Linear and knemometric growth in the early phase of rehabilitation from severe malnutrition.

The relationship between ponderal, linear and lower leg growth in children recovering from severe malnutrition remains unclear. We report on the early growth of 141 severely malnourished Bangladeshi children aged 6 to 36 months of age who were followed for 90 d. Mean (sd) weight for height (WHZ) and height for age (HAZ) catch-up growth z scores over the 90 d were 1.6 (0.85) and 0.47 (0.325) respectively. Mean (sd) lower leg length growth was 10.35 (4.5) mm. Change in HAZ was significantly associated with initial WHZ, but linear growth occurred in the presence of severe wasting and no threshold WHZ score was identified. Lower leg length gain correlated throughout with ponderal indices but with change in HAZ score only after day 45. Only initial WHZ score and maternal height predicted for linear growth and only accounted for 20 % of total variance. We conclude that linear growth occurs early in severely malnourished children but that knemometry behaves as a ponderal index acutely.     

The association of enterotoxigenic and enteropathogenic Escherichia coli and other enteric pathogens with childhood diarrhoea in Yugoslavia

The presence of enterotoxigenic and enteropathogenic Escherichia coli (ETEC and EPEC, respectively) was investigated in stool specimens of 1082 preschool children with diarrhoea and in stools of 335 healthy controls in localities in southern Yugoslavia, as well as in 566 children with diarrhoea and in 231 controls living in northern part of the country, during the seasonal peak (August-November) of enteric diseases in 1986. ETEC were found in 114 (10.5%) children with diarrhoea and in 14 (4.2%) controls (P less than 0.001) in the southern part, and in 26 (4.6%) ill children and one (0.4%) well child (P less than 0.005) in the northern part of Yugoslavia. EPEC were isolated from stools of 85 (7.9%) children with diarrhoea and of 14 (4.2%) well children (P less than 0.05) in localities of southern Yugoslavia, and from 22 (3.9%) ill children and from 10 (4.3%) controls in northern Yugoslavia. Nineteen EPEC strains expressed localized adherence to HEp-2 tissue culture cells; all were isolated from stools of ill children. In southern Yugoslavia, where other enteropathogens were sought, the most commonly found agents in ill children were shigellae (17.5%), rotavirus (11.8%), ETEC, and EPEC. Potential pathogens were detected in 44.5% cases of sporadic diarrhoea and in 15.8% controls. This study revealed that ETEC were associated with acute diarrhoeal disease in Yugoslav preschool children. On the other hand, the diagnosis of EPEC-diarrhoea by routine determination of serogroup established the association of these agents with sporadic diarrhoea only in the 0-2 years age categories in all investigated localities. In the less developed southern part of Yugoslavia bacteria were the predominant causative agents of enteric illness during the seasonal peak of this disease.     

Faecal colonization with P-fimbriated Escherichia coli between 0 and 18 months of age

A prospective study of faecal colonization with P-fimbriated Escherichia coli between 0 and 18 months of age was conducted in 751 healthy infants. The influence of breast-feeding and treatment with antibiotics on this colonization was studied. Colonization with P-fimbriated E. coli increased with age from 10% at 6 days to 30% at 18 months of age (P less than 0.01). Breast-feeding influenced colonization at 6 weeks of age when breast-fed children harboured fewer bacterial species (P less than 0.001) and fewer P-fimbriated E. coli (P = 0.06) than bottle-fed infants. Treatment with antibiotics increased the colonization rate with P-fimbriated E. coli at the age of 11 months (P less than 0.05). However, this was not true for treatment with ampicillin, which increased colonization rate with Gram-negative species other than E. coli (P less than 0.05). Fifty per cent (378) of all children were colonized and a quarter (183) had pure cultures of P-fimbriated E. coli in at least one faecal sample. The clinical importance of this colonization remains to be shown.     

Fulminating pneumococcal septicemia in a 2 year old child with sickle cell anemia

A 2-year-old boy known with homozygous sickle cell anaemia became acutely ill at home. Despite intensive care, he died a few hours later due to pneumococcal septicaemia. In young children with homozygous sickle cell anaemia, spleen function is already severely impaired in childhood due to haemolysis and frequent vaso-occlusive episodes. These children therefore have an elevated susceptibility to severe invasive infections with encapsulated bacteria. Vaccination against pneumococci at-2 years of age, re-vaccination every 3-5 years, and antibiotic prophylaxis until 5 years of age, and thereafter with possible infections, are therefore necessary.     

