Etiological factors of severe acute malnutrition and impact of nutrition rehabilitation centre: a prospective observational study from Bhavnagar

Vibhuti D. Gamit, Jayendra R. Gohil, Adithya Nikhileshwar B., Tanmay P. Vagh


Background: Severe acute malnutrition (SAM) causes almost half of childhood deaths in children <5 years in developing countries. In India, as National Family Health Survey (NFHS), prevalence of SAM has increased from 6.4 in NFHS-3 (2005-2006) to 7.5% in NFHS-4 (2015-1016); [5.8 to 9.5% Gujarat]. The aim of study was to determine the etiological factors and outcome of SAM and the benefit of nutrition rehabilitation centre (NRC) among 6 months to 5 years children at the Pediatrics, NRC ward, Sir T. General Hospital.

Methods: A prospective observational study of 151 SAM children over nine months. Etiological factors were determined by history and relevant investigations, exclude other systemic disorders. Therapeutic nutrition was provided for 14 days. Cases were followed up two weekly for 2 months by monitoring weight after NRC admission.

Results: Association was found between Small for gestational age (64.9%), joint family (59.6%) and low birth spacing (59.6%) as etiological factors leading to SAM. 81.5% children gained weight during 14 days NRC stay. Weight gain was noted at follow-up. Defaulter rate increased from 9.9% at discharge to 28.5% at 2 months follow-up. Weight was static for 9% children. 34.4% children were from rural area and 65.6% from urban area. 23.8% children had received pre lacteal feed. Timing of complementary feeding was incorrect in 29%. There were no deaths.

Conclusions: Small for gestational age, joint family, low birth spacing, and incorrect feeding practices and urban residence were etiological factors. NRC stay (defaulter rate 26%), produced weight gain in SAM children.



SAM, Severe acute malnutrition, Etiological factors, Nutrition rehabilitation centre

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UNICEF Global Database on Child Malnutrition. 2005. Available at: /wasting.php. Accessed on: 16 May 2006.

Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361:2226-34.

International Institute for Population Sciences and Macro International. National Family Health Survey (NFHS‑4), 2015‑16: Fact Sheet India, Gujarat: IIPS. 2017.

World Health Organization (WHO).Guidelines for the Inpatient Treatment of Severely Malnourished Children. Geneva: World Health Organization (WHO). 2003. Available at: /nutrition/publications/severemalnutrition/9241546093/en/. Accessed on: 26 October 2020.

Indian Academy of Pediatrics (IAP) IAP guidelines 2006 for hospital‑based management of severely malnourished children (adapted from WHO guidelines). Indian Pediatr. 2007;44:443-61.

Taneja G, Dixit S, Khatri AK, Yesikar V, Khatri D, Chourasiya S. A study to evaluate the effect of nutritional intervention measures on admitted children in selected nutrition rehabilitation centres of Indore and Ujjain divisions of Madhya Pradesh (India). Indian J Community Med. 2012;37:107-15.

Singh K, Badgaiyan N, Ranjan A, Dixit HO, Kaushik A, Kushwaha KP, et al. Management of severe acute malnutrition: Experience of Nutrition Rehabilitation Centers in UP, India. Indian Pediatr. 2014;51:21-5.

Mamidi RS, Kulkarni B, Radhakrishna KV, Shatrugna V. Hospital based nutrition rehabilitation of severely undernourished children using energy dense local foods. Indian Pediatr. 2010;47:687-93.

Apoya P, Bartram J, Bhagwan J. WHO Guidelines on sanitation and health. 2018. Available at: Accessed on: 01 December 2019.

Sharghi A, Kamran A, Faridan M. Evaluating risk factors for protein‑energy malnutrition in children under the age of six years: A case‑control study from Iran. Int J Gen Med. 2011;4:607-11.

Sakisaka K, Wakai S, Kuroiwa C, Cuadra Flores L, Kai I, Mercedes Aragón M, et al. Nutritional status and associated factors in children aged 0‑23 months in Granada, Nicaragua. Public Health. 2006;120:400-11.

Pregnancy and Institute for Quality and Efficiency in Health Care. Do all pregnant women need to take iron supplements? Available at: https://www.informed Accessed on: 22 March 2018.

Alwan A, Hirnschall GO, Branca F. WHO Guideline: Daily iron and folic acid supplementation in pregnant women. Available at: pdf/9789241501996_eng.pdf. Assessed on: 01 Dec 2019.

Sanghvi J, Mehta S, Kumar R. Predicators for weight gain in children treated for severe acute malnutrition: A prospective study at nutritional rehabilitation center. ISRN Pediatr. 2014;808756.

Mishra K, Kumar P, Basu S, Rai K, Aneja S. Risk factors for severe acute malnutrition in children below 5 y of age in India: A case‑control study. Indian J Pediatr. 2014;81:762-5.

Kumar R, Singh J, Joshi K, Singh HP, Bijesh S. Co‑morbidities in hospitalized children with severe acute malnutrition. Indian Pediatr. 2014;51:125-7.

Bloss E, Wainaina F, Bailey RC. Prevalence and predictors of underweight, stunting, and wasting among children aged 5 and under in western Kenya. J Trop Pediatr. 2004;50:260-70.

Amele EY, Demissie BW, Desta KW, Woldemariam EB. Prelacteal feeding practice and its associated factors among mothers of children age less than 24 months old in Southern Ethiopia. Ital J Pediatr. 2019;45:15.

Mitra M, Tiwari A, Ghosh R, Bharati P. Dimensions and causes of child malnutrition: A study of preschool children of Raipur, Chhattisgarh, India. Anthropologist. 2004;6:247-52.

Rana R, Vaze G, Maitrak T. Facility Based Management of Children with Severe Acute Malnutrition (SAM): Experience of Child Malnutrition Treatment Centres in Gujarat, India. Indian J Nutr. 2019;6(1):197.