Dataset Information

Survival and nutritional status of children with severe acute malnutrition, six months post-discharge from outpatient treatment in Jigawa state, Nigeria.

ABSTRACT:

Background

The Outpatient Therapeutic Program (OTP) for treatment brings the management of Severe Acute Malnutrition (SAM) closer to the community. Many lives have been saved through this approach, but little data exists on the outcome of the children after discharge from such programmes. This study was aimed to determine the survival and nutritional status of children at six months after discharge from OTP for SAM.

Methodology

This was a prospective study of children with SAM admitted into 10 OTPs in two local government areas of Jigawa state from June 2016 to July 2016. Home visits at six months after discharge enabled the collection of data on survival and nutritional status. The primary outcome measures were survival and nutritional status (Mid upper arm circumference and weight-for-height z-score).

Result

Of 494 children with SAM, 410 were discharged and 379 were followed up. Of these, 354, (93.4%) were found alive while 25 (6.6%) died. Among the survivors 333 (94.1%) had MUAC ?12.5cm and 64 (18.1%) had WHZ<-3. Mortality rates were higher 10 (8.4%) among the 6-11months old. Most deaths 16 (64%) occurred within the first 3months post-discharge. Those who died were significantly more stunted, p = 0.016 and had a smaller head circumference, p = 0.005 on entry to OTP programme. There was improvement from admission to six months follow up in the number of children with complete immunization (27.4% to 35.6%), and a decrease in the number of unimmunized children (34.8% vs 20.6%) at follow-up.

Conclusion

The study demonstrates good post discharge survival rate and improved nutritional status for SAM patients managed in OTPs. There were, however considerable post discharge mortality, especially in the first three months and lower immunization uptake post discharge. A follow-up programme will improve these indices further.

SUBMITTER: John C

PROVIDER: S-EPMC6010258 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Survival and nutritional status of children with severe acute malnutrition, six months post-discharge from outpatient treatment in Jigawa state, Nigeria.

John Collins C Diala Udochukwu U Adah Ruth R Lar Luret L Envuladu Esther Awazzi EA Adedeji Idris I Lasisi Kazeem K Olusunde Oluseyi O James Femi F Abdu Halima H

PloS one 20180620 6

<h4>Background</h4>The Outpatient Therapeutic Program (OTP) for treatment brings the management of Severe Acute Malnutrition (SAM) closer to the community. Many lives have been saved through this approach, but little data exists on the outcome of the children after discharge from such programmes. This study was aimed to determine the survival and nutritional status of children at six months after discharge from OTP for SAM.<h4>Methodology</h4>This was a prospective study of children with SAM adm ...[more]

PMID: 29924797

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Project description:ObjectivesThe prevalence of malnutrition after hospitalisation is reported to be 20%-45%, which may lead to adverse outcomes, as malnutrition increases the risk of complications, morbidity, mortality and loss of function. Improving the quality of nutritional treatment in hospitals and post-discharge is necessary, as hospital stays tend to be short. We aimed to identify and map studies that assess the effectiveness of individualised nutritional care plans to reduce malnutrition during hospitalisation and for the first 3 months post-discharge.DesignThis was a systematic scoping review.MethodsWe systematically searched for all types of studies in the following databases: EMBASE, MEDLINE via PubMed, and the Cumulative Index to Nursing and Allied Health Literature, with no restriction on data or publication language. We also reviewed the reference lists of the included studies. The abstracts and full articles were simultaneously screened by two independent reviewers. Differences of opinion were discussed among the two investigators, and a third reviewer assisted with the discussion until consensus was reached. Studies in which the patients received an individual nutritional care plan related to their hospital stay and were followed up post-discharge were included. We then conducted a thematic content analysis of the extracted literature.ResultsNine randomised controlled trial studies met the inclusion criteria: six were conducted in Scandinavian countries. All studies were mainly conducted among elderly patients (mean ages varied from 75 to 88 years). The review studies measured 10 different outcomes; the most common outcomes were nutritional status and readmission. Six studies reported one or more significant positive intervention effect. Inconsistent results were identified for four outcome variables.ConclusionsIndividualised nutritional care plans and follow-up home visits might improve patients' nutritional status. However, there is need for a systematic review that assesses study quality and extends the time to 6 months post-discharge.

Project description:BackgroundMicronutrient deficiencies from malabsorption, gut infections, and altered gut barrier function are common in children living with the human immunodeficiency virus (CLHIV) and may worsen with severe acute malnutrition (SAM). Exploratory data of baseline zinc and selenium levels and changes over 48 weeks in children living with HIV by nutritional status are presented.MethodsZinc, selenium, serum protein and albumin levels measured at study entry and over 48 weeks were compared between children aged 6 to < 36 months who were living with HIV and had SAM or mild malnutrition-normal nutrition. Children with SAM were enrolled after 10-18 days of nutritional rehabilitation. Two-sided t-tests were used to compare levels and changes in levels of micronutrients and proteins by nutritional status.ResultsFifty-two participants, 25 with and 27 without SAM, of median (Q1,Q3) age 19 (13,25) and 18 (12,25) months respectively, were enrolled. Zinc deficiency was present at entry in 2/25 (8%) of those who had SAM. Mean (SD) baseline zinc levels were [52.2(15.3) and 54.7(12.0) µg/dL] for the SAM and non-SAM cohorts respectively while selenium levels were similar [92.9(25.0), 84.3(29.2) µg/L]. Mean changes of zinc and selenium from study entry to week 48 were similar between the children with and without SAM. There was no significant difference between baseline protein levels [75.2(13.2), 77.3(9.4) g/L] and the mean change from study entry to 48 weeks was also similar between the two groups; with a mean difference of 4.6 g/L [95% CI, (-2.4,11.6)]. Children with SAM compared to those without had significantly lower serum albumin levels at study entry with similar levels at 48 weeks.ConclusionsChildren with severe malnutrition who were initiated/switched to zidovudine/lamivudine/boosted lopinavir following 10 to 18 days of nutritional rehabilitation showed normal baseline levels of selenium and zinc, and had comparable selenium levels after 48 weeks. There was a strong positive correlation in entry and week 48 selenium levels within each cohort and for zinc in the non-SAM cohort. These data support the current WHO recommended approach to management of severe malnutrition in CLHIV who are initiated on combination antiretroviral treatment.Trial registrationRegistered with ClinicalTrials.gov Identifier NCT01818258 26/03/2013.

Dataset Information

Survival and nutritional status of children with severe acute malnutrition, six months post-discharge from outpatient treatment in Jigawa state, Nigeria.

Background

Methodology

Result

Conclusion

Publications

Survival and nutritional status of children with severe acute malnutrition, six months post-discharge from outpatient treatment in Jigawa state, Nigeria.

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