Gender inequality and severe malnutrition among children in a remote rural area of Bangladesh

Bangladesh typifies many south-eastern countries where female children experience inferior health and uncertain survival, especially after the neonatal period. This paper attempts to study the gender inequality in nutritional status and the effects of various socioeconomic, demographic, and health-programme factors on gender inequality in a remote rural area of Bangladesh. Measurements of mid-upper arm circumference (MUAC) were taken from 2,016 children aged less than 5 years (50.8% male, 49.2% female) in 1994. Children were characterized as severely malnourished if MUAC was < 125 mm. Independent variables included various characteristics of children, households, and mothers. Average MUAC for all children was 130 mm; 33% were severely malnourished. Of the severely-malnourished children, 54.2% were female, and 45.8% were male. The gender gap persisted in the multivariate situation, with female 1.44 times more likely to be severely malnourished. Other variables with a statistically significant relationship included the age of children, acceptance of DPT1, and education of household heads. The persistence of such a gender discrimination now when the country has achieved a lot in terms of child survival is striking. The issue is important and demands appropriate corrective actions.     

Clinical and biochemical characteristics associated with anthropometric nutritional categories.

Clinical nutrition status as well as selected biochemical characteristics, levels of parasitic infection and aspects of family and health history were assessed in rural EI Salvadoran children categorized as severely malnourished by anthropometric measurements. The anthropometric categories used were based on weight-for-age, weight-for-height, height-for-age, and simple mid-upper-arm circumference. Results indicated that 16 of 17 children with less than 80% of expected weight-for-height ("wasted") and all 17 children with arm circumference below 12.5 cm had clinically evident malnutrition. Children with less than 82.5% of expected height-for-age ("stunted") were more frequently anemic than controls and had a higher intestinal parasite burden, but only 3 of 23 were malnourished clinically. Sixteen of 22 children with severe weight-for-age deficit (Gomez grade III) were judged clinically malnourished, but the remaining six were underweight primarily because of short stature and did not appear malnourished clinically. The results illustrated the inability of weight-for-age classification to distinguish between acute and chronic malnutrition. The interrelationships between weight-for-height, height-for-age, and weight-for-age classification are illustrated graphically as a guide to the interpretation of these results.     

The Pediatric Subjective Global Nutrition Assessment Classifies More Children With Cerebral Palsy as Malnourished Compared With Anthropometry

BackgroundNutrition assessment is multidimensional; however, much of the literature examining the nutritional status of children with cerebral palsy (CP) focuses on a single dimension.ObjectiveThe aim of the study was to evaluate nutritional status in children and adolescents with CP by comparing results from the Pediatric Subjective Global Nutrition Assessment (SGNA) with results from traditional anthropometric measures.DesignThis study was a cross-sectional observational study.Participants/settingThis study was conducted in a tertiary hospital outpatient setting in Brisbane, Australia, from February 2017 to March 2018. A total of 89 children (63 boys) with CP aged between 2 and 18 years of age were included. All Gross Motor Function Classification System levels were observed. The majority of children were in Gross Motor Function Classification System I and II (57, 64%) compared with Gross Motor Function Classification System III to V (32, 36%). Children with feeding tubes and those acutely unwell or hospitalized were excluded.Main outcome measuresChildren were classified as well nourished, moderately malnourished, or severely malnourished by dietitians using the SGNA. Weight, height, body mass index (BMI), triceps skinfold thickness, subscapular skinfold thickness, and mid upper arm circumference were measured and converted to z scores to account for age and sex differences. Moderate malnutrition was defined by z scores −2.00 to −2.99 and severe malnutrition as ≤−3.00 z scores.Statistical analysis performedMultinomial logistic analyses were used to compare results from the SGNA and each single measurement. Continuous outcomes were transformed into z scores. Agreement was assessed with 2 categories: not malnourished and malnourished. Comparison statistics included percent agreement, sensitivity, and specificity.ResultsMore children were classified as moderately or severely malnourished by SGNA than any of the anthropometric z score cutoffs. The majority of children were well nourished (n = 63) with 20 (22%) moderately malnourished and 6 (7%) severely malnourished by SGNA. The SGNA classified 11 children as malnourished that were not classified as malnourished by BMI. Children with moderate or severe malnutrition by SGNA had lower weight (P < .001, P < .001), BMI (P < .001, P < .001), mid upper arm circumference (P < .001, P < .001), triceps skinfold thickness (P = .01, P = .007), and subscapular skinfold thickness (P = .005, P = .02) z scores than well-nourished children.ConclusionThe SGNA identified more potentially malnourished children including children classified as well nourished by the single measurements such as BMI, height, and weight. The SGNA provided a clinically useful multidimensional approach to nutrition assessment for children with CP.     

