Management of severe acute malnutrition

Cloete, Jeané

doi:10.7196/samjnew.7782

Cited by 17 publications

(17 citation statements)

References 20 publications

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“…Undernutrition is a devastating condition which affects the entire body; this predisposes children to opportunistic infections and severe illness. Acute undernutrition is known to be complicated by life-threatening medical conditions such as dehydration and shock, hypoglycaemia, hypothermia, electrolyte abnormalities, and micronutrient deficiencies [3–5].…”

Section: Introductionmentioning

confidence: 99%

Undernourished children presenting to an urban emergency department of a tertiary hospital in Tanzania: a prospective descriptive study

et al. 2019

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Background: Childhood undernutrition causes significant morbidity and mortality in low- and middle-income countries (LMICs). In Tanzania, the in-hospital prevalence of undernutrition in children under five years of age is approximated to be 30% with a case fatality rate of 8.8%. In Tanzania, the burden of undernourished children under five years of age presenting to emergency departments (EDs) and their outcomes are unknown. This study describes the clinical profiles and outcomes of this population presenting to the emergency department of Muhimbili National Hospital (ED-MNH), a large, urban hospital in Dar es Salaam, Tanzania. Methods This was a prospective descriptive study of children aged 1–59 months presenting to the ED-MNH over eight weeks in July and August 2016. Enrolment occurred through consecutive sampling. Children less than minus one standard deviation below World Health Organization mean values for Weight for Height/Length, Height for Age, or Weight for Age were recruited. Structured questionnaires were used to document primary outcomes of patient demographics and clinical presentations, and secondary outcomes of 24-h and 30-day mortality. Data was summarised using descriptive statistics and relative risks (RR). Results A total of 449 children were screened, of whom 34.1% (n = 153) met criteria for undernutrition and 95.4% (n = 146) of those children were enrolled. The majority of these children, 56.2% (n = 82), were male and the median age was 19 months (IQR 10–31 months). They presented most frequently with fever 24.7% (n = 36) and cough 24.0% (n = 35). Only 6.7% (n = 9) were diagnosed with acute undernutrition by ED-MNH physicians. Mortality at 24 h and 30 days were 2.9% (n = 4) and 12.3% (n = 18) respectively. A decreased level of consciousness with Glasgow Coma Scale below fifteen on arrival to the ED and tachycardia from initial vital signs were found to be associated with a statistically significant increased risk of death in undernourished children, with mortality rates of 16.1% (n = 23), and 24.6% (n = 35), respectively. Conclusions In an urban ED of a tertiary referral hospital in Tanzania, undernutrition remains under-recognized and is associated with a high rate of in-hospital mortality.

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Section: Introductionmentioning

confidence: 99%

Undernourished children presenting to an urban emergency department of a tertiary hospital in Tanzania: a prospective descriptive study

et al. 2019

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“…The likelihood of recovery of children who took amoxicillin is two times compared with children who didn't take it. Severe acute malnutrition affects the whole system and it primarily compromises the immune system of children due to reductive adaption [60]. This paves the way for multiclausal infections which could delay the time of recovery of children [61].…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes of severe acute malnutrition and predictors of recovery in under-five children treated within outpatient therapeutic programs in Ethiopia: a systematic review and meta-analysis

