Nutritional Status of Tribal Children and Adolescents in Rural South India: The Effect of an NGO Delivered Nutritional Programme

Objectives

To investigate the prevalence of malnutrition using anthropometric measures in a cohort of tribal students attending a school in rural south India. Children attending the school were offered three meals a day during attendance. Analysis of anthropometric data obtained aimed to determine the nutritional effect of the food provided.

Methods

The nutritional status of 409 students were assessed by comparing anthropometric measurements to reference values according to WHO/NCHS guidelines. Height for age <3rd percentile was defined as stunting. BMI for age <5th percentile was defined as thinness. ‘New’ students were defined as attending the school for <1 y. ‘Old’ students were defined as being in attendance for ≥1 y. Comparison of thinness and stunting prevalence in these groups enabled evaluation of the meals provided by the organisation.

Results

Four hundred and nine students were included for analysis in the study. The prevalence of thinness was 39.4 %. 59.5 % of ‘new’ and 52.9 % of ‘old’ students at the school demonstrated thinness. 59.4 % of students were classified as stunted. 73.8 % of ‘new’ students and 52.9 % of ‘old’ students demonstrated stunting (p 0.091). Significantly (p 0.010) more ‘new’ female students had stunted growth.

Conclusions

Acute and chronic measures of malnutrition were high amongst adolescent students attending the school. Comparison of ‘new’ and ‘old’ adolescent pupils at the school hints that the ‘old’ students were less malnourished than their ‘new’ counterparts. This study demonstrates the importance for NGOs to develop their nutritional programmes with a special focus on adolescents.     

Prevalence and correlates of the composite index of anthropometric failure among children under 5 years old in Bangladesh

The prevalence of stunting, wasting, and underweight are reported separately. However, the data of the multiple anthropometric failures combinations of these conventional indicators are scant. This study attempted to estimate the overall burden of undernutrition among children under 5 years old, using the composite index of anthropometric failure (CIAF), and to explore the correlates. The study used secondary data from the Bangladesh demographic and health surveys (BDHS), undertaken in 2014. CIAF provides an overall prevalence of undernutrition, which gives six mutually exclusive anthropometric measurements of height‐for‐ age, height‐for‐weight, and weight‐for‐age. Multivariable logistic regression was used to explore the correlates of CIAF. The overall prevalence of undernutrition using the CIAF was 48.3% (95% CI [47.1%, 49.5%]) among the children under 5 years old. The prevalence of anthropometric failure due to a combination of both stunting and underweight was 18.2%, wasting and underweight was 5.5%, and wasting, underweight, and stunting was 5.7%. The odds of CIAF were higher among young maternal age, having the poorest socio‐economic status, living in rural areas, higher order of birth, and received no vaccination compared with other counterparts. In Bangladesh, one out of two children has undernutrition, which is preventing the potential of the millions of children. Mothers who gave birth before age 20 living in the rural areas with belonging to lower socio‐economic status and whose children had a higher order of birth and receive no vaccination were observed as the main determinants of undernutrition. Nutrition sensitive interventions along with social protection programmes are crucial to deal the underlying causes of undernutrition.     

Physical activity as a clinical tool in the assessment of malnutrition

Objective

To measure physical activity in children with wasting and to look for association between poor physical activity and wasting.

Methods

Physical activity was measured in 56 children with wasting, using Children’s Activity Rating Scale, and compared with age- and sex-matched controls.

Results

A significant association was found between poor physical activity and malnutrition as determined by weight-for-height Z Score <-2 (P=0.001) and midupper-arm circumference (P=0.002).

Conclusion

Physical activity can be used as clinical parameter to assess malnutrition.     

Variation in Bowel Habits of Healthy Indian Children Aged up to Two Years

Objective

To study the normal bowel habits of healthy Indian children up to 2 y of age.

Methods

This cross sectional study was conducted in medical college associated teaching hospital in Delhi. Ethical clearance was obtained from Institutional Ethical Committee. A total of 500 infants and toddlers up to 2 y of age were recruited for the study. Data were collected by interviewing parents of the eligible children who came for immunisation using pre designed Performa.

Results

There was steady decline in stool frequency with increasing age. Maximum decline in stool frequency was noted after 1 mo of age. Variation in stool frequency between children was maximum in 0–3 mo of age and decreased with increasing age. Stools at 4 wk were usually semiliquid, watery and semisolid. By 6 mo of age 55 % infants were passing semisolid stools and 40 % were passing formed stools. At 24 mo of age, 89.2 % children usually passed formed stools.