Body composition in 995 acutely ill or chronically ill patients at hospital admission: a controlled population study

OBJECTIVE: To determine if fat-free mass and fat mass in acutely ill and chronically ill patients differed from healthy controls at hospital admission and if prevalence of malnutrition differed by body mass index (BMI) or fat-free mass percentile. SUBJECTS/SETTING: 995 consecutive patients 15 to 100 years of age admitted to the hospital were measured in the hospital admission center and compared with 995 healthy age- and height-matched subjects DESIGN: Cross-sectional study. Fat-free mass, fat mass, and percentage fat mass were determined by 50 kHz bioelectrical impedance analysis. Prevalence of malnutrition was determined by BMI < or = 20 kg/m2 or fat-free mass in the 10th percentile. STATISTICAL ANALYSIS: Analysis of variance was used to examine differences between acutely ill and chronically ill patients and controls and between age groups. RESULTS: Fat-free mass was significantly lower in patients than controls (P< or = .05), and the difference with age in fat-free mass in patients was greater than the age-related difference in the controls. A higher percentage fat mass was found in spite of lower BMI in chronically ill patients older than 55 years. Among participants, 25% of acutely ill and 37.3% of chronically ill patients fell below fat-free mass in the 10th percentile, compared with 15.6% of acutely ill and 18.9% of chronically ill patients falling below BMI < or = 20 kg/m2. APPLICATIONS/CONCLUSION: Weight and BMI do not evaluate body compartments and therefore do not reveal if weight changes result in loss of fat-free mass or gain in fat mass. In spite of minimal differences in BMI between patients and controls, we found that fat-free mass was lower and fat mass was higher in acutely ill and chronically ill patients than controls. The objective measurement of body composition, as part of a comprehensive nutritional assessment, helps to identify subjects who have low fat-free mass or high fat mass.     

Maternal-child interaction in survivors of severe malnutrition who received psychosocial stimulation

Jamaican children who had recovered from severe malnutrition 3 years previously (CM group) were observed with their mothers in a structured play situation. Their behaviour was compared with two other groups; another severely malnourished group which had participated in an intervention programme of psychosocial stimulation (IM group) and an adequately nourished group (controls). All children were subjects in a longitudinal intervention study (Grantham-McGregor, Schofield & Powell, 1987). Both malnourished groups had very low levels of development (DQ) initially. The CM group's DQs remained low but the IM group caught up to the controls. During the observation the CM children stayed nearer their mothers and played less than the children in other groups. It was hypothesized that this behaviour could have contributed to their poor development. The IM children behaved similarly to the controls. It is probable that non-nutritional intervention had changed their behaviour. Only little differences were found between the mothers.     

Plasma concentrations of N-acetylneuraminic acid in severe malnutrition

In rat studies, circulating concentrations of N-acetylneuraminic acid (NANA) have been shown to be an indicator of NANA concentrations in the brain and functional brain activity, in relation to nutritional state and stimulation. Abnormal behaviour can be improved with exogenous NANA. In the present study, the plasma NANA concentration has been measured in children with severe malnutrition and compared with that in controls. NANA was measured colorimetrically in the plasma of twenty-three severely malnourished children (mean age 11.43 (SD 6.05) months) before and after recovery, and in thirty-four controls (mean age 14.28 (SD 7.32)months). In thirteen of the malnourished children, NANA was measured after infections had been treated with a course of antibiotics. Mean plasma NANA concentration was significantly higher in protein-energy malnutrition (PEM) (2.89 (SD 0.58) mumol/ml; n 23) compared with controls (2.13 (SD 0.37) mumol/ml; n 34, P less than 0.001). The levels remained high in PEM after infections had been treated (2.87 (SD 0.43) mumol/ml, n 13) but returned to control levels at recovery from PEM (2.14 (SD 0.24) mumol/ml). In contrast to the findings in rats, in malnourished children plasma NANA concentrations were not reduced and did not relate directly to nutritional state or, by inference, brain function. These findings do not provide any support for the use of exogenous NANA supplements to improve brain function in humans.     

