Malnutrition and infection
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
|
Malnutrition and infection |
|
|
P13 - Malnutrition and Diarrhoea Contributing to Under-Five Mortality L. Braja Mohon Singh , L. Ranbir Singh, Lalawmpuia, Ebenezer War, S. Bijoy Singh, P. Ibomacha Singh. Department Of Pediatrics, The Regional Institute Of Medical Sciences, P. O. Imphal, Manipur State, India.Objective: To investigate the contribution made by malnutrition and diarrhoea to under-five children mortality. Design: Prospective observational study. Setting: Paediatric patient in a Regional Medical Teaching Institute Methods: During the study period from January 1998 to December 1998, out of a total admission of 1962 under-five children 131 patients died giving a mortality of 6.67%. These cases were analysed going into the details of the cause of death. Particular attention was given to the contribution made by malnutrition and diarrhoea to this mortality and other factors related to it. Results: Malnutrition was found in 54 cases (41.22%). Acute diarrhoea was the cause of death in 11cases (8.39%). Other factors like socio – economic status, maternal age & parity, birth weight, mother’s literacy, immunisation status and dietary intake are also found to be important. Conclusion: In the developing countries there are many factors contributing to the high mortality of the under-five children. Malnutrition and diarrhoea are having their own good shares in it. To conclude the under-five mortality can be reduced by taking up measures for the overall improvement of the health status and some of them are to improve the socio – economic status, heath education, nutritional education, dietary supplementation and prevention of the malnutrition and diarrhoea. P14 - Diarrhoea and Malnutrition in HIV Infected Children. P. Ibomacha Singh, L. Braja Mohon Singh, *Ng. Braja Chand Singh, Ibochouba Singh Khaidem, R. Wapang Imchen. Department Of Pediatrics And * Microbiology, The Regional Institute of Medical Sciences, PO Imphal, Manipur State, India. Objective: To investigate the diarrhoeal disease and malnutrition in HIV infected children. Design: Prospective observational study. Setting: Paediatric patient in a Regional Medical Teaching Institute Methods: 50 new cases of Human Immunodeficiency Virus positive children were taken in the age group 0 – 12 years during the study period of 18 (Eighteen) months from January, 1999 to June, 2000 and their HIV status was determined with Elisa Test and Western Blot Test. Wellcome International Classification was engaged for the nutritional status. The incidence of the diarrhoeal disease was studied along with other associated findings. Results: Malnutrition was evident in 33 cases (66%). Prolonged diarrhoea was noted In 40 cases (80%). Other findings were prolonged fever, oral ulcer, ear discharge, skin infection, sweating, swollen gland, failure to thrive weight loss and delayed milestones, recurrent chest infections. Conclusion: For the last few years we experienced the relatively smaller children having protracted infections, particularly the diarrhoeal disease, recurrent chest infections, unexplained fever and malnutrition. The high index of suspicion leads us to the diagnosis of HIV infection with its associated problems. The future will hopefully, provide us with the better skills of diagnosis and management of the HIV infection and its accompanying problems in general and diarrhoeal disease and malnutrition in particular. P15 - Dietary Management in Persistent DiarrhoeaNR Bhandari . Gandhi Medical College, Bhopal, IndiaDiarrhoea that starts as an acute episode and lasts for at least – 14 days, is called persistent diarrhoea. This definition excludes specific conditions like coeliac disease, tropical sprue, and metabolic disorders. Predominant causes of persistent diarrhoea could be, persistent infection, malabsorption and enteric infection. Majority of such patients pass several loose stools but remain well hydrated. It is more common in malnourished infants and young children. Persistent diarrhoea rarely occurs in infants below 4 months is of age, who are exclusively breast fed. If infants in this age group develop diarrhoea breast feeding must be continued. If it is inadequate then animal milk/curd/lactose free milk formula should be advised. From third month onwards, cooked, precooked rice can be mixed with it. In older patients, an animal milk, the quantity should be reduced to 50-60 mL/kg and cereals, curd, rice, gruel, Suji should be added. Some children can be kept on lactose free diet with reduced starch. 70 to 80% children respond well in 7 to 10 days and start gaining weight. Reduced lactose diet can be prepared by mixing milk, sugar, oil, puffed rice powder and water. Reduced starch diet can be prepared by mixing egg white, puffed rice powder, glucose, oil and water. P16 - Home-based nutritional rehabilitation of severely malnourished children recovering from diarrhoea and other acute illnesses. M. Munirul Islam, Tahmeed Ahmed, Baitun Nahar, M. A. Salam, Ann Ashworth1, George J. Fuchs. International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). GPO Box 128, Dhaka, Bangladesh. 