Study of risk factors of severe acute malnutrition (SAM) in children 6 months to 5 years of age and evaluation of effect of micronutrient supplementation (WHO protocol) on serum zinc and magnesium levels: a case control study

Kamatham Madhusudhan, Rajeev P.K, Shireesha A, Gummadi Vandana Ushashree


Background: Although risk factors for malnutrition have been identified earlier, individual factors potentially change in specific areas over time and a current characterization of risk factors provide the basis for preventative intervention strategies. No guidelines in relation to duration of micronutrient supplementation for treatment of SAM are available. Thus, the study was done to know the adequacy of dose of micronutrients that are presently being supplemented (WHO Protocols) for treating SAM.

Methods: It is a case-control study involving 100 cases with severe acute malnutrition and 100 controls having normal nutrition status 6 months to 5 years of age. Detailed clinical data (using a predesigned questionnaire) and anthropometric measurements were recorded for analysis. Blood assay of Zinc, Magnesium and serum Proteins were done on the day of admission (day 1) and again after 2 weeks of treatment with nutritional supplementation (WHO protocols).

Results: Out of 100 SAM Cases, 42% were from rural area whereas 76% of controls belonged to urban region (p value 0.03). Twenty-four (24%) mothers of SAM cases were Illiterate, whereas only 6 % of mothers in controls were illiterate. 57 % SAM cases were given breast feeding after 4 hours of life, where as 61% controls were given their first feed within 1 hour of birth with p value <0.01. Eighty-eight controls (88%) were given colostrum, whereas only 62 % SAM cases were given colostrum feeds with p value <0.01. Seventy controls (70%) were given exclusive breast feeding for 6 months whereas only 40% of cases (SAM) was given exclusive breast feeding till 6months of age (p value of <0.01). 57% of top fed cases were given over diluted feeds, only 27% of top fed controls were given over diluted feeds (p value 0.02). 53% of cases were bottle fed and 14% of controls were bottle fed with p value <0.01. Mean value of magnesium and zinc before supplementation was 2.4 mg/dl and 117 mcg/dl respectively with no significant rise after supplementation.

Conclusions: Here is a correlation of severe acute malnutrition with rural area, maternal Illiteracy and low socioeconomic status, deprivation of colostrums feeding, lack of exclusive breast feeding for 6 months, over dilution of top feeds and use of bottle feeding. There is no correlation between SAM and immunization status and demographic parameters like age, sex and religion. SAM is inversely related to duration of exclusive breast feeding. 23% of severely malnourished children had delay of developmental milestones. No significant rise of serum levels was seen with WHO recommended doses of micronutrient supplementation


Breast feeding, Illiteracy, Immunization, Magnesium, Severe acute malnutrition, Zinc

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