Conclusions

This is the first study in India to date documenting the frequency and consistency of the stools of young children. These results make an important contribution to defining normal stool patterns in young Indian children.     

Risk Factors for Severe Acute Malnutrition in Children below 5 y of Age in India: A Case-Control Study

Objective

To determine the possible risk factors for severe acute malnutrition (SAM) in children below 5 y admitted in a hospital in north India.

Methods

This case-control study was conducted in a medical college hospital in children below 5 y of age. All cases of SAM (diagnosed as per WHO definition) between 6 and 59 mo of age were compared with age-matched controls with weight for height above -2SD of WHO 2006 growth standards. Data regarding socio-demographic parameters, feeding practices and immunization were compared between the groups by univariable and multivariable logistic regression models.

Results

A total of 76 cases and 115 controls were enrolled. Among the 14 factors compared, maternal illiteracy, daily family income less than Rs. 200, large family size, lack of exclusive breast feeding in first 6 mo, bottle feeding, administration of pre-lacteals, deprivation of colostrum and incomplete immunization were significant risk factors for SAM. Regarding complementary feeding, it was the consistency, rather than the age of initiation, frequency and variety which showed a significant influence on occurrence of SAM. Multivariate analysis revealed that the risk of SAM was independently associated with 6 factors, namely, illiteracy among mothers, incomplete immunization, practice of bottle feeding, consistency of complementary feeding, deprivation of colostrum and receipt of prelacteals at birth.

Conclusions

The present study identifies certain risk factors which need to be focused on during health planning and policy making related to children with SAM in India.     

Prevalence of undernutrition among Kora-Mudi children aged 2–13 years in Paschim Medinipur District,West Bengal,India

Background  

Nutritional status of tribal children in West Bengal has not been investigated adequately. The present study was undertaken to determine the prevalence of underweight, stunting and wasting in Kora-Mudi children of Paschim Medinipur, West Bengal, India.     

Longitudinal growth and post-discharge mortality and morbidity among extremely low birth weight neonates

Objectives

To study post-discharge growth, mortality and morbidity of extremely low birth weight neonates at corrected age of 2 years.

Methods

Weight, length and head circumference were compared on WHO growth charts at corrected ages 3 (n=54), 6, 9, 12 (n=51) and 24 months (n=37); rates of underweight, stunting, microcephaly and wasting were calculated.

Results

The mean Z-score for weight, length, head circumference and weightfor-length significantly improved from 3 to 24 months (P<0.001); a significant proportion remained malnourished at 2 years. Nine infants (11%) died and 35 (44%) required readmission during first year of age.

Conclusion

Extremely low birth weight neonates remain significantly growth retarded at corrected age of 2 years.     

Impact of Water,Sanitation and Hygiene Interventions on Growth,Non-diarrheal Morbidity and Mortality in Children Residing in Low- and Middle-income Countries: <Emphasis Type="Italic">A Systematic Review</Emphasis>

Objective

To evaluate the impact of water, sanitation and hygiene (WASH) interventions in children (age <18 y) on growth, non-diarrheal morbidity and mortality in children.

Design

Systematic review of randomized controlled trials, non-randomized controlled trials and controlled before-after studies.

Setting

Low- and middle-income countries.

Participants

41 trials with WASH intervention, incorporating data on 113055 children.

Intervention

Hygiene promotion and education (15 trials), water intervention (10 trials), sanitation improvement (7 trials), all three components of WASH (4 trials), combined water and sanitation (1 trial), and sanitation and hygiene (1 trial).

Outcome Measures

(i) Anthropometry: weight, height, weight-for-height, mid-arm circumference; (ii) Prevalence of malnutrition; (iii) Non-diarrheal morbidity; and (iv) mortality.

