5 research outputs found
Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition : A Randomised Controlled Trial in Nigeria
Background Globally, Médecins Sans Frontières (MSF) treats more than 300,000
severely malnourished children annually. Malnutrition is not only caused by
lack of food and poor infant and child feeding practices but also by
illnesses. Breaking the vicious cycle of illness and malnutrition by providing
ill children with nutritional supplementation is a potentially powerful
strategy for preventing malnutrition that has not been adequately
investigated. Therefore, MSF investigated whether incidence of malnutrition
among ill children <5 y old could be reduced by providing a fortified food
product or micronutrients during their 2-wk convalescence period. Two trials,
one in Nigeria and one in Uganda, were conducted; here we report on the trial
that took place in Goronyo, a rural region of northwest Nigeria with high
morbidity and malnutrition rates. Methods and Findings We investigated the
effect of supplementation with ready-to-use therapeutic food (RUTF) and a
micronutrient powder (MNP) on the incidence of malnutrition in ill children
presenting at an outpatient clinic in Goronyo during February to September
2012. A three-armed, partially-blinded, randomised controlled trial was
conducted in children diagnosed as having malaria, diarrhoea, or lower
respiratory tract infection. Children aged 6 to 59 mo were randomised to one
of three arms: one sachet/d of RUTF; two sachets/d of micronutrients or no
supplement (control) for 14 d for each illness over 6 mo. The primary outcome
was the incidence of first negative nutritional outcome (NNO) during the 6 mo
follow-up. NNO was a study-specific measure used to indicate occurrence of
malnutrition; it was defined as low weight-for-height z-score (<−2 for non-
malnourished and <−3 for moderately malnourished children), mid-upper arm
circumference <115 mm, or oedema, whichever came first. Of the 2,213
randomised participants, 50.0% were female and the mean age was 20.2 (standard
deviation 11.2) months; 160 (7.2%) were lost to follow-up, 54 (2.4%) were
admitted to hospital, and 29 (1.3%) died. The incidence rates of NNO for the
RUTF, MNP, and control groups were 0.522 (95% confidence interval (95% CI),
0.442–0.617), 0.495 (0.415–0.589), and 0.566 (0.479–0.668) first events/y,
respectively. The incidence rate ratio was 0.92 (95% CI, 0.74–1.15; p = 0.471)
for RUTF versus control; 0.87 (0.70–1.10; p = 0.242) for MNP versus control
and 1.06 (0.84–1.33, p = 0.642) for RUTF versus MNP. A subgroup analysis
showed no interaction nor confounding, nor a different effectiveness of
supplementation, among children who were moderately malnourished compared with
non-malnourished at enrollment. The average number of study illnesses for the
RUTF, MNP, and control groups were 4.2 (95% CI, 4.0–4.3), 3.4 (3.2–3.6), and
3.6 (3.4–3.7). The proportion of children who died in the RUTF, MNP, and
control groups were 0.8% (95% CI, 0.3–1.8), 1.8% (1.0–3.3), and 1.4%
(0.7–2.8). Conclusions A 2-wk supplementation with RUTF or MNP to ill children
as part of routine primary medical care did not reduce the incidence of
malnutrition. The lack of effect in Goronyo may be due to a high frequency of
morbidity, which probably further affects a child’s nutritional status and
children’s ability to escape from the illness–malnutrition cycle. The duration
of the supplementation may have been too short or the doses of the supplements
may have been too low to mitigate the effects of high morbidity and pre-
existing malnutrition. An integrated approach combining prevention and
treatment of diseases and treatment of moderate malnutrition, rather than
prevention of malnutrition by nutritional supplementation alone, might be more
effective in reducing the incidence of acute malnutrition in ill children
Childhood diabetes mellitus in sokoto, north-western Nigeria: A ten year review
Background : There is paucity of literature on childhood diabetes mellitus (DM) from developing countries, especially North-Western Nigeria. We describe the clinical presentation and outcome of childhood DM as seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria. Materials and Methods : This was a 10-year retrospective review of case files of children aged 15 years and below with childhood DM seen between September 1 st 2001 and August 31 st 2011. The age, gender, presenting features, complications, laboratory features, and outcome of the patients were extracted and analyzed. Results: Eight out of the 23,931 children admitted during the study period were diagnosed with type 1 (T1) DM, giving a case prevalence rate of 0.33/1000 (3/10 000). The male-to-female ratio was 1:1. The mean age at presentation was 11.8 ± 3.1 years. The mean duration of symptoms before presentation was 6 ± 4.9 weeks (range 1.2-12 weeks). The most prevalent symptoms were polyuria and weight loss, 7 (87.5%) each, polydipsia, 6 (75%), polyphagia, 5 (62.5%), and weakness, 4 (50%). Five (62.5%) patients presented with diabetes ketoacidosis (DKA). The mean random blood sugar (RBS) was 22.6 ± 12.01 (range 13-49.5) mmol/L. Five (62.5%) patients were discharged while three (37.2%) left against medical advice. Four (80%) of the discharges were lost to follow up. Conclusion: Childhood DM is relatively uncommon in UDUTH, Sokoto. There is a high frequency of DKA, late presentation, and default to follow up. We recommend increased awareness campaigns and health education on childhood DM
Flow diagram of participants of the supplementation study in Goronyo.
<p>MNP, micronutrient powder; RUTF, ready-to-use therapeutic food; SAM, severe acute malnutrition; TFC, therapeutic feeding centre.</p