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CATCH-UP GROWTH IN CHILDREN WITH SEVERE ACUTE MALNUTRITION: COMPARISON OF TWO THERAPEUTIC FEEDING APPROACHES AT A DISTRICT HOSPITAL, SOUTH AFRICA

Liana Steenkamp, A Nomvete, Danie Venter

Abstract


Although the World Health Organisation (WHO) guidelines have proved to be effective in the treatment of severe acute malnutrition (SAM) in other countries, limited data is available in South Africa, especially in relation to HIV-infected children. This study aimed to describe the recovery of clinically stable children with SAM, 12–60 months of age, treated as in-patients at a specialised district hospital in KwaZulu-Natal, South Africa, using two WHO recommended treatment approaches. A prospective cohort with clinically stable SAM referred to Clairwood Hospital between August 2012 and September 2013 was followed from admission until discharge in this descriptive study. Children were nutritionally managed, after being stratified and randomly assigned to one of the two suggested nutritional treatment groups, F-100 or Ready-to-use Therapeutic Foods (RUTF). Of the total of 41 children admitted with SAM during the year, 35 children participated and 34 completed the study. About 56% were younger than 18 months and 73.5% HIV-infected. A mean growth velocity of 7.77g/kg/day (RUTF group) versus 6.11g/kg/day (F100 group) was observed (p  = 0.23). Recovery was achieved in 88.8% (n=15) of children on RUTF, and 64.7% (n=11) in the F-100 group, within 2.7 and 4.4 weeks, respectively. The RUTF group recovered significantly (p=0.02) faster. HIV-infection in this study did not affect growth velocity. RUTF can be used as effectively as F-100 in the rehabilitation of SAM to achieve catch-up growth and similar recovery rates are possible in HIV-infected children if managed according to WHO guidelines.


Keywords


children; catch-up growth; HIV; in-patients; malnutrition; recovery

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References


Anthony, A.C. 2013. Assessment of clinical practices in children admitted with severe acute malnutrition in three District hospitals, in the Western Cape, South Africa. MSc thesis, School of Public Health, University of the Western Cape, Cape Town.

Ashworth, A., Kanum, S., Jackson, A. & Schofield, C. 2003. Guidelines for the inpatient treatment of severely malnourished children. Geneva: World Health Organization.

Biggs, C. 2012. Clinical dietetic practice in the treatment of severe acute malnutrition in a high HIV setting. Journal of Human Nutrition and Dietetics, 26 (2): 175-181.

Black, R.E., Allen, L.H., Bhutta, Z.A., Caulfield, L.E., De Onis, M., Ezzati, M., Mathers, C., Rivera, J. & Maternal and Child Undernutrition Study Group. 2008. Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet, 371(9608): 243-260.

Briend, A. 2001. Highly nutrient-dense spreads: a new approach to delivering multiple micronutrients to high-risk groups. British Journal of Nutrition, 85(Suppl2): S175-179.

Ciliberto, M.A., Sandige, H., Ndekha, M.J., Ashorn, P., Briend, A., Ciliberto, H.M. & Manary, M.J. 2005. Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial. The American Journal of Clinical Nutrition, 81(4): 864-870.

Cobb, G. & Bland, R.M. 2013. Nutritional supplementation: the additional costs of managing children infected with HIV in resource-constrained settings. Tropical Medicine and International Health, 18 (1): 45-52.

Diop, E.H.I., Dossou, N.I., Ndour, M.M., Briend, A. & Wade, S. 2003. Comparison of the efficacy of a solid ready-to-use and a liquid, milk-based diet for the rehabilitation of severely malnourished children: a randomized trial. The American Journal of Clinical Nutrition, 78 (2): 302-307.

Fergusson, P., Chinkhumba, J., Grijalva-Eternod, C., Banda, T., Mkangama, C. & Tomkins, A. 2009. Nutritional recovery in HIV-infected and HIV-uninfected children with severe acute malnutrition. Archives of Disease in Childhood, 94 (7):512–516.

Gibson, R.S. 2005. Principles of Nutrition Assessment. 2nd Edition. New York: Oxford University Press, Inc.

Gravatter, F.J. & Wallnau, L.B. 2009. Statistics for the Behavioral Sciences. 8th Edition. Belmont: Wadsworth Cengage Learning.

Health Systems Trust. 2014. District Health Barometer 2012/2013. Available at: http://www.hst.org.za/publications/district-health-barometer-201213

Heikens, G.T., Bunn, J., Amadi, B., Manary, M., Chhagan, M., Berkley, J.A., Rollins, N., Kelly, P., Adamczick, C., Maitland, K., Tomkins, A. & Blantyre Working Group. 2008. Case management of HIV-infected severely malnourished children: challenges in the area of highest prevalence. The Lancet, 371 (9620): 1305-1307.

Hossain, M.I., Dodd, N.S., Ahmed, T., Miah, G.M., Jamil, K.M., Nahar, B., Alam, B. & Mahmood, C.B. 2009. Experience in Managing Severe Malnutrition in a Government Tertiary Treatment Facility in Bangladesh. Journal of Health, Population, and Nutrition, 27 (1): 72-79.

Human Sciences Research Council (HSRC). 2014. South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Cape Town: HSRC.

Kessler, L., Daley, H., Malenga, G. & Graham, S. 2000. The impact of the human immunodeficiency virus type 1 on the management of severe malnutrition in Malawi. Annals of Tropical Paediatrics, 20 (1): 50-56.

Kimani, F. & Sharif, S.K. 2009. National Guideline for Integrated Management of Acute Malnutrition. Kenya: National Department of Health Kenya.

KwaZulu Natal Department of Health. 2011. Annual Performance Plan. MTEF 2011/12-2013/14. KwaZulu Natal: Department of Health.

Nannan, N., Dorrington, R., Laubscher, R., Zinyakatira, N., Prinsloo, M., Darikwa, T., Matzopoulos, R. & Bradshaw, D. 2012. Under-5 mortality statistics in South Africa: Shedding some light on the trends and causes 1997-2007. Cape Town: South African Medical Research Council.

Puoane, T., Sanders, D., Ashworth, A., Chopra, M., Strasser, S. & Mccoy, D. 2004. Improving the hospital management of malnourished children by participatory research. International Journal for Quality Health Care, 16 (1): 31-40.

Shah, R.H. & Javdekar, B.B. 2014. Management of children with severe acute malnutrition: experience of nutrition rehabilitation centre at Baroda, Gujarat. International Journal of Contemporary Pediatrics, 1(1): 3-6.

United Nations Children’s Fund. 2007. Young lives: statistical data on the status of children aged 0-4 in South Africa. Available at: http://www.Unicef.org/southafrica/SAF_resources_younglives.pdf

United Nations Children’s Fund. 2012. Committing to Child Survival: A Promise Renewed. Progress Report 2012. New York: UNICEF.

United Nations. 2013. We can end Poverty. Millennium Development Goals and Beyond 2015 Fact Sheet. Available at http://www.un.org/millenniumgoals/childhealth.shtml

World Health Organization. 1999. Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva: World Health Organization.

World Health Organization. 2013. Guideline Updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization.

World Health Organization. 2014. Community-based management of severe acute malnutrition; A joint statement by the World Health Organization, the World Food Programme, the United Nations Systems Standing Committee on Nutrition and the United Nations Children’s Fund. Available at: http://www.who.int/nutrition/topics/statement_commbased_malnutrition/en/




DOI: https://doi.org/10.25159/2520-5293/199