Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study.
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ABSTRACT:
SUBMITTER: Ghimire U
PROVIDER: S-EPMC7249365 | biostudies-literature | 2020 May
REPOSITORIES: biostudies-literature
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Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study.
Ghimire Umesh U Aryal Binod Kumar BK Gupta Ankush Kumar AK Sapkota Suman S
BMC pediatrics 20200526 1
<h4>Background</h4>Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6 to 59 months in the two districts of Nepal.<h4>Methods</h4>We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centers (OTCC). The nutritional status of children was ...[more]
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Project description:BACKGROUND:In South Africa, 30.9% of children under five years with Severe Acute Malnutrition (SAM) died in 2018. We aimed to identify factors associated with mortality among children under five years hospitalized with SAM in Limpopo province, South Africa. METHODS:We conducted a cross-sectional study including children under five years admitted with SAM from 2014 to 2018 in public hospitals of Limpopo province. We extracted socio-demographic and clinical data from hospital records. We used logistic regression to identify factors associated with mortality. FINDINGS:We included 956 children, 50.2% (480/956) male and 49.8% (476/956) female. The median age was 13 months (inter quartile range: 9-19 months). The overall SAM mortality over the study period was 25.9% (248/956). The most common complications were diarrhea, 63.8% (610/956), and lower respiratory tract infections (LRTIs), 42.4% (405/956). Factors associated with mortality included herbal medication use (adjusted Odds Ratio (aOR): 2.2, 95% Confidence Interval (CI): 1.4-3.5, p = 0.001), poor appetite (aOR: 2.7, 95% CI: 1.4-5.2, p = 0.003), Mid-upper circumference (MUAC) <11.5 cm (aOR: 3.0, 95% CI: 1.9-4.7, p<0.001), lower respiratory tract infections (LRTIs) (aOR: 1.6, 95% CI: 1.2-2.0, p<0.001), anemia (aOR: 2.5, 95% CI: 1.1-5.3, p = 0.021), hypoglycemia (aOR: 12.4, 95% CI: 7.1-21.8, p<0.001) and human immunodeficiency virus (HIV) infection (aOR: 2.3, 95% CI: 1.6-3.3, p<0.001). INTERPRETATION:Herbal medication use, poor appetite, LRTIs, anemia, hypoglycemia, and HIV infection were associated with mortality among children with SAM. These factors should guide management of children with SAM.
| S-EPMC7209205 | biostudies-literature
Project description:BACKGROUND:The prevalence of child malnutrition in Angola is still very high, and little is known about its associated factors. The aim of this study was to identify these factors in children under 2 years in a suburban area of the country's capital city. METHODS:We used data from a cross-sectional population-based study conducted in 2010. The outcomes studied were stunting and underweight. Multivariable analysis was conducted; prevalence ratios were estimated by Poisson regression with robust variance using a hierarchical model. RESULTS:Of the children studied (N = 749), 232 [32.0% (95% CI: 28.7-35.5%)] were stunted and 109 [15.1% (95% CI: 12.6-17.9%)] were underweight. In multivariable analysis, occurrence of diarrhea (PR 1.39 [95% CI: 1.07-1.87]) and the death of other children in the household (PR 1.52 [95% CI: 1.01-2,29]) were associated with stunting and underweight, respectively. In the model composed only of distal and intermediate factors, the primary caregiver not being the mother increased the prevalence of stunting by 42% (PR 1.42 [95% CI: 1.10-1.84], and a mother's working outside the house while not being self-employed was associated with its reduced prevalence (PR 0.55 [95% CI: 0.34-0.89]). In the intermediate model, each additional month of delay in the onset of prenatal care increased the relative prevalence of underweight by 20% (PR 1.20 [95% CI: 1.03-1.40]). CONCLUSIONS:Despite the high prevalence rates of stunting and underweight, relatively few risk factors were identified for these conditions, suggesting that collective exposures are likely to play a major role in causing malnutrition in Angola. The individual factors identified can be useful for the development of strategies to deal with this public health problem.