Management of severe acute malnutrition in an urban nutritional rehabilitation center in Burkina Faso

BACKGROUND: Management of acute severe malnutrition greatly contributes to the reduction of childhood mortality rate. In developing countries, where malnutrition is common, number of acute severe malnutrition cases exceeds inpatient treatment capacity. Recent success of community-based therapeutic care put back on agenda the management of acute severe malnutrition. We analysed key issues of inpatient management of severe malnutrition to suggest appropriate global approach. METHODS: Data of 1322 malnourished children, admitted in an urban nutritional rehabilitation center, in Burkina Faso, from 1999 to 2003 were analyzed. The nutritional status was assessed using anthropometrics indexes. Association between mortality and variables was measured by relative risks. Kaplan-Meier survival curves and Cox model were used. RESULTS: From the 1322 hospitalized children, 8.5% dropped out. Daily weight gain was 10.18 (+/-7.05) g/kg/d. Among hospitalized malnourished children, 16% died. Patients were at high risk of early death, as 80% of deaths occurred during the first week. The risk of dying was highest among the severely malnourished: weight-for-height<-4 standard deviation (SD), RR=2.55 P<0,001; low MUAC-for-age, RR=2.05 P<0.001. Kaplan-Meier survival curves and Cox model showed that the variables most strongly associated with mortality were weight-for-height and MUAC-for-age. Among children discharged from the nutritional rehabilitation centre, 10.9% had weight-for-height<-3 SD. CONCLUSION: The nutrition rehabilitation centre is confronted with extremely ill children with high risk of death. There is need to support those units for appropriate management of acute severe malnutrition. It is also important to implement community-based therapeutic care for management of children still malnourished at discharge from nutritional rehabilitation centre. These programs will contribute to reduce mortality rate and number of severely malnourished children attending inpatient nutrition rehabilitation centers, by prevention and early management.     

Body Composition in 995 Acutely ill or Chronically ill Patients at Hospital Admission: A controlled population Study

Objective To determine if fat-free mass and fat mass in acutely ill and chronically ill patients differed from healthy controls at hospital admission and if prevalence of malnutrition differed by body mass index (BMI) or fat-free mass percentile.Subjects/Setting 995 consecutive patients 15 to 100 years of age admitted to the hospital were measured in the hospital admission center and compared with 995 healthy age- and height-matched subjectsDesign Cross-sectional study. Fat-free mass, fat mass, and percentage fat mass were determined by 50 kHz bioelectrical impedance analysis. Prevalence of malnutrition was determined by BMI <20 kg/m² or fat-free mass in the 10th percentile.Statistical Analysis Analysis of variance was used to examine differences between acutely ill and chronically ill patients and controls and between age groups.Results Fat-free mass was significantly lower in patients than controls (P<.05), and the difference with age in fat-free mass in patients was greater than the age-related difference in the controls. A higher percentage fat mass was found in spite of lower BMI in chronically ill patients older than 55 years. Among participants, 25% of acutely ill and 37.3% of chronically ill patients fell below fat-free mass in the 10th percentile, compared with 15.6% of acutely ill and 18.9% of chronically ill patients falling below BMI ≤20 kg/m².Applications/Conclusion Weight and BMI do not evaluate body compartments and therefore do not reveal if weight changes result in loss of fat-free mass or gain in fat mass. In spite of minimal differences in BMI between patients and controls, we found that fat-free mass was lower and fat mass was higher in acutely ill and chronically ill patients than controls. The objective measurement of body composition, as part of a comprehensive nutritional assessment, helps to identify subjects who have low fat-free mass or high fat mass. J Am Diet Assoc. 2002;102:944-948,953-955.     

Bacteraemia among severely malnourished children in jimma university hospital, ethiopia

Background

Sever acute malnutrition severely suppresses every component of the immune system leading to increased susceptibility and severity to infection. However, symptoms and signs of infections are often unapparent making prompt clinical diagnosis and early treatment very difficult. The aim of the study was to determine the magnitude of bacteraemia and antimicrobial sensitivity among severely malnourished children.

Methods

Severely malnourished children admitted in Jimma University Specialized Hospital were enrolled between October, 2009 to May, 2010. Blood samples were collected, processed and bacterial isolates were identified using standard bacteriological procedures. Then, antibiotic susceptibility pattern of the isolates was determined by using Kirby-Bauer technique.

