Clinical spectrum of severe acute malnutrition among children admitted to nutritional rehabilitation centre of a tertiary care hospital with special reference to incidence of bilateral pitting pedal oedema in children with severe acute malnutrition
DOI:
https://doi.org/10.18203/2349-3291.ijcp20183533Keywords:
Oedema, Pneumonia, Severe acute malnutritionAbstract
Background: Malnutrition is a major cause of morbidity and mortality in under five children globally, according to global nutrition report 2016, forty five percent of deaths in under five children are linked to malnutrition. The objective of this study was to study the clinical spectrum in children with Severe Acute Malnutrition (SAM) admitted to nutritional rehabilitation center of a tertiary care hospital.
Methods: Children between the age group of 6 months to 5 years admitted in the nutritional rehabilitation centre during the period of 1 year (from April 2016 to March 2017) meeting our inclusion criteria were included in the study. We retrospectively reviewed the medical records of these children. Clinical spectrum of SAM was compared with comparison group.
Results: A total of 100 cases were included in the study. Ninety five percent of children met the criteria of weight for height less than 3SD, 45% of children met the criteria of Mid Upper arm Circumference (MUAC) less than 11.5 cms and 5% of children met the criteria of bilateral pitting pedal oedema. Mean age of presentation of children in the present study was 15.8 months among which 45% were males and 55% were females. Major symptoms of the study group were fever, cough, hurried breathing, loss of appetite and loose stools with 79%, 45%, 27%, 26% and 23% as respective frequencies. Pneumonia (43%) was the major comorbidity among children admitted with severe acute malnutrition. Diarrhoea (21%), meningitis (8%), urinary tract infection (6%) were the other co-morbidities present in the study group.
Conclusions: Pneumonia and diarrhoea are the major co-morbidities present in children with SAM. Majority of children fulfil the criteria of weight for height ≤3SD for diagnosis of SAM. There is a low incidence of oedematous malnutrition in the present study.
Metrics
References
UNICEF. Global nutrition report. From promise to impact ending malnutrition by 2030. UNICEF. 2016. Available at http://www.ifpri.org/publication/global-nutrition-report-2016-promise-impact-ending-malnutrition-2030
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):396.
Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, et al. Global, regional, and national comparative risk assessment of behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;386(10010):2287-323.
IIPS. National family health survey - 4. International Institute of Population Sciences, Mumbai; 2015-16. Available at http://rchiips.org/nfhs/pdf/NFHS4/KA_FactSheet.pdf.
Mishra K, Kumar P, Basu S, Rai K, Aneja S. Risk factors for severe acute malnutrition in children below 5 years of age in India: a case-control study. Indian J Pediatr. 2014;81(8):762-5.
Chiabi A, Malangue B, Nguefack S. The clinical spectrum of severe acute malnutrition in children in Cameroon: a hospital-based study in Yaounde, Cameroon. Translational Pediatr. 2017;6(1):32-9.
Kumar R, Singh J, Joshi K, Singh HP, S Bijesh. Co-morbidities in Hospitalized Children with Severe Acute Malnutrition. Indian Pediatr. 2014;51:125-7.
Coulthard M. Oedema in kwashiorkor is caused by hypoalbuminaemia. Paediatr Intl Child Health. 2015;35(2):83-9.
Rytter MJH, Namusoke H, Babirekere-Iriso E, Kæstel P, Girma T, Christensen VB, et al. Social, dietary and clinical correlates of oedema in children with severe acute malnutrition: a cross-sectional study. BMC Pediatr. 2015;15:25.
Saini T, Verma A, Berwal PK. Pattern of co-morbidities in children with severe acute malnutrition admitted in MTC of a teaching hospital of Westeren Rajasthan, India. JMSCR. 2016;4(4):10070-3.
Mutombo T, Keusse J, Sangare A. AIDS and malnutrition in the middle semi-rural pediatric-experience. The protestant hospital of Dabou in Cote d'Ivoire. Med Black Africa. 1996;43:72-7.
Bernal C, Velásquez C, Alcaraz G, Botero J. Treatment of severe malnutrition in children: experience in implementing the World Health Organization guidelines in Turbo, Colombia. J Pediatr Gastroenterol Nutr. 2008;46(3):322-8.
Morgan G. What, if any, is the effect of malnutrition on immunological competence? Lancet. 1997;349(9066):1693-5.
Golden MH. Oedematous malnutrition. Br Med Bull. 1998;54(2):433-44.
Irena AH, Mwambazi M, Mulenga V. Diarrhea is a major killer of children with severe acute malnutrition admitted to inpatient set-up in Lusaka, Zambia. Nutr J. 2011;10:110.
Garg M, Devpura K, Saini SK, Kumara S. A hospital-based study on co-morbidities in children with severe acute malnutrition. J Pediatr Res. 2017;4(01):82-8.
WHO. Maternal, newborn, child and adolescent health: Serious childhood problems in countries with limited resources. WHO. 2004. Available at http://apps.who.int/iris/bitstream/handle/10665/42923/9241562692.pdf;jsessionid=C497AEC0D549E4177798D018AB576573?sequence=1
Chisti MJ, Salam MA, Bardhan PK, Faruque ASG, Shahid ASMSB, Shahunja KM, et al. Severe sepsis in severely malnourished young Bangladeshi children with pneumonia: a retrospective case control study. PLoS One. 2015;10(10):e0139966.
Page AL, de Rekeneire N, Sayadi S, Aberrane S, Janssens A-C, Rieux C, et al. Infections in children admitted with complicated severe acute malnutrition in Niger. PLoS One. 2013;8(7):e68699.
Annane D, Bellissant E, Cavaillon JM. Septic shock. Lancet. 2005;365(9453):63-78.
Ebrahim GJ. Sepsis, septic shock and the systemic inflammatory response syndrome. J Trop Pediatr. 2011;57(2):77-9.
Eisenhut M. Malnutrition causes a reduction in alveolar epithelial sodium and chloride transport which predisposes to death from lung injury. Med Hypotheses. 2007;68(2):361-3.
Eisenhut M. Changes in ion transport in inflammatory disease. J Inflamm (Lond). 2006;3:5.
Waterlow JC. Protein energy malnutrition-the nature and extent of the problem. Clin Nutri. 1997;16(1):3-9.
Whitehead RG, Lunn PG. Endocrines in protein-energy malnutrition. Proc Nutr Soc. 1979;38:69-76.
Hendrickse RG, Coulter JB, Lamplugh SM, MacFarlane SB, Williams TE, Omer MI, et al. Aflatoxins and kwashiorkor. Epidemiology and clinical studies in Sudanese children and findings in autopsy liver samples from Nigeria and South Africa. Bull Soc Exotic Pathol Subsidiaries. 1983;76:559-66.
Golden MH, Ramdath D. Free radicals in the pathogenesis of kwashiorkor. Proceedings Nutr Soc. 1987;46:53-68.
Ciliberto H, Ciliberto M, Briend A, Ashorn P, Bier D, Manary M. Antioxidant supplementation for the prevention of kwashiorkor in Malawian children: randomised, double blind, placebo-controlled trial. BMJ. 2005;330:1109.
Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E. Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome. PLoS One 2012;7(6):e38321.
Frison S, Checchi F, Kerac M. Omitting edema measurement: how much acute malnutrition are we missing? Am J Clin Nutr. 2015;102:1176-81.
Patel B, Gandhi D. WHO classification detecting more severe malnutrition: A comparative study with IAP classification. Indian J Basic Applied Med Res. 2016;5(2):628-34.