Social, dietary and clinical correlates of oedema in children with severe acute malnutrition:a cross-sectional study

BACKGROUND: Severe acute malnutrition is a serious public health problem, and a challenge to clinicians. Why some children with malnutrition develop oedema (kwashiorkor) is not well understood. The objective of this study was to investigate socio-demographic, dietary and clinical correlates of oedema, in children hospitalised with severe acute malnutrition. METHODS: We recruited children with severe acute malnutrition admitted to Mulago Hospital, Uganda. Data was collected using questionnaires, clinical examination and measurement of blood haemoglobin, plasma c-reactive protein and α(1)-acid glycoprotein. Correlates of oedema were identified using multiple logistic regression analysis. RESULTS: Of 120 children included, 77 (64%) presented with oedematous malnutrition. Oedematous children were slightly older (17.7 vs. 15.0 months, p = 0.006). After adjustment for age and sex, oedematous children were less likely to be breastfed (odds ratio (OR): 0.19, 95%-confidence interval (CI): 0.06; 0.59), to be HIV-infected (OR: 0.10, CI: 0.03; 0.41), to report cough (OR: 0.33, CI: 0.13; 0.82) and fever (OR: 0.22, CI: 0.09; 0.51), and to have axillary temperature > 37.5°C (OR: 0.28 CI: 0.11; 0.68). Household dietary diversity score was lower in children with oedema (OR: 0.58, CI: 0.40; 85). No association was found with plasma levels of acute phase proteins, household food insecurity or birth weight. CONCLUSION: Children with oedematous malnutrition were less likely to be breastfed, less likely to have HIV infection and had fewer symptoms of other infections. Dietary diversity was lower in households of children who presented with oedema. Future research may confirm whether a causal relationship exists between these factors and nutritional oedema. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12887-015-0341-8) contains supplementary material, which is available to authorized users

Gut microbiota in children hospitalized with oedematous and non-oedematous severe acute malnutrition in Uganda

BACKGROUND:Severe acute malnutrition (SAM) among children remains a major health problem in many developing countries. SAM manifests in both an oedematous and a non-oedematous form, with oedematous malnutrition in its most severe form also known as kwashiorkor. The pathogenesis of both types of malnutrition in children remains largely unknown, but gut microbiota (GM) dysbiosis has recently been linked to oedematous malnutrition. In the present study we aimed to assess whether GM composition differed between Ugandan children suffering from either oedematous or non-oedematous malnutrition. METHODOLOGY/PRINCIPAL FINDINGS:As part of an observational study among children hospitalized with SAM aged 6-24 months in Uganda, fecal samples were collected at admission. Total genomic DNA was extracted from fecal samples, and PCR amplification was performed followed by Denaturing Gradient Gel Electrophoresis (DGGE) and tag-encoded 16S rRNA gene-targeted high throughput amplicon sequencing. Alpha and beta diversity measures were determined along with ANOVA mean relative abundance and G-test of independence followed by comparisons between groups. Of the 87 SAM children included, 62% suffered from oedematous malnutrition, 66% were boys and the mean age was 16.1 months. GM composition was found to differ between the two groups of children as determined by DGGE (p = 0.0317) and by high-throughput sequencing, with non-oedematous children having lower GM alpha diversity (p = 0.036). However, beta diversity analysis did not reveal larger differences between the GM of children with oedematous and non-oedematous SAM (ANOSIM analysis, weighted UniFrac, R = -0.0085, p = 0.584; unweighted UniFrac, R = 0.0719, p = 0.011). CONCLUSIONS/SIGNIFICANCE:Our results indicate that non-oedematous SAM children have lower GM diversity compared to oedematous SAM children, however no clear compositional differences were identified

Changes in whole-blood PUFA and their predictors during recovery from severe acute malnutrition

Published by Cambridge University Press in the British Journal of Nutrition. Babirekere-Iriso, E., Mortensen, C. G., Mupere, E., Rytter, M. J. H., Namusoke, H., Michaelsen, K. F., … Lauritzen, L. (2016). Changes in whole-blood PUFA and their predictors during recovery from severe acute malnutrition. British Journal of Nutrition, 115(10), 1730–1739. https://doi.org/10.1017/S0007114516000817. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works. © The AuthorsChildren with severe acute malnutrition (SAM) with complications require in-patient management including therapeutic feeding. Little attention has been given to the effects of these feeds on the essential fatty acid status of children with SAM. The objective of this study was to describe changes in the PUFA composition in whole blood in children with SAM during treatment and to determine predictors of change. This prospective study took place in a paediatric nutrition rehabilitation unit in Kampala, Uganda, and assessed whole-blood fatty acid composition of children with SAM at admission, transition, discharge and follow-up (8 and 16 weeks). ANCOVA was used to identify predictors of change in whole-blood PUFA. The study included 120 children with SAM and twenty-nine healthy control children of similar age and sex. Among the SAM children, 38% were female and 64% had oedema. Whole-blood n-6 PUFA proportions increased from admission to follow-up, except for arachidonic acid, which decreased by 0.79 (95% CI 0.46, 1.12) fatty acid percentage (FA%) from admission to transition and 0.10 (95% CI 0.23, 0.44) FA% at discharge. n-3 Long-chain (LC) PUFA decreased by 0.21 (95% CI 0.03, 0.40) FA% at discharge and 0.22 (95% CI 0.01, 0.42) FA% at 8 weeks of follow-up. This decrease was greater in children from families with recent fish intake and those with nasogastric tube feeding. Current therapeutic feeds do not correct whole-blood levels of LCPUFA, particularly n-3 LCPUFA, in children with SAM. Increased attention is needed to the contents of n-3 LCPUFA in therapeutic feeds.University of CopenhagenAugustinus FondenBrodrene Hartmanns FondArvid Nielsens FondAxel Muusfeldts FondAase and Einar Danielsens FondTorkild Steenbecks Lega

Effects of armed conflict on access to emergency health care in Palestinian West Bank: systematic collection of data in emergency departments

Objective To assess the impact of restrictions in access to hospital services imposed on the civilian population during the armed conflict in the Palestinian territories occupied by Israel. Design Consecutive registration of demographic and medical data, with information about transportation time, delay in access to hospital, and course of hospital contact. Setting Three hospital emergency departments in Bethlehem and Nablus, in the occupied Palestinian West Bank, during one week in each hospital. Participants All patients seeking health care in the three hospitals during the study period. Results A total of 394 of the 2228 emergency department contacts reported being delayed at checkpoints or by detours on their way to the emergency department. Hospital admission was significantly more common for these patients: 32% (n = 125) compared with 13% (n = 205) among those who were not delayed. Conclusion 18% of the emergency department contacts were delayed because of the occupation. The higher hospital admission rate in this group suggests that restrictions in access to hospital services influence the severity of the medical conditions presented