Results

Bacteraemia was seen in 35 (20.6%) of the 170 study subjects. There were a total of 35 bacterial isolates, Gram positive bacteria constitute 24(68.6%) of the isolates, where Staphylococcus aureus was the leading Gram positive isolate while Klebsiella species were the dominant Gram negative isolates. Twelve (7.1%) children died and 4 (33.3%) of them had bacteraemia. While susceptibility was more than 80% to Gentamicin, Ciprofloxacin and Ceftriaxone, increased level of resistance was documented to commonly used antibiotics, such as Amoxycillin, Co-trimoxazole and Chloramphenicol.

Conclusion

High prevalence of bacteraemia with predominating Gram positive isolates and increased level of resistance to commonly used antibiotics was shown among severely malnourished children in Jimma. Further studies are required to revise the current guideline for antibiotic choice.     

入托对儿童急性上呼吸道感染发病及咽部病原体变化的影响

目的 了解入托对儿童急性上呼吸道感染(AURI)发病及咽部病原体变化的影响, 为制定有效的AURI预防措施及治疗对策提供参考。方法 选取91名首次于本市某公立幼儿园入托的健康学龄前儿童, 入托前体检及首学期入托期间首次发生AURI后行咽拭子多病原体检测, 探讨入托后集体生活对咽部病原体变化的影响。结果 91名儿童发病前后咽拭子标本分离细菌种次无明显差别, AURI发病后≥2+细菌总比例高于基线(42.28% vs. 33.77%, P=0.036);发病前支原体阳性 1名(1.1%), 衣原体及呼吸道病毒7项均未检出。发病后病毒及支原体阳性25名(27.47%), 前后差别有统计学意义(χ²=37.11, P<0.001)。经过分析, 51.65%为细菌感染、27.47%为非细菌感染, 其中混合感染5.50%, 常见病原体在发病时间上存在集中分布趋势。 结论 健康学龄前儿童咽部存在细菌混合定植, 病毒及支原体、衣原体定植极为罕见。幼儿园集体生活可能促进儿童AURI发生及互相传播, 加强托幼机构儿童保健及疾病预防工作十分重要。     

Nutritional rehabilitation in Bangladesh--the importance of zinc

Our aim was to investigate whether zinc deficiency becomes apparent during nutritional rehabilitation and limits the rate of weight gain. Twenty-five severely malnourished children, who were admitted to the Children's Nutrition Unit in Bangladesh, were alternately allocated to two groups. Their mean dietary Zn intake was 3.7 mg/d and mean caloric intake greater than 150 kcal.kg-1.d-1; one group received a daily Zn supplement of 50 mg for 2 wk. During the first week, weight gain was similar in the two groups, but during the second week, weight gain was 73% more in the Zn-supplemented group (8.83 +/- 1.56 vs 5.09 +/- 1.62 g.kg-1.d-1). The 95% confidence limits were 0.88 less to 8.36 g.kg-1.d-1 more gain in children receiving Zn supplements. The results strongly suggest that Zn supplements are beneficial to severely malnourished children during nutritional rehabilitation. Polymorphonuclear (PMN) cell Zn increased in the group receiving Zn supplements (p less than 0.001), confirming that the Zn content of PMN cells reflects available Zn.     

The relationship of siblings to the size of rural Nigerian preschoolers

Staff from a health education project in Eket village in Cross River State, Nigeria collected 1985-1986 height and weight data from at least 286 preschool children. Results from the 1 way analysis of variance tests revealed that age significantly affected mean weights for age and for height (p.01). For example, between 1 and 2 years of age the weights for age and for height fell substantially due to a decrease in breast feeding and introduction of solid foods. Similarly, birth rank significantly accounted for mean height for age (p=.01) and mean weight for age (p.01). For instance, the mean height for age and mean weight for age fell for 2nd born children. After the 2nd child, they climbed to the point where at the 6th child and greater the means were greater than for the 1st born. Number of children in the household only significantly affected mean weight for age (p=.01). A single child ranked significantly better in weight for age and weight for height than households with 2-6 children. After the 3rd child, however, a steady increase in mean percentile rank occurred with each additional child. In fact, mean percentile weight for age values of all the children in households of 7 or more children were higher than for any other household size. Observations of field staff supported the hypothesis that, in large families, the older children care and nurture the younger siblings and do not have high demands to work in the fields and maintain the households thereby accounting for the superior nutritional status for children in families of 7 or more children. Nevertheless overall nutritional status of 28% of the children were severely malnourished. Further, current nutritional status of 14% were severely malnourished. Moreover 36% ranked as chronically malnourished.     