2020

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Background: Severe acute malnutrition affects around 17 million under-five children in the world, of which the highest burden is accounted by Sub-Saharan Africa where Ethiopia is found. Though there are few individual, inconsistent and inconclusive studies, there is no nationally representative study on treatment outcomes of SAM in outpatient therapeutic feeding programs of Ethiopia. This study aimed at estimating the pooled treatment outcomes and predictors of recovery rate among under-five children with SAM in Ethiopia. Methods: Electronic databases (PubMed, Medline (EBSCOhost), EMBASE (Elsevier), CINAHL (EBSCOhost), web of science, Scopus, Science Direct and Food Science and Technology Abstracts (FSTA)), and grey literature sources (Google scholar, Mednar, World Cat and google) were used to retrieve articles. The random effect model was used to estimate the pooled treatment outcomes. Hazard ratios were used to determine the predictors of recovery rate. Cochran's Q, I 2 , and univariate Meta regression were done for heterogeneity. Begg's & Egger's tests were used for publication bias. Results: Nineteen articles with a total number of 23,395 under-five children with SAM were used for this metaanalysis. The pooled recovery, death, defaulter and non-recovery rates were 70% (95% CI: 64, 76), 2% (95% CI: 1, 2), 10% (95%CI: 7, 12), 15% (95% CI: 10, 20), respectively. Diarrhea (HR = 0.8, 95% CI: 0.75, 0.94), no edema (HR = 0.41, 95% CI: 0.33, 0.50) and amoxicillin (HR = 1.81, 95% CI: 1.18, 2.44) were independent predictors of recovery rate of children with SAM in Ethiopia. Publication year was found to be the potential source of heterogeneity between included studies.

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“…Similarly, food insecurity could contribute to sharing food among family members and this may affect recovery rate of children (33). (60). This paves the way for multiclausal infections which could delay the time of recovery of children (61).…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes of severe acute malnutrition and Predictors of Recovery in Under-Five children treated within Outpatient Therapeutic Program in Ethiopia: A systematic review and meta-analysis

Bitew

Alemu

Worku

2020

Preprint

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Introduction Severe acute malnutrition affects around 17 million under-five children in the world, of which the highest burden is accounted by Sub-Saharan Africa where Ethiopia is found. Besides few individualized, inconsistent and inconclusive studies, there is no nationally representative study conducted on treatment outcomes of SAM in outpatient therapeutic feeding programs in Ethiopia. This study aimed at estimating the pooled treatment outcomes and predictors of recovery rate among under- five children with SAM in Ethiopia. Methods Both electronic databases (PubMed, Medline (EBSCOhost), EMBASE (Elsevier), CINAHL (EBSCOhost), web of science, Scopus, Science Direct and Food Science and Technology Abstracts (FSTA)) and grey literature sources (Google scholar, Mednar, World Cat and google) were used to retrieve articles. The random effect model was used to estimate the pooled treatment outcomes. Hazard ratios were used to determine the predictors of recovery rate. Cochran’s Q, I 2 , and univariate Meta regression were done for heterogeneity as well as Begg’s & Egger’s tests for publication bias. Results Nineteen articles with a total number of 23395 under-five children with SAM were used for this meta-analysis. The pooled recovery, death, defaulter and non-recovery rates were 70% (95% CI: 64.45, 75.72), 1.69% (95% CI: 1.06, 2.31), 9.7% (95%CI: 7, 12.4), 15.14% (95% CI: 10.11, 20.16), respectively. Diarrhea (HR=0.8, 95% CI: 0.75, 0.94), no edema (HR=0.41, 95% CI: 0.33, 0.50) and amoxicillin (HR=1.81, 95% CI: 1.18, 2.44) were independent predictors of recovery rate of children with SAM in Ethiopia. Publication year was found to be the potential source of heterogeneity among the included studies. Conclusion The treatment outcomes of children with SAM from outpatient therapeutic feeding programs of Ethiopia are lower than the sphere guidelines, WHO and national recommendations. Diarrhea and no edema antagonized the recovery rate of children while amoxicillin enhanced the recovery rate of children from SAM. Community health workers need to be trained. Especial attention should be given while treating children with diarrhea and severe wasting. Community mobilization is also recommended to increase community awareness about the therapeutic foods.

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Management of severe acute malnutrition

Cited by 17 publications

References 20 publications

Undernourished children presenting to an urban emergency department of a tertiary hospital in Tanzania: a prospective descriptive study

Undernourished children presenting to an urban emergency department of a tertiary hospital in Tanzania: a prospective descriptive study

Treatment outcomes of severe acute malnutrition and predictors of recovery in under-five children treated within outpatient therapeutic programs in Ethiopia: a systematic review and meta-analysis

Treatment outcomes of severe acute malnutrition and Predictors of Recovery in Under-Five children treated within Outpatient Therapeutic Program in Ethiopia: A systematic review and meta-analysis

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