Results

There may be little or no effect of hygiene intervention on most anthropometric parameters (low- to very-low quality evidence). Hygiene intervention reduced the risk of developing Acute respiratory infections by 24% (RR 0.76; 95% CI 0.59, 0.98; moderate quality evidence), cough by 10% (RR 0.90; 95% CI 0.83, 0.97; moderate quality evidence), laboratory-confirmed influenza by 50% (RR 0.5; 95% CI 0.41, 0.62; very low quality evidence), fever by 13% (RR 0.87; 95% CI 0.74, 1.02; moderate quality evidence), and conjunctivitis by 51% (RR 0.49; 95% CI 0.45, 0.55; low quality evidence). There was low quality evidence to suggest no impact of hygiene intervention on mortality (RR 0.65; 95% CI 0.25, 1.7). Improvement in water supply and quality was associated with slightly higher weight-for-age Z-score (MD 0.03; 95% CI 0, 0.06; low quality evidence), but no significant impact on other anthropometric parameters or infectious morbidity (low to very low quality evidence). There was very low quality evidence to suggest reduction in mortality (RR 0.45; 95% CI 0.25, 0.81). Improvement in sanitation had a variable effect on the anthropometry and infectious morbidity. Combined water, sanitation and hygiene intervention improved height-for-age Z scores (MD 0.22; 95% CI 0.12, 0.32) and decreased the risk of stunting by 13% (RR 0.87; 95% CI 0.81, 0.94) (very low quality of evidence). There was no evidence of significant effect of combined WASH interventions on non-diarrheal morbidity (fever, respiratory infections, intestinal helminth infection and school absenteeism) (low- to very-low quality of evidence). Any WASH intervention (considered together) resulted in lower risk of underweight (RR 0.81; 95% CI 0.69, 0.96), stunting (RR 0.77; 95% CI 0.68, 0.86) and wasting (RR 0.12, 0.85) (low- to very-low quality of evidence).

Conclusion

Available evidence suggests that there may be little or no effect of WASH interventions on the anthropometric indices in children from low- and middle-income countries. There is low- to very-low quality of evidence to suggest decrease in prevalence of wasting, stunting and underweight. WASH interventions (especially hygiene intervention) were associated with lower risk of non-diarrheal morbidity (very low to moderate quality evidence). There was very low quality evidence to suggest some decrease to no change in mortality. These potential health benefits lend support to the ongoing efforts for provision of safe and adequate water supply, sanitation and hygiene.

     

Possible effect of maternal safe food preparation behavior on child malnutrition in Benin,Africa

Background

In many developing countries, faulty complementary feeding practises and frequently contaminated foods are contributing factors to child malnutrition. The aims of this study were to evaluate the nutrition status of, and clarify the maternal safe food preparation behaviors associated with malnutrition in, children aged <5 years in Cotonou, Benin.

Methods

This study targeted 300 mother–child pairs visiting the University Hospital of Mother and Child Cotonou Lagoon. Mothers were interviewed using a structured questionnaire. Child height/length and weight measurements were determined and Z ‐scores were calculated using the 2006 World Health Organization Child Growth Standards. Children with Z ‐score < ?2 were considered to have stunting or be underweight. On logistic regression analysis, significant variables on bivariate analysis, the associations of which were clarified in previous studies, were established as independent variables. Approximately 80% of the children who participated in this study were aged < 1 year. Being underweight was analyzed as a dependent variable.

Results

Regarding nutrition status, 11.0% of the children had stunting and 14.7% were underweight. On logistic regression analysis, underweight was correlated significantly with birthweight. As a remarkable point, food refrigeration was statistically significant. Food refrigeration can possibly be regarded as a maternal safe food preparation behavior.

Conclusions

Maternal safe food preparation behaviors can prevent child malnutrition, even after considering biological and socioeconomic factors.

     

Effect of Nutritional Status on Tuberculin Skin Testing

Objectives

To evaluate Tuberculin skin test (TST) results in a population of immigrants and internationally adopted children from several geographical areas; to analyze whether nutritional status can modify TST results.

Methods

This cross-sectional observational study included adopted children and immigrants evaluated in the authors’ unit between January 2003 and December 2008. Children diagnosed with tuberculosis, or vaccinated with live attenuated virus 2 mo earlier, HIV-infected, chronically ill or under treatment with immunosuppressive agents were excluded. TST was considered as dependent variable. Independent variables were gender, age, geographical origin, BCG scar, nutritional status, immune status and intestinal parasitism.

Results

One thousand seventy four children were included; 69.6 % were girls. There was a BCG scar in 79 % of children. Mantoux?=?0 mm was found in 84.4 %, <10 mm in 4.1 %, and ≥10 mm in 11.4 % of children. Nutrition (McLaren’s classification) was normal (≥90 %) in 26.7 % of the subjects, with mild malnutrition (80–89 %) in 36 %, moderate (70–79 %) in 23.2 % and severe (≤69 %) in 14.1 %. There was no difference in TST results among different nutritional status children.

Conclusions

The nutritional status, measured by McLaren’s classification, does not changes the results of TST. McLaren’s classification only grades protein-caloric malnutrition, so in authors’ experience this type of malnutrition does not interfere with TST results. Implementing other nutritional parameters could help to determine whether nutritional status should be taken into account when interpreting TST results.     