1 London School of Hygiene & Tropical Medicine, LondonObjective: To investigate the efficacy of home-based nutritional rehabilitation (NR) compared to expensive, hospital-based NR of severely malnourished children recovering from diarrhoea and other acute illnesses. Methodology: After treatment of the acute phase of severe malnutrition and associated illnesses including diarrhoea, pneumonia or septicemia, severely malnourished children (weight-for-length <70% and/or oedema) aged 6 months to 5 years are randomised to receive any of the three treatments: home-based NR with home follow-up (treatment A), home-based NR with outpatient follow-up (treatment B), hospital-based NR (treatment C). After randomisation, children on treatments A and B stay in the nutritional rehabilitation unit (NRU) of the ICDDR,B hospital for approximately 7 days for stabilisation of general condition and education of mothers regarding preparation of low-cost, nutritious diets. Upon discharge from the hospital, children on treatment A are visited at home at regular intervals during which growth is monitored and morbidity recorded until achievement of weight-for-length (WL) >80%. Children on treatment B attend the outpatient follow-up clinic after discharge while those on treatment C remain in the NRU until they achieve WL >80%. Children on treatments A and B receive only micronutrients but no food supplements from the hospital during follow-up. Outcome measures include time to achieve oedema-free WL >80% and rate of weight gain. Results: Of 248 children treated for the acute phase, 144 children were randomised to the study (sample size, 225 children). 104 children could not be randomised because of reasons including parent’s refusal to stay in the NRU, persistent diarrhoea necessitating special dietary therapy, tuberculosis, distant residence, or leaving against medical advice (LAMA). Two children out of 248 children died during the acute phase treatment (case-fatality rate 0.8%). The status of 144 children randomised so far is as follows: achieved WL >80%, 91; LAMA, 25; left without notice, 9; migrated, 4; termination of study, 14; death, 1. The child who died after randomisation was on treatment C. She developed pneumonia in the NRU and later died of septicemia and acute renal failure. The children, who achieved WL >80% in the three treatment groups, were comparable in terms of age, gender, enrolment weight, length and WL, and proportion with oedema. Weight and length upon achievement of WL >80% were similar among the groups. Children on hospital-based NR took fewer days to achieve WL >80% compared to children in other groups, although the difference was not significant (median days 21.5, 29, 18 for treatments A, B and C respectively; Kruskal Wallis p=0.07). Rates of weight gain differed among the groups (median 9.4, 7.5, 12.6 g/kg per day for treatments A, B and C respectively; Kruskal Wallis p=0.01). Conclusion: Preliminary results suggest that home-based NR coupled with home visitation for follow-up may be an effective alternative to expensive, hospital-based NR of severely malnourished children recovering from acute illnesses. P17 - A Study of Malnutrition and associated Infection in Children in an Urban Private Hospital in India Manju Lata Sharma. IndiaMalnutrition is one of the major health problems in developing countries. According to WHO data in 1995 more than 30% of world’s children under five are still malnourished in terms of being under weight. Associated infection worsen the problem and are major cause of mortality and morbidity in malnourished children. Objectives 1. To know the prevalence of malnutrition. 2.To know about the various infection associated with malnutrition. Design Prospective study over a period of two years. Setting Urban Private Hospital and Research Center. Methods 150 children (72 males and 78 females) with malnutrition interlinked with infections and age range 6 months to 12 years were studied. A detailed physical examination and clinical evaluation of children with malnutrition was done and the various infections associated with malnutrition were evaluated by detail history, clinical examination. Relevant laboratory investigation was done to find out the nature of infections. Results The incidence of malnutrition interlinked with infection was 8%. About 80% of children belonged to low socio-economic class with poor hygienic and sanitary condition, 60% parents literate. Most mothers continued to breast-feed their babies up to 1 year and weaning was done at the age of 4 months. Most of the children were not fully vaccinated. Primary vaccination against BCG, DPT and Polio was 70%. The prevalence of malnutrition was significantly higher in girls than boys, in children under 2 years of age and among those who had more than 2 to 3 sibling. 20% had more moderate and severe malnutrition as judged by IAP classification marasmic-kwashiorkor constitute 40% of cases. Diarrhoea and dysentery constitute majority of the infections about 50%. 2nd most common infection recurrent upper and lower respiratory infection. Primary complex was diagnosed in 8 children. The diagnosis was based on clinical criteria. Radiological findings and response to anti-tuberculosis treatment most of them had positive Mantoux test. The vitamin A deficiency judged by Bitot Spots and night blindness was 5% worm infestation present in most of children. Some children had other associated infections like measles, chickenpox and enteric fever. Commonest cause of mortality in malnutrition is chronic diarrhoea and respiratory infections. Conclusion Poverty, illiteracy, ignorance, poor sanitary conditions, faulty feeding habits were found to be the major contributory factors for malnutrition. The cumulative effect of reduced energy and nutrient intake caused by frequent infections was found to be the most important cause of malnutrition. The paediatrician in India is faced with a number of diverse problems ranging from population explosion, limited resources to a low literacy rate. Preventive programs are the key strategy for improving child health status in India. Identification of specific population groups and required need based programs should be implemented in India although efforts have been made by implementing several programs like midday meal, integrated child development services etc., their complete success as effective preventive measures is yet to be proved. |
|
Questions or comments to info@capgan.org or Fax: +852 26360020 or Tel: +852 26322861Last modified: December 10, 2001 |