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Complications of Severe Acute Malnutrition in Children at Nutrition Stabilization Center Hyderabad

Journal of Research in Medical and Dental Science
eISSN No. 2347-2367 pISSN No. 2347-2545

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Research Article - (2022) Volume 10, Issue 5

Complications of Severe Acute Malnutrition in Children at Nutrition Stabilization Center Hyderabad

Muhammad Nadeem Chohan*, Farah Naz, Salma Shaikh, Fouzia Shaikh, Sehrish Muzaffar and Saleem Shaikh

*Correspondence: Muhammad Nadeem Chohan, Department of Pediatrics, Liaquat University of Medical and Health Sciences Jamshoro, Jamshoro, Pakistan, Email:

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Abstract

Introduction: About 3 lac deaths are cause by malnutrition all over the world each year in children 1-5 years of age. About 5.9 million children of less than 5 years die each year globally and malnutrition is top of the list causing deaths due to its complications like Pneumonia Diarrhea and measles.
Aim:
To assess the complications at admission in children having Severe Acute Malnutrition (SAM).
Methods:
This Cross-sectional Study was conducted in the Pediatrics Department Unit-I, Liaquat University of Medical & Health Sciences from 1st January 2019 to 31st December 2019. Total 99 children aged 6-59 months with WHO defined severe acute malnutrition along with complications were selected and admitted. Strict monitoring done for vitals, development of complications and response to treatment. Outcome was monitored and recorded in term of complete recovery, development of new complication (s), and/or Expiry.
Results:
Out of 99 children 91 (92%) had Marasmus, 05 (5%) had Kwashiorkor and 3 (3%) had (Marasmus and Kwashiorkor). Total 37.4% children were between the ages of 6–11 months. The most common complications at the time of admission were fever, diarrhoea, and anaemia. The mean stay at NSC was 7.864+4.4 days. Out of total 99 Patients, (91.9%) recovered fully from complication while the remaining 08 patients (8.1%) were in poor condition which was transferred to intensive care unit.
Conclusion:
We found higher recovery rate from complications along with good weight gain. Few children developed new complication and become sicker, hence shifted to intensive care unit. There was no expiry in children of SAM with complications.

Keywords

Severe acute malnutrition, Complications, Children, Nutritional stabilization unit, Weight gain, Marasmus

Introduction

Protein and energy malnutrition causes kwashiorkor, marasmus and marasmus kwashiorkor. According to World Health Organization one common name is given to all these conditions i.e. Severe Acute Malnutrition (SAM). Children with SAM can present with complications or without complications [1]. SAM is defined as weight foe height <70% or <-3 below the standard deviation or bilateral pitting edema due to nutritional deficiency or mid upper arm circumference <115 mm in children between 6 months to 5 years of age.

About 3 lac deaths are cause by malnutrition all over the world each year in children 1-5 years of age [2]. About 12 million children with SAM resides in Six Asian countries among them 0.6 million in Afghanistan, 0.6 million in Bangladesh, 8.0 million in India, 1.2 million in Indonesia, 1.4 million in Pakistan, and 0.6 million in Yemen [3]. About 5.9 million children of less than 5 year die each year globally and malnutrition is top of the list causing deaths due to its complications like Pneumonia Diarrhea and measles [4]. According to a recent local study prevalence of severe acute malnutrition in Pakistan is 11.3% [5].

Children having severe acute malnutrition should first be assessed for medical complications and whether they have an appetite. Children who have appetite and are clinically well and alert should be treated as outpatients. Children who have medical complications, severe oedema (+++), or poor appetite, or present with one or more Integrated Management of Childhood Illness (IMCI) danger signs should be treated as inpatients [6]. Severe acute malnutrition is managed in 2 phases. In 1st phase children are stabilized and complications are treated, while in 2nd phase catch up growth is the main focus [7]. In an international study the common complications in SAM children were Pneumonia (54.8%) and diarrhea (41.8%) [8].

In Pakistan there is little epidemiologic research on the complications in Severe Acute Malnutrition children. That’s why this study is planned to assess the frequency of various complications in SAM children.