Prevalence and determinants of undernutrition and its trends among pre-school tribal children of Maharashtra State, India

A community-based cross-sectional study carried out in tribal areas of Maharashtra covering 1751 pre-school children to assess nutritional status. Nutritional status was assessed using new WHO Growth Standards. Household wealth index was constructed using principle component analysis. The prevalence of underweight, stunting and wasting was 64, 61 and 29%, respectively. There was a significant (p?相似文献   

Clinical and Ultrasonographic Measurement of Liver Size in Normal Children

Objectives

To measure the normal range of dimensions of liver in children of various age groups and to compare the liver measurement obtained by palpation-percussion, auscultation and ultrasonography.

Methods

This was a cross-sectional comparative study in which 500 normal (weight for height between ± 2 SD of WHO standards for children aged less than 5 y and BMI between ± 2 SD of WHO standards for children aged more than 5 y) children (0–15 y) divided in 5 age groups (100 in each age group). Subjects were enroled from normal hospital delivery neonates, children visiting immunization and well baby clinics, children visiting outpatient and inpatient department with minor illnesses and healthy school children.

Results

The normal range of dimensions of liver in children were estimated and percentile tables of liver size were established. Though the measurements obtained by clinical methods were significantly (P?<?0.001) lower than those obtained by ultrasonography, there was a strong correlation between clinical and ultrasonographic measurement. Palpation-percussion method could estimate the liver size within ± 1.0 cm of what was obtained by ultrasonography in 88 % of cases. In more than half of the study children (54.2 %), this estimation was within ± 0.5 cm.

Conclusions

Clinical methods of liver span estimation strongly correlate with ultrasonographic measurement. The performance of palpation-percussion method is better than that of auscultation. Clinical methods should continue to be used for the estimation of liver size.     

Pattern of Pediatric Dermatoses at a Referral Centre

Objective

To determine the pattern of skin disorders seen among children attending a Medical College Hospital, Bangalore

Methods

All children 18 y and below attending the Pediatric Dermatology OPD with skin diseases between the period of January 2011 and June 2011 were included in the study.

Results

A total of 1,090 new cases (boys 589; girls 501) with 1,118 dermatoses were recorded during this period. Twenty eight children had more than one dermatoses. Most of the disorders were seen between 5 and 11 y age group. The most common dermatoses was infections and infestations (32.47 %) followed by eczematous eruptions and dermatitis (20.66 %), papulosquamous and related disorders (6.08 %) and pigmentary disorders (5.81 %). Insect bite reactions and papular urticaria formed 5.1 %. Acne was seen in 5.28 % of children followed by urticaria (3.67 %), photodermatoses 2.5 % and genetic disorders (3.04 %).

Conclusions

In the present setting bacterial infections and scabies still remained the most common pediatric dermatoses followed by molluscum contagiosum and atopic dermatitis. Childhood psoriasis contributed to major part of the study among papulosquamous disorders.     

Corrosive Substance Ingestion in Children

Objectives

To evaluate children who ingested corrosive substances, in terms of demographic features, nature of ingested substances, clinical findings, management and complications.

Methods

A total of 1709 cases aged between 0 and 16 y who ingested corrosive substance were analyzed retrospectively by evaluating the medical records of the patients.

Results

The mean age of the cases was 35.23?±?30.65 mo and male:female ratio was 1.45. Forty one percent of corrosive substances causing intoxication contained NaOH. Thirty percent of the families consisted of 5 or more members. Fourteen percent of the mothers were illiterate. Stricture formation was observed in 29 (1.69 %) of the cases during follow-up. In 79.31 % of those cases alkaline substance ingestion was responsible for stricture development. It was found that stricture formation occurred more frequently among cases who were older than 5 y of age and this finding was statistically significant (p?=?0.001).

Conclusions

The cases older than 5 y of age with the diagnosis of grade 2b esophagitis must be followed up closely for the stricture formation. In order to protect children from corrosive ingestion, importance must be given to preventive measures such as education of families, keeping and storing these agents out of the reach of children and providing safety caps for these products.     

Delivering Sprinkles Plus through the Integrated Child Development Services (ICDS) to Reduce Anemia in Pre-school Children in India

Objective

To assess the effectiveness of micronutrient powder (MNP) supplementation in reducing anemia levels in children aged 6 mo to 6 y in India.

Methods

Sixty sachets of MNP (Sprinkles Plus) were administered flexibly over a 4 mo period to 17,124 children at anganwadi centers or at home through Integrated Child Development Services (ICDS). Compliance was monitored using compliance cards and an assessment of mother’s recall at post-intervention survey. Hemoglobin was measured in separate random samples of 1,786 children before and 1,782 children after MNP supplementation.

