The Role of Food Insecurity and Dietary Diversity on Recovery from Wasting among Hospitalized Children Aged 6–23 Months in Sub-Saharan Africa and South Asia

Abstract

Background: Current guidelines for the management of childhood wasting primarily focus on the provision of therapeutic foods and the treatment of medical complications. However, many children with wasting live in food-secure households, and multiple studies have demonstrated that the etiology of wasting is complex, including social, nutritional, and biological causes. We evaluated the contribution of household food insecurity, dietary diversity, and the consumption of specific food groups to the time to recovery from wasting after hospital discharge. Methods: We conducted a secondary analysis of the Childhood Acute Illness Network (CHAIN) cohort, a multicenter prospective study conducted in six low- or lower-middle-income countries. We included children aged 6–23 months with wasting (mid-upper arm circumference [MUAC] ≤ 12.5 cm) or kwashiorkor (bipedal edema) at the time of hospital discharge. The primary outcome was time to nutritional recovery, defined as a MUAC > 12.5 cm without edema. Using Cox proportional hazards models adjusted for age, sex, study site, HIV status, duration of hospitalization, enrollment MUAC, referral to a nutritional program, caregiver education, caregiver depression, the season of enrollment, residence, and household wealth status, we evaluated the role of reported food insecurity, dietary diversity, and specific food groups prior to hospitalization on time to recovery from wasting during the 6 months of posthospital discharge. Findings: Of 1286 included children, most participants (806, 63%) came from food-insecure households, including 170 (13%) with severe food insecurity, and 664 (52%) participants had insufficient dietary diversity. The median time to recovery was 96 days (18/100 child-months (95% CI: 17.0, 19.0)). Moderate (aHR 1.17 [0.96, 1.43]) and severe food insecurity (aHR 1.14 [0.88, 1.48]), and insufficient dietary diversity (aHR 1.07 [0.91, 1.25]) were not significantly associated with time to recovery. Children who had consumed legumes and nuts prior to diagnosis had a quicker recovery than those who did not (adjusted hazard ratio (aHR): 1.21 [1.01,1.44]). Consumption of dairy products (aHR 1.13 [0.96, 1.34], p = 0.14) and meat (aHR 1.11 [0.93, 1.33]), p = 0.23) were not statistically significantly associated with time to recovery. Consumption of fruits and vegetables (aHR 0.78 [0.65,0.94]) and breastfeeding (aHR 0.84 [0.71, 0.99]) before diagnosis were associated with longer time to recovery. Conclusion: Among wasted children discharged from hospital and managed in compliance with wasting guidelines, food insecurity and dietary diversity were not major determinants of recovery.

Various Risk Factors of Severe Acute Malnutrition in Children Under 5 Years of Age Presenting at a Secondary Care Hospital

“…Children in South Asia and sub-Saharan Africa are moderately acutely malnourished at a rate of 19% and 9%, respectively and roughly 2% of children in developing nations are severely acutely malnourished 3 . In Pakistan, stunting affects 42% of children, wasting affects 14%, and malnutrition affects 50-60% of children 4 .…”

Faktor-faktor yang Mempengaruhi Kejadian Wasting pada Balita Usia 36-59 Bulan di Wilayah Kerja Puskesmas Rao Kabupaten Pasaman

“…Namun, pemulihan nutrisi muncul lebih lambat di antara anak-anak yang keluar dari rumah sakit dibandingkan dengan anak-anak yang dirawat di masyarakat, meskipun alasan lambatnya tingkat pemulihan ini tidak jelas dipahami Berbagai faktor, termasuk perbedaan etiologi wasting di antara individu anak, adanya komorbiditas, dan kerentanan sosial ekonomi, semuanya mempengaruhi pemulihan nutrisi setelah keluar dari rumah (Shen et al, 2020). sakit Secara global, sepertiga dari anakanak antara usia 6 dan 23 bulan mengalami tingkat sedang kerawanan pangan yang parah, dan hanya sepertiga yang mengkonsumsi makanan yang cukup beragam Paling anak-anak dengan wasting sedang atau berat tinggal di rangkaian terbatas sumber daya di mana rumah tangga kerawanan pangan dan keragaman makanan yang tidak memadai merupakan pendorong penting gizi buruk hasil (Tsegaye et al, 2022).…”