Management of children with severe acute malnutrition: experience of nutrition rehabilitation centre at Baroda, Gujarat

Abstract

Children with severe acute malnutrition, defined as weight for height <70% of reference median or bilateral pedal edema or midarm circumference <11 cm having complications were managed following the WHO guidelines, in the nutrition rehabilitation centre of medical college, Baroda. Total 60 children aged less than five years were admitted during October 2011 to September 2012. Of them majority were aged less than two years, & the predominant age presented was 6-12 months. Severe malnutrition is more among females. 86.65% & 5% study population formed by marasmus & kwashiorkor respectively. Most patients stayed for inpatients treatment between 16-20 days, mean duration of stay was 15.6 days. Reasons for bringing children to the hospital were associated major illnesses & complaint such as fever in 65% of patients, 40% had diarrhea. 96.6% had pallor, and associated co morbidities observed were bronchopneumonia followed by acute gastroenteritis. Observed complications of SAM in our study were hypoglycemia (5%), hypothermia (1.66%) some and severe dehydration were (18.33%) and (13.33%) respectively, hyponatremia (13.33%), hypokalemia (8.33%), hypernatremia (5%), hyperkalemia (1.66%), septic shock (11.6%), severe anemia (58.33%), congestive cardiac failure (28.5%). Majority of patients had weight for height between 61-70% on admission and between 71-80% on discharge. Average weight for height on admission was 68.5% and average weight for height on discharge was 77.2%. 29 % patients reached more than 90% weight for height. Mean weight gain was 9.3 gm/kg/day.78.33% patients who were admitted were discharged, 8.33% absconded, 5% expired. Case fatality rate in our study was 5%.

Outcome of nutritional intervention measures at a nutrition rehabilitation centre in Krishna district, Andhra Pradesh

“…This is like that seen in other studies conducted by Shah et al where the duration was 16 days and Taneja et al where the duration of stay was 14 days. 8,9 In the present study it is observed that there is significant weight gain from admission to the discharge and from discharge to third follow up. The same result was also found in various other studies conducted by Colecraft et al, Gaboulaud et al, Taneja et al, Savadago et al 5,7,8,10 But the weight gain is not present at fourth visit which could be due to lack of adequate information on health issues and composition and preparation of therapeutic diets amongst mothers.…”

Evaluation of the Effects of Nutritional Intervention Measures on Sam Children in a Nutritional Rehabilitation Centre, Acsr Government Medical College, Nellore, A. P.

“…In a study by Rinki Shah et al, the duration of stay was 16 days while in a study by G Taneja et al, the duration of stay was 14 days. 8,12 In a study done by Hashmi G et al, it was 7.17±1.6 days which was comparable to the present study, though it is far less than the standard treatment guidelines of 14 days stay. To achieve a target weight gain of 15% of the initial weight before discharge, a stay of 14 days with nutrition rehabilitation, micronutrient supplementation is recommended.…”

Clinical Profile of Children with Severe acute Malnutrition Admitted to the Nutritional Rehabilitation Centre of a Tertiary Care Teaching Hospital of Assam

“…The most common presenting complaint on admission was fever (65%) and diarrhoea (40%) in a study done by Rinki Shah et al in Baroda, Gujrat 12 . The present study also shows that fever, cough and diarrhoea as the main presenting complaints.…”