This section provides information on current research on facility and community based management of Severe Acute Malnutrition. Other new research activities on SAM in general are presented
A study has been published in the Lancet on the magnitude and causes of hospital-acquired (nosocomial) bacteraemia in African children has
A research has found that visible severe wasting failed to detect approximately half of the children admitted to hospital with severe acute malnutrition diagnosed anthropometrically
Ingrid M le Roux, Karl le Roux, W Scott Comulada, Erin M Greco, Katherine A Desmond, Nokwanele Mbewu, and Mary Jane Rotheram-Borus
A study has found that paraprofessional Mentor Mothers are an effective strategy for delivering home visiting programs by providing the knowledge and support necessary to change the behavior of families at risk.
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A paper has demonstrated that an oral ciprofloxacin dose of 10 mg/kg three times daily (30 mg/kg/day) may be a suitable alternative antibiotic for the management of sepsis in severely malnourished children.
Brewster DR.
A review has been published in Annals of Tropical Paeditrics which suggests the following eight changes to reduce case-fatality rates in severe acute malnutrition (SAM) in African hospitals:
Isanaka S, Grais RF, Briend A, Checchi
Abstract
Expected incidence of acute malnutrition is the most appropriate measure for projecting the needs of a nutritional treatment program over time in terms of staffing, food, and other treatments, but direct estimation of incidence is rarely feasible at the onset of an intervention.
Nielsen J, Prudhon C, de Radigues X.
The humanitarian response to the crisis in Darfur is considered the largest humanitarian operation in the world. Nielsen et al conducted a meta-analysis of 164 publicly available surveys to analyse trends in malnutrition and mortality in Dafur, Sudan.
Wilford R, Golden K, Walker DG.
The study showed that scaling-up CMAM within essential health services in Dowa District, Malawi was cost-effective and scaling up CMAM in similar contexts is also likely to be cost-effective
A study has found that wasting among infants under 6 months is prevalent in many developing countries whether NCHS or WHO definitions are used. However using WHO standards to define wasting results in a greater disease burden, particularly for severe wasting.
TARUN GERA
This systematic review showed that the use of therapeutic nutrition products like RUTF for home based management of uncomplicated SAM appears to be safe and efficacious.
Indian Pediatrics has brought out a Special Issue (August 2010) on Severe Acute Malnutrition, which deliberates in detail on the global and national evidence relating to pertinent issues on this subject.
Hendricks KM. Nutr Rev. 2010 Jul;68(7):429-35.
Abstract
Undernutrition is a major contributor to child mortality and total global disease burden. Ready-to-use therapeutic food (RUTF) is recommended by the World Health Organization for community-based management of uncomplicated forms of severe acute malnutrition.
Nackers F, Broillet F, Oumarou D, Djibo A, Gaboulaud V, Guerin PJ, Rusch B, Grais RF, Captier V.
A study has found that RUTF resulted in a higher weight gain, a higher recovery rate, a shorter length of stay and a lower transfer rate to the Inpatient-Therapeutic Feeding Centres (I-TFC) compared to a Corn/Soy Blend (CSB) pre-mix among children located in the Zinder Region in Niger.
Giugliani C, Duncan BB, Harzheim E, Breysse S, Jarrige L.
A study has shown that short-term intervention with in-service supervision based on the WHO guidelines in a setting of limited resources contributed to a reduction in fatality rates from severe malnutrition
Katherine Hampshire, Rachel Casiday, Kate Kilpatrick and Catherine Panter-Brick
ABSTRACT
In 2004–05, Niger suffered a food crisis during which global attention focused on high levels of acute malnutrition among children. In response, decentralised emergency nutrition programmes were introduced into much of southern Niger.
Mark J. Manary, Heidi L. Sandige and Kenneth Maleta
Treating severely malnourished children with a 10 percent milk RUTF results in a lower rate of recovery and slower growth rates when compared to the standard 25 percent milk RUTF
Israëls T, Borgstein E, Jamali M, de Kraker J, Caron HN, Molyneux EM.
This study concluded that acute malnutrition, superimposed on chronic malnutrition, is common in patients with Wilms tumour in Malawi. Chiponde, a peanut butter based ready-to-use-therapeutic-food, is an attractive means of nutritional support which needs further study.
In-spite of abundant literature on the epidemiology and management of Protein Endery Malnutrition (PEM), focus on metabolism and therapeutic drug monitoring is lacking. This review discussed the pathophysiological changes in children with PEM that may affect the disposition of drugs frequently used for their treatment.
Guerrier G, Zounoun M, Delarosa O, Defourny I, Lacharite M, Brown V, Pedalino B.
The study found a high mortality rate among Internally Displaced Persons and an elevated prevalence of wasting not only in IDP camps but also in villages located in the same region.
The Food and Nutrition Bulletin, vol 30, No 3 (2009) Supplement published in September, 2009, featured articles mainly on Managment of children with Moderate Malnutrition and other related topics.
Isabelle Defourny, Andrea Minetti, Ge´za Harczi, Ste´phane Doyon, Susan Shepherd, Milton Tectonidis, Jean-Herve´ Bradol, Michael Golden
This study demonstrated the potential for distribution of fortified spreads to reduce the incidence of severe wasting in large population of children 6–36 months of age in a District of the Maradi Region, Niger.
Kerac M, Bunn J, Seal A, Thindwa M, Tomkins A, Sadler K, Bahwere P, Collins S.
In Malawi, Synbiotic2000 Forte did not improve severe acute malnutrition outcomes.
Nathanael Lapidus, Francisco J. Luquero, Valérie Gaboulaud, Susan Shepherd, Rebecca F. Grais
A study of children being treated for malnutrition in Niger has shown that, Weight-for-Height indicators calculated using WHO standards were more accurate for predicting mortality risk than those calculated using the NCHS reference.
This study sought to compare the acceptability and energy intake of Ready-to-Use Therapeutic Food (RUTF) with cereal legume based khichri among malnourished children in urban low to middle socioeconomic neighborhoods in Delhi and concluded that RUTF and khichri were both well accepted by study children. The energy intake from RUTF was however higher due to its extra energy density.
Defourny I, Minetti A, Harczi G, Doyon S, Shepherd S, Tectonidis M, Bradol JH, Golden M.
A study has shown the potential for distribution of fortified spreads to reduce the incidence of severe wasting in large population of children 6-36 months of age in a district of Maradi Region, Niger.
Matilsky DK, Maleta K, Castleman T, Manary MJ.
A study has shown that Fortified Spreads (FS) are superior supplementary foods to Corn-Soy Blended flour (CSB) for moderately wasted Malawian children.
In India, 48% of children under five years of age are stunted and 43% are underweight: almost 8 million children suffer from Severe Acute Malnutrition.
Dr Prasad and colleagues are of the view that "the current thinking - that a centrally produced and processed Ready to use Therapeutic Foods should supplant the locally prepared indigenous foods in treating SAM - ignores the multiple causes of malnutrition and destroys the diversity of potential solutions based on locally available foods".
Jobiba Chinkhumba, Andrew Tomkins, Theresa Banda, Catherine Mkangama, Pamela Fergusson
This study showed that routine testing and treatment for HIV among all malnourished children is necessary to improve quality of care and reduce mortality among children with SAM.