children has received very little attention, although this is very important in the management of pneumonia in children living in communities where TB is highly endemic. Our aim was to identify confirmed TB in children with acute pneumonia and HIV infection and/or severe acute malnutrition (SAM) (weight-for-length/height or weight-for-age z score <-3 of the WHO median, or presence of nutritional oedema). We conducted a literature search, using PubMed and Web of Science in April 2013 for the period from January 1974 through April 2013. We included only those studies that reported confirmed TB identified by acid fast bacilli (AFB) through smear microscopy, or by culture-positive specimens from children with acute pneumonia and SAM and/or HIV infection. The specimens were collected either from induced sputum (IS), or gastric lavage (GL), or broncho-alveolar lavage (BAL), or percutaneous lung aspirates (LA). Pneumonia was defined as the radiological evidence of lobar or patchy consolidation and/or clinical evidence of severe/very severe pneumonia according to the WHO criteria of acute respiratory infection. A total of 17 studies met our search criteria but 6 were relevant for our review. Eleven studies were excluded as those did not assess the HIV status of the children or specify the nutritional status of the children with acute pneumonia and TB. We identified only 747 under-five children from the six relevant studies that determined a tubercular aetiology of acute pneumonia in children with SAM and/or positive HIV status. Three studies were reported from South Africa and one each from the Gambia, Ethiopia, and Thailand where 610, 90, 35, and 12 children were enrolled and 64 (10%), 23 (26%), 5 (14%), and 1 (8%) children were identified with active TB respectively, with a total of 93 (12%) children with active TB. Among 610 HIV-infected children in three studies from South Africa and 137 SAM children from other studies, 64 (10%) and 29 (21%) isolates of M. tuberculosis were identified respectively. Children from South Africa were infected with HIV without specification of their nutritional status whereas children from other countries had SAM but without indication of their HIV status. Our review of the existing data suggests that pulmonary tuberculosis may be more common than it is generally suspected in children with acute pneumonia and SAM, or HIV infection. Because of the scarcity of data, there is an urgent need to investigate PTB as one of the potential aetiologies of acute pneumonia in these children in a carefully-conducted larger study, especially outside Africa.

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Section: Methodsmentioning

confidence: 99%

Pulmonary Tuberculosis in Severely-malnourished or HIV-infected Children with Pneumonia: A Review

Chisti

Ahmed

Pietroni

et al. 2013

J Health Popul Nutr

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“…Severe malnutrition: defined as marasmus, kwashiorkor or marasmic‐kwashiorkor according to the classification of the Wellcome Trust International Working Party (Walker 1970).…”

Section: Methodsmentioning

confidence: 99%

Evaluation of simple laboratory investigations to predict fatal outcome in infants with severe malnutrition presenting in an urban diarrhoea treatment centre in Bangladesh

Chisti

Ahmed

Bardhan

et al. 2010

Tropical Medicine &Amp; International Health

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Summaryobjective To evaluate rapid and simple laboratory investigations to predict fatal outcome in infants presenting with diarrhoea and severe malnutrition. results In logistic regression analyses, after adjusting for all available potential confounders (abnormal WBC count, higher CRP level, hyponatraemia, hypokalaemia, hypocalcaemia, and hypomagnesaemia), cases (n = 10) were significantly associated only with hypoglycaemia (measured using a portable bedside finger blood glucose test) (odds ratio 5.0, CI 1.1-23.0, P = 0.039) on admission.conclusion A simple rapid bedside glucose test may be used to predict the outcome of diarrhoeal infants presenting with severe malnutrition.

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“…In this classification system, children were classified as severe acute malnutrition (SAM), moderate acute malnutrition (MAM), not acutely malnourished but considered at risk (NAM@risk), not acutely malnourished (NAM) or obese as defined by the WHO growth standards [ 4 ]. The definition was based on oedema or weight-for-length z score as reported by the admitting clinicians and verified by the discharging clinician and dietician.MUAC scores were not used as this documentation of this was inconsistent in the reviewed charts In children in whom the Wellcome classification system was used, where the terms kwashiorkor, marasmus or marasmic kwashiorkor were utilised, cases were reclassified according to the WHO classification system using available weights, lengths and clinical information [ 26 ]. The primary focus of this study was to analyse children classified as having SAM, as these children are generally deemed most at risk for mortality.…”

Section: Methodsmentioning

confidence: 99%

Changing mortality amongst hospitalised children with Severe Acute Malnutrition in KwaZulu-Natal, South Africa, 2009 – 2018

et al. 2022

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Background The under-five mortality rates of children in South Africa (SA) remain high despite successful HIV prevention and treatment programs. The in-hospital mortality of children with severe acute malnutrition remains a key obstacle. This study identifies and describes changes in the mortality of under-five children with severe acute malnutrition (SAM) following the implementation of HIV and malnutrition prevention and treatment programmes. Methods This was a retrospective review of in-hospital mortality records and databases. The study was based at a large referral hospital in KwaZulu-Natal (KZN), where HIV and malnutrition rates are high, and SAM children are managed with standard WHO guidelines. Records of children under five years old who died from 2009 to 2018 were analysed. Results Of the 698 under-five children who died in this period, 285 (40, 8% of all under-5 deaths) were classified as having SAM. The number of HIV-infected SAM deaths dropped significantly, especially those below six months of age, mirroring the expansion of HIV treatment and prevention programmes. Despite this and a significant drop in the proportion of SAM admissions identified, there was no change in SAM case fatality rates over the ten years. Septicaemia remained the most common cause of death in children with SAM. Conclusions Despite significant decreases in HIV-related malnutrition deaths over ten years, the lack of change in SAM case fatality rates is a concern at this referral hospital. Standardised WHO inpatient management protocols, may require review, especially where underlying medical conditions may contribute to SAM deaths in HIV-negative children.

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Classification of Infantile Malnutrition

Cited by 37 publications

References 0 publications

Pulmonary Tuberculosis in Severely-malnourished or HIV-infected Children with Pneumonia: A Review

Pulmonary Tuberculosis in Severely-malnourished or HIV-infected Children with Pneumonia: A Review

Evaluation of simple laboratory investigations to predict fatal outcome in infants with severe malnutrition presenting in an urban diarrhoea treatment centre in Bangladesh

Changing mortality amongst hospitalised children with Severe Acute Malnutrition in KwaZulu-Natal, South Africa, 2009 – 2018

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