DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20162372

Clinico-laboratory profile and outcome of edematous severe acute malnutrition in children aged 6 months to 5 years

Rameshwar Lal Suman, Bharat Lal Sharma, Pradeep Meena, Neeraj Kumar

Abstract


Background: Malnutrition is still rampant in India. There are so many cases of edematous malnutrition present in Rajasthan. So we planned to study the Clinico-Laboratory profile And Outcome of Edematous Severe Acute Malnutrition in children aged 6 months to 5 years.

Methods: An observational hospital based prospective study was conducted at Malnutrition Treatment Center (MTC), Bal Chikitsalya, RNT Medical College, Udaipur, Rajasthan, India from July 2015 to Dec 2015. We enrolled total 50 SAM children aged 6 Months to 5 years having nutritional edema with medical complications. All the enrolled cases were hospitalized, acute complications were treated and nutritional rehabilitation by WHO feeding protocol was done. Clinical, laboratory parameters and outcome of E-SAM were analyzed.

Results: A total of 50 children were studied. Mean age of children was 16.54±11.05 months, 52.0% were male and 48.0% were female children, Majority of them were under <-3SD and <-4SD z-score (48.0%) followed by <-2SD and in <-1SD z-score (32.0%). Onset of edema reduction occurs on 3.22±0.91day, complete disappearance of edema occurs in 10.02±2.80 days, mean weight fall was 0.91±0.31% per day, mean length of stay in hospital was 14.93 ±4.10 days. Mean weight gain was 14.18±5.42 gm/kg/day and case fatality rate was nil. All these outcomes except weight gain were significantly associated with grade of edema (p value <.05).

Conclusions: Majority of the patients they were in WHO z-score of <-3SD and <-4SD z-score but extremes are also occurring up to <-8SD z-score Pneumonia and tuberculosis are the affected co morbidities for outcome of E-SAM children. Disappearance of edema, and length of stay are little bit longer than usual WHO guideline recommendations and they had a significant association with grade of edema. Percentage of wt. fall also had association with grade of edema.

 


Keywords


Edematous severe acute malnutrition, Malnutrition treatment center, Nutritional rehabilitation, WHO feeding protocol

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References


Heinkens GT, Bunn J, Amadi B, Manary M, Chhagan M, Berkl JA, et al. Case management of HIV-infected severely malnourished children: challenges in the area of highest prevalence. Lancet. 2008;371:1305-7.

Operational guidelines on facility based management of children with severe acute malnutrition. Ministry of Health and Family Welfare, Government of India. 2011:1.

Human Development Report Rajasthan. (An update-2008) prepared for Government of Rajasthan under Planning Commission-GOI and UNDP assisted project ‘Strengthening state Plans for Human Development’ By Institute of Development Studies, Jaipur page 28.

Kliegman, Geme SST. Nutrition, Food security and Health Nelson Textbook of Pediatrics, 19th. Edition, part-1, Elsevier. 2011:175.

Operational guidelines on facility based management of children with severe acute malnutrition. Ministry of Health and Family Welfare, Government of India. 2011:49-50.

Aydin E, Ayfer G, Yaser B. Effect of malnutrition on kidney size in children. Pediatric nephrology 2007;22:857-63.

Ahmed MM. Prevalence of under nutrition, risk factors and outcomes of severe malnutrition among under nourished children. Thesis (M.D.) Catholic University, Tanzania. 2013:1-75.

Singh K, Badgaiyan N, Kushwaha KP. Management of Children with Severe Acute Malnutrition in India: Experience of Nutrition Rehabilitation Centres in Uttar Pradesh, India. Indian Pediatrics. 2012;49:181-5.