DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20212808

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

Abstract


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.


Keywords


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

Full Text:

PDF

References


International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005-06, India: Key Findings. Mumbai: IIPS.

Goyal S, Agarwal N. Risk factors for severe acute malnutrition in Central India. Inter J Medical Sci Res Pract. 2015;2(2):70-2.

Mishra K, Kumar P, Basu S, Rai K, Aneja S. Risk factors for severe acute malnutrition in children below 5 years of age in India: a case control study. Indian J Pediatr. 2014;81(8):762-5.

Aguayo VM, Agarwal V, Agnani M, Agrawal D, Bhambhal S, Rawat AK, et al. Integrated program achieves good survival but moderate recovery rates among children with severe acute malnutrition in India. Am J Clin Nutr. 2013;98(5):1335-42.

Kumari R, Agrawal A, Shivakumar S, Singh PK, Singh GPI, Dubey GP. Hyperhomocysteinemia, cognitive deficits, and delayed p300 latencies in malnourished children from Northern India. Ment Health Fam Med. 2016;12:175-80.

Richards L, Claeson M, Pierce NF. Management of acute diarrhea in children: lessons learned. Pediatr Infect Dis J. 1993;12(1):5-9.

Bwakura-Dangarembizi M, Amadi B, Bourke CD, Robertson RC, Mwapenya B, Chandwe K, et al. Health outcomes, pathogenesis and epidemiology of severe acute malnutrition (HOPE-SAM): rationale and methods of a longitudinal observational study. BMJ Open. 2019;9(1):023077.

Black RE, Victora CG, Walker SP, Butta ZA, Christain P, deOnis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427-51.

Dalwai S, Choudhury P, Bavdekar SB, Dalal R, Kapil U, Dubey AP, et al. Consensus statement of the Indian academy of pediatrics on integrated management of severe acute malnutrition. Indian Pediatr. 2013;50:399-404.

National Family Health Survey - 4 (NFHS-4) district factsheets. 2015-16. Available at: http://rchiips.org/nfhs/districtfactsheet_NFHS-4. Accessed on 10 May 2021.

Murthy KA, Malladad A, Kariyappa M. Estimation of serum folate and vitamin B12 levels in children with severe acute malnutrition. Int J Contemp Pediatr. 2020;7(5).

Goyal S, Tiwari K, Meena P, Malviya S, Mohd A. Cobalamin and folate status in malnourished children. Int J Contemp Pediatr. 2017;4(4):1480-4.

Black MM. Effects of vitamin B12 and folate deficiency on brain development in children. Food Nutr Bull. 2008;29(1):126-31.

Matoth Y, Zehavi I, Topper E, Klein T. Folate nutrition and growth in infancy. Arch Dis Child. 1979;54(9):699-702.

Rasmussen SA, Fernhoff PM, Scanlon KS. Vitamin B12 deficiency in children and adolescents. J Pediatr. 2001;138(1):10-7.

WHO. Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children- A Joint Statement by the World Health Organization and the United Nations Children’s Fund. Geneva- World Health Organization. 2009.

WHO, CDC. Assessing the iron status of populations: including literature reviews: report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level. 2nd ed. Geneva, Switzerland: World Health Organization and Centers for Disease Control and Prevention; 2004.

Benoist BD. Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food Nutr Bull. 2008;29(2):238-44.

Choudhary M, Sharma D, Nagar RP, Dutt B Nagar T, Pandita A. Clinical profile of severe acute malnutrition in western Rajasthan: A prospective observational study from India. J Pediatr Neonatal Care. 2015;2(1):00057.

Mamidi RS, Kulkarni B, Radhakrishna KV, Shatrugna V. Hospitalbased nutrition rehabilitation of severely undernourished children using energy dense local foods. Indian Pediatr. 2010;47(8):687-93.

Singh K, Badgaiyan N, Ranjan A, Dixit HO, Kaushik A, Kushwaha KP, et al. Management of children with severe acute malnutrition: experience of nutrition rehabilitation centers in Uttar Pradesh, India. Indian Pediatr. 2014;51(1):21-5.

Rao S, Joshi SB, Kelkar RS. Change in nutritional status and morbidity over time in preschool children from slums in Pune, India. Indian Pediatr. 2000;37(10):1060-71.

Devi RU, Krishnamurthy S, Bhat BV, Sahai A. Epidemiological and clinical profile of hospitalized children with moderate and severe acute malnutrition in South India. Indian J Pediatr. 2015;82(6):504-10.

Dasgupta R, Ahuja S, Yumnam V. Can nutrition rehabilitation centers address severe malnutrition in India? Indian Pediatr. 2014;51(2):95-9.

Aprameya HS, Kamath SP, Kini PK, Baliga BS, Shenoy UV, Jain A, et al. Socioepidemiological determinants of severe acute malnutrition and effectiveness of nutritional rehabilitation centre in its management. Int J Health Allied Sci. 2015;4(3):148-53.

Kumar R, Singh J, Joshi K, Singh HP, Bijesh S. Comorbidities in hospitalized children with severe acute malnutrition. Indian Pediatr. 2014;51(2):125-7.

Improving Child Nutrition. The achievable imperative for global progress. New York- United Nations Children's Fund (UNICEF). April 2013. Available at: www.unicef.org/publications/index. html. Accessed on 10 May 2021.

Dwivedi D, Singh V, Singh J, Sharma S. Study of anaemia in children with severe acute malnutrition. J Nepal Paediatr Soc. 2017;37(3):250-3.

Chandelia S, Chandra J, Narayan S, Aneja S, Chawla HM, Sharma S, et al. Addition of cobalamin to iron and folic acid improves hemoglobin rise in nutritional anemia. Indian J Pediatr. 2012;79(12):1592-6.

Bharati S, Pal M, Bharati P. Prevalence of anaemia among 6-to 59-monthold children in India: THE latest picture through the NFHS-4. J Biosoc Sci. 2020;52(1):97-107.

Girum T, Kote M, Tariku B, Bekele H. Survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study. Ther Clin Risk Manag. 2017;13:101-10.