Materials And Methods

This cross sectional study was conducted by non-probability convenient sampling technique at NSC ward in the Department of Pediatrics, Liaquat University Hospital over a period of 12 months.Total 99 children age 6 to 59 months having Severe Acute Malnutrition with Complications was enrolled. Children who did not have complications were excluded from the study.

At the time to admission every patient was managed according to WHO critical care pathway protocol for the SAM patients and then data collected through structure CCP form. The patients who fulfil inclusion criteria were enrolled in the study and written consent was taken. Data entered in the proforma by the researcher herself. The outcome in relation to complication was measured by duration for hospital stay, time required gaining weight, time required for complication to improve, tolerance of feed. The data was analysed by using SPSS version 22. Mean and standard deviations computed for age and sex while frequency and percentage calculated for complication hypoglycemia, Hypothermia, Severe anaemia etc.

Result

During the study period, 99 patients were selected according to inclusion criteria. All patients were severely malnourished, out of them 91% (91.91%) had marasmus 5 (5.05%) had kwashiorkor and 3 (3.03%) had both marasmus and kwashiorkor. In this study male to female ratio was 1:1, male children were 42 (42.42%) and female children were 57 (57.57%,). Total 38 (38.38%) children were under 6 to 11 months age, 30 (30.30%) children were under 12 to 23 months of age (Table 1). The percentage of common symptoms is given in Table 2 which shows history of fever 27 (27.27%) as a common factor. Out of total 99 children 71% children had 3 or more complications (Table 2). Total 91 (91.9%) children recovered fully and discharge to home while remaining 08 (8.1%) became sicker and shifted to Intensive Care Unit. The Mean weight gain was 6.689 ± 5.680 (Table 3). There was no expiry during this study.

Table 1: Profile of study participants (n=99).

Characteristics n (%)
Gender
Male 42 (42.42)
Female 57 (57.57)
Age group in month
6-11 months 38 (38.38)
12-23 months 30 (30.30)
24-59 months 32 (32.32)
Malnourished children
Marasmus 91 (91.91)
Kwashiorkor 5 (5.05)
Marasmic Kwashiorkor 3 (3.03)
Z-score (WHZ)
<-3 67 (67.67)
>-3 23 (23.23)
Seasonal Cases
Dry 64 (64.64)
Rainy 36 (36.36)

Table 2: Symptoms and complications of study participants (n=99).

Characteristics N (%)
Common symptoms
Shock 1 (1.01)
UTI 3 (3.03)
Cough 6 (6.06)
Vomiting 16 (16.16)
Fits 6 (6.06)
Respiratory distress 3 (3.03)
Abdominal Pain 3 (3.03)
Diarrhea 35 (35.35)
Fever 27 (27.27)
Complications in malnutrition children
Hypernatremia 9 (9.09)
Hyponatremia 4 (4.04)
Sepsis 3 (3.03)
Cardiac Failure 6 (6.06)
Corneal Opacification 6 (6.06)
Hypokalemia 28 (28.28)
Hypoglycemia 36 (36.36)
Hypothermia 19 (19.19)
Poor Appetite 43 (43.43)
Dermatitis 65 (65.65)
Anemia in malnutrition children
Anemia present 74 (74.74)
Anemia Absent 26 (26.26 )
Patients developed more than one complications
2 or <2 29 (29.99)
3 or >3 71 (71.71)
Time to improve complications
<24 hours 23 (23.6)
24-48 31 (31.3)
>48 hours 43 (43.2)
Calorie consumption in the NSC for SAM children
<150 Kcal/kg/day 71 (71.3)
>150 Kcal/kg/day 28 (28.7)
OUTCOME
Improved 91 (91.9)
Worse 8 (8.1 )

Table 3: Number of days and weight gain status of study participants (n=99).

No. (99) % Mean Standard Deviation
Number of days Stay at NSC
1-7 days 57 57.60%
8-14 days 36 36.30% 7.864 days +4.4 days
15-21 days 6 6.10%
Weight gain
>7 g/kg/day 39 39.30%
5 to <7 g/kg/day 38 38.30% 6.689 ± 5.680
<5 g/kg/day 22 22.20%

Discussion

About 13 million children suffers Severe Acute Malnutrition every year, among them about 2 million deaths are preventable. Child Survival Programme has ignored this component. Treatment of children with SAM needs lot of resources and needs skilled and motivated staff.