Outcome of severely malnourished children treated according to UNICEF 2004 guidelines: a one-year experience in a zone hospital in rural Ethiopia

Malnutrition still has a dramatic impact on childhood mortality in sub-Saharan African countries. Very few studies have tried to evaluate the outcome of severely malnourished children treated according to the UNICEF 2004 guidelines and reported fatality rates are still very high. During 2006, 1635 children were admitted to the paediatric ward of St. Luke Catholic Hospital in Wolisso, South West Shewa, Ethiopia. Four hundred and ninety-three (30.15%) were severely malnourished and were enrolled in the study. We reviewed the registration books and inpatient charts to analyze their outcome. A mortality rate of 7.1% was found, which is significantly lower than reported in the literature. 28.6% of deaths occurred within 48h of admission; the recovery rate was 88.4%; the drop-out rate was 4.5%. Early deaths were due to the poor condition of the children on admission, leading to failure of treatment. Late mortality was considered to be related to electrolyte imbalances, which we were unable to measure. The clinical skills of nursing and medical staff were considered an important factor in improving the outcome of malnourished patients. We found that proper implementation of WHO guidelines for the hospital treatment of severely malnourished children can lead to a relatively low mortality rate, especially when good clinical monitoring is assured.     

Children of mentally ill mothers: mental development, somatic growth and social outcome

A two-year cohort of children of parapartum mentally ill mothers born in Stockholm during the mid-70s was studied with regard to mental development, somatic growth and social outcome. The observation period covered the pre-school-age period and the study was based on Well-Baby-Clinic (WBC) data. The findings were compared with those of matched controls. Nearly 40% of the children of the mentally ill mothers, compared to 3% of the controls, did not live with their biological mothers during the pre-school ages. No difference was found in somatic growth between the index and control children. However, more index children--especially those of addicts and neurotic or temporarily insufficient mothers--than controls suffered from developmental (p less than 0.05) and behavioural (p less than 0.001) disturbances. Fifteen per cent of the index children compared to 5% of the controls were judged by the staff of the WBC to be in need of treatment for psychological problems (p less than 0.01). The results of the present study emphasize the fact that children of mentally ill mothers constitute a high-risk group regarding mental and behavioural development. The study supports earlier research reports claiming that, while parental mental illness constitutes an important indicator of psychiatric risk for the children, the main risk stems from associated psychosocial disturbances in the family.     

Epidemiology and serology of Giardia lamblia in a developing country: Bangladesh

The age-specific prevalence of Giardia lamblia was determined in two Bangladeshi villages and malnourished children in hospital in Dhaka City. Age-specific acquisition rates, the duration of infection and age-specific sero-positivity to (immunofluorescent assay) G. lamblia trophozoites were determined. Infection was acquired early (less than one year) and in 16% of infected children persisted for longer than three months. Prevalence was higher in 5 to 10-year-old village children (21%) and one to five-year-old malnourished children (51%). Over 40% of the children much less than 7 years acquired G. lamblia within 18 months; acquisition rates did not change with age. Positive antibody titres were acquired between six months and one year and the prevalence of sero-positivity remained high in all age groups No association was found between positive antibody titres and positive stool examinations. In developing countries serum antibodies are useful epidemiologically, but are not diagnostic in the individual patient.     

Follow-up of children with moderate or severe malnutrition in the peripheral population (Brazil)]

What happens to children who develop moderate or severe malnutrition? What is done for them? Keeping in mind these questions, the present research was undertaken with the following objectives: to assess the nutritional status of children who develop moderate or severe malnutrition before the age of 5 years, after a period from 2 to 4 years after diagnosis; to assess the nutritional status of the under 5-year old siblings of these children; to study the influence of nutritional programs available in the community for the improvement of the nutritional status of the malnourished children; and to identify factors interfering with nutrition of these children during the study period. After a period of 2 to 4 years from the time of diagnosis of moderate or severe malnutrition the authors tried to locate the families of 61 malnourished children of Porto Alegre, RS (Brazil). The mothers their substitutes were interviewed and the children and siblings under 5 years of age were weighed and measured. Thirty-nine children were located. Of these, 4 (10%) died and 22 (56%) presented an increase of at least 10% in weight for age. Of the 35 children who survived, 29 (82%) still presented some degree of malnutrition (weight/age < or = 90% of the standard), 25 (71%) were stunted (height/age < or = 95%), and 5 (14%) were wasted (weight/height < or = 90%). The nutritional status of the 5-year old siblings was similar to that of the malnourished children.(ABSTRACT TRUNCATED AT 250 WORDS)