Comorbidities in children hospitalized with severe acute malnutrition

Abstract

Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the state of Tamil Nadu are severely wasted. The outcome of hospitalized severe acute malnutrition (SAM) children is dependent on the comorbidities present. Objective: The objective of this study is to describe the comorbid conditions in SAM children hospitalized in a tertiary care center. Methodology: This study was a hospital-based descriptive study, conducted from July 2015 to June 2016. A total number of 200 children, who were admitted with SAM as per the World Health Organization criteria, were included in the study. Systemic illness, anemia, vitamin deficiencies, sepsis, retroviral infection, tuberculosis, pneumonia, acute gastroenteritis, urinary tract infection (UTI), measles, skin infections, and worm infestations were the comorbidities considered. Results: Among 200 hospitalized SAM children, the median (interquartile) age was 15 (11–21.75) months; there were 93 (46.5%) boys. Acute gastroenteritis (57.5%) was the most common comorbidity, followed by pneumonia (44.5%), anemia (27%), systemic illness (17%), worm infestation (13.5%), UTI (13.5%), sepsis (13%), skin infection (8%), measles (6%), vitamin deficiency (4%), retroviral infections (3.5%), and tuberculosis (1%). The case fatality rate was 10.5%. Conclusion: Prompt identification of comorbidities is crucial in hospitalized SAM children, which will pave way for their treatment, resulting in better outcomes.

Demographic and clinical profile of children with severe acute malnutrition: an experience from nutritional rehabilitation centre in South Kashmir

“…16,17 Acute gastroenteritis 82.14% was the most common associated infection followed by acute respiratory tract infections 66.07% in our study comparable to similar studies. 11,14 The most common metabolic disturbances were hypoglycaemia 14.28% and hypokalemia 8.9% comparable to studies by Sharma et al and Syed et al 8,11 The Government of India is currently strengthening the integrated child development (ICDS) scheme, working on national guidelines on community-based management of severe acute malnutrition in India (CMAM) and allowing controlled use of ready-to-use therapeutic food (RUTF) in various states so that in the years to come, more SAM children can be taken care well at home. However, in a vast country like India where there is a deficiency of community health workers, it would be difficult to monitor domiciliary care, especially in remote areas hence it is vital to continue with the functioning of NRCs.…”

Clinico-biochemical profile of sick children with severe acute malnutrition

“…[ 3 4 ] The case fatality rate of SAM in under-five children ranges from 30-50% and 35% of death among under-five children is directly or indirectly contributed by malnutrition. [ 5 ] SAM clinically manifests as edema and marasmus, however, kwashiorkor represents the most severe phenotype of edematous malnutrition. [ 6 7 ] Pathophysiology of edema in malnutrition was not established, although current evidence in literature correlates developmental origin and prenatal factors influence the clinical phenotype of malnutrition.…”

Prevalence of tuberculosis in severe acute malnutrition: a prospective observational study

“…The same study found that poor appetite/weight loss was the presenting complaint only in 31% of SAM cases similar to our study (19.6%). In a retrospective study done by Derseh B et al [20] among 413 children, common comorbidities reported were pneumonia(54.8%), gastroenteritis(41.8%) and in a descriptive study by Baskaran VM et al [21] among 200 SAM cases the common comorbidities were acute gastroenteritis (57.5%), pneumonia (44.5%) and anemia (27%). These ndings were similar to our study.…”