This study was conducted at Liaquat University Hospital, Hyderabad over period of 12 months, 99 malnourished children with complications were assessed; females were higher 57 (57.57%) than malnourished males 42 (42.42%). In this study all of the children were 6 to 59 months old. 91% children had Marasmus, 5.05% had Kwashiorkor and 3.03% had both marasmus and kwashiorkor. 67% children had <-3 score (Z score of weight and height). Most common complaints were fever 27 (27.27%) and loose motion 35 (35.35%).

Most common complications were severe anaemia 74 (74.74%), hypoglycaemia 36 (36.36%) and Poor appetite 43 (43.43%). 71% children had 3 or more than 3 complications.

A couple of studies show different result as compared to our study. In their study most represented age group was 6 to 12 months with 34.6% of the children. In an international study common complication at the time of admission were evaluated, fever was present in 210 (51.7%), pneumonia was 179 (44.1%), and diarrhoea was 164 (40.4%) [9].

The most frequent complication on admission was fever (53.6%). Respiratory tract infections were the most common comorbidities and were present in 45 patients (25.1%), followed by malaria in 15.1% of cases [10]. While an Indian study had similar results to us, Anaemia (50%) and Diarrhoea (46.30%) was most common complications in children with SAM [11]. In a meta-analysis study Diarrhoea, dehydration and anemia were statistically significant predictors of mortality among SAM children [12].

Total 23.6% children recovered within 24 hours, while 43.2% children improved after 48 hours. 57.6% remained hospitalized for 1-7 weeks, while 6.1% children discharged after 15-21 days.

Regarding length of stay in the hospital, 57.6% patients remained hospitalized for 1-7 days, 36.3% for 8-14 days, while 6.1% for greater than 15-21 days. In a similar study 89.1% of children with kwashiorkor and 69.4% of children with marasmus were recovered. The median time of recovery was 35 days for children with kwashiorkor and 49 days for children with marasmus [13].

Weight gain was >7 g/kg/day in 39.9% children, while 22.2% children’s weight gain was <5 g/kg/day. Out of total 99 patients, 91 (91.9%) recovered fully and discharged to home, while 8 (8, 1%) children did not improved and shifted to intensive care unit. There was no expiry in our study participants. In an Ethiopian study the mean age of children was 16 months. Out of 413 children with SAM, 231 (55.9%) recovered, 24 (5.8%) died. The mean weight gain was 15.61 g/kg/day 8. In a study outcome in SAM children with complications was assessed that showed, treatment outcome was successful (cured) in 168 (66.9 %) and potentially unsatisfactory in 53 (21.2%), while 30 (11.9%) died [14]. In another study Among 633 patients admitted with SAM, 13.1% were lost to follow-up and 9.2% died while in hospital. Children infected with HIV were 3.90 times more likely to die compared to their counterparts [15]. There were no expires in our patients because we have separate team allocated for the care of Severe Acute Malnutrition children, they picked the complications earlier and managed them appropriately. Further there was proper vigilance, as the patients become sicker; they were shifted to Intensive Care Unit.

Conclusion

We found higher recovery rate from complications along with good weight gain. Few children developed new complication and become sicker, hence shifted to intensive care unit. There was no expiry in children of SAM with complications. Early identification of complications at triage in severe acute malnutrition children can decrease the mortality.

References

Author Info

Muhammad Nadeem Chohan*, Farah Naz, Salma Shaikh, Fouzia Shaikh, Sehrish Muzaffar and Saleem Shaikh

1Department of Pediatrics, Liaquat University of Medical and Health Sciences Jamshoro, Jamshoro, Pakistan
 

Citation: Farah Naz, Salma Shaikh, Muhammad Nadeem Chohan, Fouzia Shaikh, Sehrish Muzaffar, Saleem Shaikh, Complications of severe acute malnutrition in children at nutrition stabilization center Hyderabad. J Res Med Dent Sci, 2022, 10(5): 88-92.

Received: 21-Feb-2022, Manuscript No. 47233; , Pre QC No. 47233; Editor assigned: 23-Feb-2022, Pre QC No. 47233; Reviewed: 09-Mar-2022, QC No. 47233; Revised: 22-Apr-2022, Manuscript No. 47233; Published: 04-May-2022

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