Results

Mean compliance rate was estimated at 56.4 % (based on mother’s recall) and 91.7 % (based on compliance cards) for children who received MNP at home. Mean compliance was 96.9 % (based on compliance cards) for children who received MNP at anganwadis. A significant reduction in anemia (50 % to 33 % in boys; p-value?<?.000; 47.4 % to 34.2 % in girls) was seen following MNP supplementation.

Conclusions

Integration of a flexibly administered MNP supplementation into the ICDS is effective in reducing and treating anemia in children 6 mo to 6 y age.     

Tuberculin Skin Test, Chest Radiography and Contact Screening in Children ≤5 Y: Relevance in Revised National Tuberculosis Control Programme (RNTCP)

Objectives

To ascertain the status of Tuberculin Skin Test (TST) in the children aged 0–5 y who are household contacts of adults having sputum smear positive pulmonary tuberculosis and also to study the relationship of TST and Chest X-Ray (CXR) and their relevance in contact screening under RNTCP setup.

Methods

This prospective hospital based clinical study was conducted at a tertiary level referral medical college in Northern India. Study subjects were 200 children ≤5 y of age who were household contacts of adults with sputum smear positive pulmonary tuberculosis. All these adult index cases were registered and taking regular treatment at RNTCP centre attached to a medical college. Demographic data collection, detailed clinical history along with clinical examination, growth assessment, TST and chest radiography (CXR) was done for every child.

Results

TST was positive in 39 % children and out of these 68 % of child contacts had CXR findings suggestive of tuberculosis. This correlation was found to be highly significant (p?<?0.001), especially in children less than 1 y of age. A high percentage of clinically asymptomatic children also had positive TST and CXR consistent with definition of TB disease.

Conclusions

Contact screening must be prioritized in RNTCP. Unlike presently, TST and CXR should be actively employed in RNTCP for contact screening.     

Stunting, underweight and wasting among Integrated Child Development Services (ICDS) scheme children aged 3-5 years of Chapra, Nadia District, West Bengal, India

This study investigated age and sex variations in height and weight, levels of stunting, underweight and wasting among 533 (254 boys; 279 girls) 3- to 5-year-old rural children of Bengalee ethnicity at 11 Integrated Child Development Services centres of Nadia District, West Bengal, India. Height-for-age, weight-for-age and weight-for-height < -2 z-scores were used to evaluate stunting, underweight and wasting, respectively, following the National Center for Health Statistics (NCHS) Guidelines. Results revealed that boys were significantly heavier than girls at age 3 years. Significant age differences existed in mean height and weight in both sexes. Mean z-scores of height-for-age, weight-for-age and weight-for-height were lower than those of NCHS for both sexes at all ages. The overall (age and sex combined) rates of stunting, underweight and wasting were 23.9%, 31.0% and 9.4%, respectively. The rate of underweight and wasting was higher among girls (underweight = 35.1%, wasting = 12.2%) compared with boys (underweight = 26.5%, wasting = 6.3%). In general, the frequency of stunting increased with increasing age in both sexes. Based on the World Health Organization classification of severity of malnutrition, the overall prevalence of underweight was very high (>or=30%). The prevalence rates of stunting (20-29%) and wasting (5-9%) were medium. In conclusion, the nutritional status of the subjects is unsatisfactory. There is scope for improvement in the form of enhanced supplementary nutrition.     

The Unforeseen Toll of Birth Defects and their Economic Burden at a Tertiary Care Public Institute in Mumbai

Objectives

To determine the proportion of patients with birth defects receiving indoor medical care and the economic burden incurred by the Institution in terms of cost of hospitalization.

Methods

This single center, prospective, observational study recruited children >28 d and <12 y of age with birth defect(s) not attributable to an acquired disease. Demographic data, maternal and antenatal data, nature of the defect and information about current and past hospitalization were recorded. Economic burden was estimated by computing bed charges and daily costs incurred by the Institution.

Results

Ninety-eight children (mean age was 3.18 y, M : F ratio was 2.4:1) with 268 birth defects represented 13 % of indoor admissions. The cardiovascular system was involved in 42.9 %. The defect was isolated in 58.2 % of cases and 41.8 % (9.2 % having Down syndrome) had multiple defects. Mean duration of hospital stay (11.23 d) of the birth defect cohort was significantly more (p value?=?0.0005) than other children (7.81 d). Average cost of stay for those with birth defects (18.3 % of the total cost) and other indoor patients was INR 23,481 and INR 16,328 respectively.

Conclusions

Birth defects are an emerging burden in referral centers, incurring one-fifth of the hospital expenditure, partly due to increased length of stay. The figure is an underestimate as the expenses are highly subsidized in a Public health facility.