Clinical Profile And Major Co-morbidities Among Children With Severe Acute Malnutrition (SAM): Experience From A Tertiary Care Teaching Hospital
Keywords:
Severe acute malnutrition (SAM), complementary feeding, co-morbidities, outcomeAbstract
Background: Malnutrition is a leading cause of morbidity and mortality in children aged less than 5 years and is responsible for 60% of the 10 million deaths in this age group worldwide. Aim: To study the clinical profile and major clinical co-morbidities among children with severe acute malnutrition (SAM) admitted in a tertiary care teaching hospital. Methods: A prospective study was conducted in a tertiary care teaching hospital of Haryana. All children aged (6 months to 5 years) with severe acute malnutrition (as per WHO definition) admitted in pediatrics ward during 1stApril 2018 to 31st March 2019 were included in the study. The socio-demographic details, anthropometry, clinical details and outcome were recorded in a pre-designed structured performa. Statistical analysis was done using SPSS software versionl6.Chi-square analysis was applied where applicable and Pvalue<0.05 was considered significant. Results: After screening a total of 131children, 102 children who met the inclusion criteria were enrolled in the study. Out of these, 50 (49.02%) were males and 52 (50.98%) were females. Majority of children (i.e. 59.8%) belonged to 6-12 months age group whereas 32.35% were in 12-24 months age group and 7.84% in 24-59 months age group. Majority (92.16% ) belonged to lower socio-economic status. Exclusive breastfeeding for first 6 months was documented in 74.51% of the children while the rest had incomplete/faulty feeding. Delayed initiation of complementary feeds was observed in 80 (78.43%) children and had a significant association with poor future outcome (p<0.05). Major clinical co-morbidities were severe anemia (56.86%), diarrhea (27.45%) and acute lower respiratory tract infection (19.6% ).Specific nutritional deficiencies were rickets in 8 (7.8%) children, nutritional tremors syndrome (NTS) in 03 and scurvy in 01 child respectively. Conclusions: In our study, most vulnerable age group for severe malnutrition was 6-12 months infants. Low socioeconomic status of family and delayed complementary feeding were the major risk factors. Most common co-morbidities were anemia, diarrhea and lower respiratory tract infections.Downloads
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Onis, M.D. and Blossner, M. (1997) WHO global database on child growth and malnutrition. WHO. Available from: http://whalibdoc. who.int/ha/1997/WHO NUT 97.4.pdf.
World Health Organization, Country Office for India; National Rural Health Mission (IN ). Facility Based Care of Severe Acute Malnutrition: Participant Manual. (New Delhi): World Health Organization, Country Office for India; 2011 Mar. 119p.
Amsalu, S.and Tigabu, Z. (2008). Risk factors for severe acute malnutrition in children under the age of five: A case control study. EthiopJ Health Dev 22: 21-25.
Black, R.E., Allen, L.H., Bhutta, Z.A., Caulfield, L.E., de Onis, M, Ezzati, M et al. (2008). Maternal and child undernutrition: global and regional exposures and health consequences. Lancet (London, England) 371(9608): 243-260.
Martins, V.J.B., Toledo Florencio, T.M.M., Grillo, L.P., do Carmo ,P Franco M, Martins, P.A., Clemente, A.P.G et al. (2011).Long-lasting effects of undernutrition. Int J Environ Res Public Health8(6): 1817-1846.
International Institute for Population Sciences (UPS). (2017). National Family Health Survey (NFHS-4), 2015-16. UPS, Mumbai, India.
WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. A joint statement by WHO and UNICEF, 2009. Accessed from http://www.who.int /nutrition/publications/severemal nutrition/9789241598163_eng.p df 8. Singh, T., Sharma, S and Nagesh, S. (2017). Socio-economic status scales updated for 2017. Int J Res Med Sci 5: 3264-3267.
Bhatnagar, S., Lodha, R., Choudhury, P., Sachdev, H.P.S., Shah, N. and Narayan, S.(2007). Guidelines 2006 on hospital based management of severly malnourished children (Adapted from the WHO guidelines). Indian Paediatr44: 443-461.
Das, K., Swain, A., Nayak, A.S., Behera, S and Satpathy, S.K. (2017). Clinical profile and outcome of children with severe acute malnutrition. Int J Ped Res 4(05): 350-356.
A guayo, V .M ., Jacob, S., Badgaiyan, N., Chandra, P., Kumar, A and Singh, K. (2012). Providing care for children with severe acute malnutrition in India: new evidence from Jharkhand. Public Health Nutrition 17(1): 206-211.
Ubesie, A.C.I., Ibeziako,N.S., Ndiokwelu, C.I., Uzoka, C.M. and Nwafor, C.A. (2012). Under-five protein energy malnutrition admitted at the University of Nigeria Teaching Hospital, Enugu: a 10 year retrospective review. NutrJ 11: 43-50.
Gernaat, H.B., Dechering, W.H and Voorhoeve, W.H. (1998). Mortality in severe protein-energy malnutrition at N chelenge, Zambia. J Trap Pediatr 44(4): 211- 217.
Jena, P., Rath, S., Nayak, M.Kand Satapathy, D. (2018). Study of social and demographic determinants of severe acute malnutrition in children aged 6-59 months in a tertiary care centre of Odisha, India. Int J Contemp Pediatr 6(1): 46-51.
Mahgoub, H.M and Adam, I. (2012). Morbidity and mortality of severe malnutrition among Sudanese children in New Haifa Hospital, Eastern Sudan. Trans R SocTrop Med Hyg 106 (1): 66-68.
Singh, M.B., Fotedar, R., Lakshminarayana, J and Anand, P.K. (2006). Studies on the nutritional status of children aged 0-5 years in a drought affected desert area of western Rajasthan, India. Public Health Nutr 9(8): 961-967.
Kumar, P., Singh, A and Nidhi. (2018). Outcome and comorbidities associated with severe acute malnutrition: admitted at Nutrition Rehabilitation Centre (NRC) of a tertiary care centre. J. Evid. Based. Med. Health 5(14): 1258- 1261.
Sharma, M. (2004). P1190 A study of malnutrition and associated infection in children in urban private hospital in India. J Pediatr Gastroenterol Nutr 39(1): S509.
Mathur, A., Tahilramani, G. Yadav, D and Devgan, V. (2016). Experience in managing children with severe acute malnutrition in nutritional rehabilitation centre of tertiary level facility, Delhi, India. Int J Contemp Pediatr 3(2): 597-600.