| S-EPMC6385448 | biostudies-other
Project description:BackgroundSevere acute malnutrition is defined by <70% weight for length/height, by visible severe wasting, by the presence of pitting edema, and in children 6 to 59 months of age, mid upper arm circumference <110 mm. Severe acute malnutrition remains to be a worldwide problem, claiming lives of millions of children, especially in sub-Saharan Africa and south Asia. Though the Ethiopian national guideline states the total length of stay in therapeutic feeding units should not be more than four weeks, there is huge difference, varying from 8 to 47 days of stay. Therefore, the objective of this study was to assess length of stay to recover from severe acute malnutrition and associated factors among under five children hospitalized to the public hospitals in Aksum Town.MethodsSample size was calculated using STATA version 12.0. A retrospective cohort study was conducted using pretested questionnaire in the public hospitals in Aksum on children aged 0-59 months. Cleaned data was entered to Epi info version 7.1.4 and then exported into SPSS version 21 for analysis. Bivariable and multivariable analyses were performed using Kaplan Meier and Cox regression models. During bivariable analysis, variables with p-value < 0.05 were selected for multivariable analysis to identify independent factors associated with length of stay.ResultsA total of 564 participants enrolled to the study. The rate of recovery was 56% with median length of stay of 15 days (95% CI: 14.1, 15.9). The independent predictors of length of stay to recovery were presence of diarrhea at admission (AHR = 0.573, 95% CI: 0.415-0.793), being HIV positive (AHR = 0.391, 95% CI: 0.194-0.788), palmar pallor (AHR = 0.575, 95% CI: 0.416-0.794), presence of other co-morbidities at admission (AHR = 0.415, 95% CI: 0.302-0.570) and not being treated with plumpy nut (AHR = 0.368, 95% CI: 0.262-0.518).ConclusionsLength of stay is in the acceptable range of the international and national set of standards. Nevertheless, the recovery rate was lower compared to the Sphere standard. Presence of diarrhea, palmar pallor, HIV other co-morbidities and not treated with plumpy nut were found independent protective factors for recovery from sever acute malnutrition.
| S-EPMC7523984 | biostudies-literature
Project description:BACKGROUND:Low- and Middle-Income Countries (LMIC) have remained plagued with the burden of severe acute malnutrition (SAM). The decomposition of the educational inequalities in SAM across individual, household and neighbourhood characteristics in LMIC has not been explored. This study aims to decompose educational-related inequalities in the development of SAM among under-five children in LMIC and identify the risk factors that contribute to the inequalities. METHODS:We pooled successive secondary data from the Demographic and Health Survey conducted between 2010 and 2018 in 51 LMIC. We analysed data of 532,680 under-five children nested within 55,823 neighbourhoods. Severe acute malnutrition was the outcome variable while the literacy status of mothers was the main exposure variable. The explanatory variables cut across the individual-, household- and neighbourhood-level factors of the mother-child pair. Oaxaca-Blinder decomposition method was used at p?=?0.05. RESULTS:The proportion of children whose mothers were not educated ranged from 0.1% in Armenia and Kyrgyz Republic to as much as 86.1% in Niger. The overall prevalence of SAM in the group of children whose mothers had no education was 5.8% compared with 4.2% among those whose mothers were educated, this varied within each country. Fourteen countries (Cameroon(p <?0.001), Chad(p <?0.001), Comoro(p =?0.047), Burkina Faso(p <?0.001), Ethiopia(p <?0.001), India(p <?0.001), Kenya(p <?0.001), Mozambique(p =?0.012), Namibia(p =?0.001), Nigeria(p <?0.001), Pakistan(p <?0.001), Senegal(p =?0.003), Togo(p =?0.013), and Timor Leste(p <?0.001) had statistically significant pro-illiterate inequality while no country showed statistically significant pro-literate inequality. We found significant differences in SAM prevalence across child's age (p?<?0.001), child's sex(p?<?0.001), maternal age(p?=?0.001), household wealth quintile(p?=?0.001), mother's access to media(p?=?0.001), birth weight(p?<?0.001) and neighbourhood socioeconomic status disadvantage(p?<?0.001). On the average, neighbourhood socioeconomic status disadvantage, location of residence were the most important factors in most countries. Other contributors to the explanation of educational inequalities are birth weight, maternal age and toilet type. CONCLUSIONS:SAM is prevalent in most LMIC with wide educational inequalities explained by individual, household and community-level factors. Promotion of women education should be strengthened as better education among women will close the gaps and reduce the burden of SAM generally. We recommend further studies of other determinate causes of inequalities in severe acute malnutrition in LMIC.
