Clinico-epidemiology and assessment of folate and vitamin B12 status in severe acute malnourished children: a hospital-based observational study in the rural area of Uttar Pradesh

Divya Verma, Sunil Kumar Singh, M. Ziauddin, Rinki Kumari


Background: Severe acute malnutrition (SAM) is a serious health problem in children in India. Vitamin B12 and folate are crucial micronutrients along with others required for rapid growth and development during infancy and early childhood, whereas their deficiencies contribute to malnutrition. The study aimed to evaluate iron, folate and vitamin B12 status in hospitalized SAM children aged between 6-59 months and their clinical, epidemiological profile.

Methods: A hospital-based observational study on 159 children with SAM in the age group 6-59 months who were enrolled in the study based on anthropometric indicators after written informed consent from parents. The clinical, demographic profile and pertinent details of each patient were collected using standardized proforma and the blood samples were collected. Serum ferritin level was done in all anaemia cases, while vitamin B12 and folic acid (FA) were done only in children with macrocytic or dimorphic anaemia. For statistical analysis, SPSS 20.0 software was used.

Results: Mean age of admitted children was 23.77±13.95 months belonging mainly to lower socioeconomic scale and joint families with preferential vegetarian diet. 39.62% SAM patients were between 6-12 months of age at the time of admission. The most common associated infections were GI infections (gastrointestinal tract) in 52.20%. Out of all cases, 93.71% of SAM patients were anaemic. 39.59% cases had macrocytic anaemia followed by microcytic anaemia in 30.20%. Of the 91 cases with macrocytic/dimorphic anaemia (based on MCV and morphology), vitamin B12 and FA levels were done, 92.30% and 61.53% had a deficiency of vitamin B12 and FA, respectively. Overall out of all admitted patients, 52.83% of SAM children had vitamin B12 deficiency and folate deficiency was found in 35.22% of children.

Conclusions: SAM children had a high prevalence of vitamin B12 and folate deficiency. Efforts should be made to prevent deficiency of such micronutrients in pregnant and breastfeeding mothers and their infants. Treatment can affect a child's prognosis.


Anthropometric, Clinical-demographic, Folate, Severe acute malnutrition, Vitamin B12

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