| S-EPMC7183681 | biostudies-literature
Project description:Background:The term malnutrition generally refers to both under-nutrition and over-nutrition, but this study uses the term to refer solely to a deficiency of nutrition. In Ethiopia, child malnutrition is one of the most serious public health problem and the highest in the world. The purpose of the present study was to identify the high risk factors of malnutrition and test different statistical models for childhood malnutrition and, thereafter weighing the preferable model through model comparison criteria. Methods:Bayesian Gaussian regression model was used to analyze the effect of selected socioeconomic, demographic, health and environmental covariates on malnutrition under five years old child's. Inference was made using Bayesian approach based on Markov Chain Monte Carlo (MCMC) simulation techniques in BayesX. Results:The study found that the variables such as sex of a child, preceding birth interval, age of the child, father's education level, source of water, mother's body mass index, head of household sex, mother's age at birth, wealth index, birth order, diarrhea, child's size at birth and duration of breast feeding showed significant effects on children's malnutrition in Ethiopia. The age of child, mother's age at birth and mother's body mass index could also be important factors with a non linear effect for the child's malnutrition in Ethiopia. Conclusions:Thus, the present study emphasizes a special care on variables such as sex of child, preceding birth interval, father's education level, source of water, sex of head of household, wealth index, birth order, diarrhea, child's size at birth, duration of breast feeding, age of child, mother's age at birth and mother's body mass index to combat childhood malnutrition in developing countries.
| S-EPMC5883335 | biostudies-literature
Project description:BackgroundAnemia adversely affects children's mental, physical and social development, particularly in Africa. In the early stages of life, it leads to severe negative consequences on the cognitive, growth and development of children.ObjectiveThis study aimed to assess anemia and associated risk factors among children under-five years old in the West Guji Zone, southern Ethiopia, from October to November 2020.MethodA hospital-based quantitative cross-sectional study was conducted at Bule Hora General Hospital, Southern Ethiopia. A convenience sampling technique was used to include 375 under-five children enrolled in the study. The pretested structure questionnaire was used to collect socioeconomic and demographic characteristics of study individuals after taking appropriate written informed consent. Then, a venous blood sample was collected from each child and analyzed for hemoglobin determination using a Midray BC 3000 Plus machine. Binary logistic regression models were used to identify associated factors of anemia. A p-value ≤ 0.05 was considered statistically significant.ResultThe overall prevalence of anemia among under-five children was 13.2% (50) [95% CI = 5.2-21.2%]. Among anemic children under-five years of age, 12% (6) had mild anemia, 32% (16) had moderate anemia and 56% (28) had severe anemia. In this study, anemia was significantly associated with a history of intestinal protozoan infection [AOR = 2.55, 95% CI = 1.28-10.42], malaria infection [AOR = 5.01, 95% CI = 0.18-11.44] and soil-transmitted helminths infection [AOR = 6.39, 95% CI = 1.75-29.08].ConclusionThe prevalence of anemia among under-five children was found to be low in the study area; however, the majority of anemic children were in a severe stage. It could be managed by preventing malaria infection, intestinal protozoa and soil-transmitted helminthic infection.
| S-EPMC9255756 | biostudies-literature
Project description:BackgroundSevere acute malnutrition (SAM) affects about 13 million under-five children (U5), with an estimated one million dying every year. In this study we aimed at determining the in hospital mortality and its associated factors among U5s admitted with SAM.MethodsThis was a prospective cohort study of children 6 months to 5 years with SAM admitted at Mbarara Regional Referral Hospital (MRRH) between June and August 2015. Care-takers were interviewed to collect socio-demographic and clinical information. Children under-went physical examination and had blood drawn for HIV, serum glucose, malaria, full blood count, culture and serum electrolytes investigation. Children were managed according to WHO treatment guidelines for SAM. All participants were followed up for a maximum period of 30 days. The proportion of U5 deaths within the first 48 hours and during the entire admission period was calculated. Using Poisson regression analysis, predictors of in-hospital mortality were analyzed with STATA/IC 11.0.ResultsWe enrolled 122 children, median age of 15 months [IQR:11-24], 58.2% males, 90% immunized, 81% ill for more than 2 weeks before admission, 71% from lower health facilities and majority with unknown HIV status(76%). Overall, 13 (10.7%) children died in hospital. Seven (5.7%) died within the first 48 hours. Intravenous (IV) fluid administration significantly predicted in-hospital mortality (adjusted IRR: 7.2, 95%CI: 2.14-24.08, p = 0.001).ConclusionThe in-hospital mortality in U5s with SAM was lower than that previously reported in central Uganda. Intravenous fluid administration significantly predicted overall in-hospital mortality. While Administration of intravenous fluids is still the main stay of managing severely malnourished children with shock, more research needs to be conducted in order to review the parameters presently used to assess children for shock with a view of diagnosing and managing shock in these children when it is still early. Adequate guidance on use of IV fluids in management of severely malnourished children should be prioritized during continuous medical education for healthcare workers and in the treatment guidelines.
| S-EPMC7319331 | biostudies-literature
Project description:BackgroundSevere acute malnutrition is a common cause of morbidity and mortality among under five children in Ethiopia. A child may experience more than one episode of SAM depending on the improvement of the underlying factors. However, there is no study that determined the frequency of relapse of SAM cases after discharge in Ethiopia.ObjectiveTo identify the frequency of relapse and associated factors among children discharged after undergoing treatment for SAM in Hadiya Zone, South, Ethiopia.MethodsAn institution based retrospective cohort study was done among children admitted to health posts for treatment of SAM from 2014/2015-2019/2020 under-five children's after discharge in health post for severe acute malnutrition in the last five years in Hadiya zone, SNNPR, Ethiopia. Both first admission data and relapse data were abstracted from the records of the SAM children from Aguste 1-30 /2020 Using a data collection format. Data were coded and edited manually, then doubly entered into Epi-Data statistical software version 3.1 and then exported to SPSS for windows version 26. After checking all the assumptions finally Negative binomial regression for poison has been used. All tests were two sided and P values <0.05 were used to declare statistical significance.ResultsIn the last five year there were the proportion of relapsed cases were 9.6%, 95% CI: (7.7%, 11.7%) On multivariable negative binomial regression model, after adjusting for background variables relapse of severe acute undernutrition was significantly associated with having edema during admission with (IRR = 2.21, 95% CI:1.303-3.732), being in the age group of 6-11 months (IRR = 4.74,95% CI:1.79-12.53), discharge MUAC for the first admission (P = 0.001, IRR = 0.37, 95% CI:0.270-0.50) increase the risk of incidence rate ratio(IRR) relapse case of severe acute under nutrition.ConclusionFrequency of SAM relapse was positively associated with age, having edema during admission, while it was negatively associated with discharge MUAC. The results imply the need for reviewing the discharge criteria taking into account the recovery of MUAC as a marker for lean tissue accretion, especially in edematous children and those in the younger age.
| S-EPMC7993841 | biostudies-literature
Project description:ObjectiveThe objective of the study was to assess the prevalence of stunting and associated factors among under-five children of Wukro town, Tigray, Ethiopia, 2017-2018.ResultTotally 394 under-five children were participated in this study with a response rate of 98.5%. A total of 222 (56.3%) of respondents were females and 106 (26.95%) were in the age group of 12-23 month. One hundred ninety-eight (50.3%) of the participants were between 2 and 3 in birth order and 194 (49.2%) had 4 to 5 house hold size. The overall prevalence of stunting was 194 (49.2%). Being female and presence of washing facilities nearby latrine were significantly associated with stunting. Under-five female children were 35.4% lower odds of stunting compared to male children (p?=?.041, OR?=?.644, and 95% CI (.422, .983)).
| S-EPMC6693130 | biostudies-literature
Project description:Background:Globally, approximately 19 million children under 5 years are suffering from Severe Acute Malnutrition (SAM). It is a major cause of morbidity and mortality in low-income countries including Ethiopia. However, little is known regarding predictors of mortality among these children in Ethiopia. The current study aimed to assess the potential predictors of mortality among under-five children with SAM admitted to a stabilization center. Method:A retrospective cohort study was conducted in 527 under-five children who were admitted for SAM at the University of Gondar comprehensive specialized hospital from 2014 to 2016. Data were collected from a randomly selected chart after getting ethical clearance. Data were cleaned, coded and entered to Epi-info (version 7) and analyzed using STATA (version14). The outcome was computed by using tables and graphs. A multivariable cox proportional hazards model was fitted to identify predictors of mortality. Result:Overall, the median follow-up period was 10 days with interquartile range (Q1, Q3: 8, 17). At the end of the follow-up, the mortality rate was 66(12.52%). Anemia (AHR(Adjusted Hazard Ratio): 2.3, 95% CI: 1.2, 4.5), Shock (AHR: 7.9, 95% CI: 3.7, 16.7), no intake of antibiotics (AHR: 2.3 95% CI: 1.2, 4.4), IV-Fluid (AHR: 3.2, 95% CI: 1.7, 5.8), no intake of F75 (AHR: 6.6,95% CI: 2.9, 14.7) and no intake of F100 (AHR: 3, 95% CI: 1.6, 5.4) were independent predictors of mortality. Conclusion:The survival status of under-five children with SAM was lower than the national standard protocol. Altered general conditions such as shock, anemia, not adhering to medical and nutritional therapies were identified as predictors of mortality among SAM children. Health education on early medical seeking behavior and adherence on the routine regimens may improve this gap in child survival.
| S-EPMC6158814 | biostudies-other