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Critical evaluation of the appetite test for children with severe acute malnutrition

Published on Jan 6, 2020in Tropical Medicine & International Health2.423
· DOI :10.1111/TMI.13360
Mike Zangenberg1
Estimated H-index: 1
(UCPH: University of Copenhagen),
Alemseged Abdissa14
Estimated H-index: 14
(JU: Jimma University)
+ 6 AuthorsTsinuel Girma12
Estimated H-index: 12
(JU: Jimma University)
Abstract
OBJECTIVES: The appetite test is used to risk stratify for children with severe acute malnutrition (SAM) in inpatient or outpatient care. The test is recommended in guidelines despite lack of evidence. We evaluated its ability to identify children at risk of a poor treatment outcome. METHODS: We conducted an observational study of children diagnosed with SAM at three health facilities in Ethiopia. The appetite test was done independently, and the result did not affect decisions about hospitalisation and clinical care. Data were analysed using mixed linear and logistic regression models. RESULTS: Appetite was tested in 298 (89%) of 334 children enrolled; 56 (19%) passed. Children failing the appetite test had a 6.6% higher weight gain per day (95% CI: 2.6, 10.8) adjusted for type of treatment, oedema, duration of follow-up and age than children passing the test. We found medical complications in 179 (54%) children. Medical complications were associated with blood markers of metabolic disturbance. Children with medical complications tended to have lower weight gain than those without complications (3.5%, 95% CI: -0.25, 7.0). Neither the appetite test nor medical complications were correlated with bacteraemia or treatment failure. CONCLUSIONS: Our findings question the use of the appetite test to identify children who need inpatient care. An assessment of medical complications alone could be a useful risk indicator but needs to be evaluated in other settings.
  • References (11)
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References11
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#1Mike Zangenberg (UCPH: University of Copenhagen)H-Index: 1
#2Alemseged Abdissa (JU: Jimma University)H-Index: 14
Last. Jørgen A. L. Kurtzhals (UCPH: University of Copenhagen)H-Index: 37
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Abstract Objectives Children with severe acute malnutrition (SAM) are treated with empiric amoxicillin or penicillin and gentamicin because of the high risk of severe infections. Experts have suggested, based on available evidence, adding metronidazole to cover anaerobic bacteraemia and diarrhoea caused by Giardia duodenalis or Clostridium difficile. The objective of this study was to assess the importance of these infections in children with SAM. Methods Children from 6 months to 15 years with ...
Source
#1Scott B. IckesH-Index: 9
#2Muttaquina Hossain (International Centre for Diarrhoeal Disease Research, Bangladesh)H-Index: 1
Last. Donna M. DennoH-Index: 19
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#1Nicolette Nabukeera-Barungi (MUK: Makerere University)H-Index: 7
#2Benedikte Grenov (UCPH: University of Copenhagen)H-Index: 3
Last. Henrik Friis (UCPH: University of Copenhagen)H-Index: 43
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We determined the predictors of mortality among children admitted with severe acute malnutrition (SAM). This was a prospective study nested in a randomized trial among 6–59-month-old children admitted with SAM. Socio-demographic and medical history data were collected using questionnaires and clinical examination, anthropometry and laboratory tests were performed. They were monitored daily until discharge or death during hospitalization while receiving care according to national guidelines. Pred...
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#1Maren Johanne Heilskov Rytter (UCPH: University of Copenhagen)H-Index: 8
#2Esther Babirekere-Iriso (UCPH: University of Copenhagen)H-Index: 5
Last. Henrik Friis (UCPH: University of Copenhagen)H-Index: 43
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BACKGROUND:Children who receive in-hospital treatment of severe acute malnutrition often have high mortality rates, and the reasons are not well understood. OBJECTIVE:We assessed risk factors for death in children who were treated for malnutrition in a hospital. DESIGN:In a prospective observational study of 120 children who were receiving in-hospital treatment of severe acute malnutrition in Uganda with therapeutic formulas F-75 and F-100, we collected data on symptoms, clinical findings, plasm...
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Summary Background Children with complicated severe acute malnutrition (SAM) have a greatly increased risk of mortality from infections while in hospital and after discharge. In HIV-infected children, mortality and admission to hospital are prevented by daily co-trimoxazole prophylaxis, despite locally reported bacterial resistance to co-trimoxazole. We aimed to assess the efficacy of daily co-trimoxazole prophylaxis on survival in children without HIV being treated for complicated SAM. Methods ...
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Summary Maternal and child malnutrition in low-income and middle-income countries encompasses both undernutrition and a growing problem with overweight and obesity. Low body-mass index, indicative of maternal undernutrition, has declined somewhat in the past two decades but continues to be prevalent in Asia and Africa. Prevalence of maternal overweight has had a steady increase since 1980 and exceeds that of underweight in all regions. Prevalence of stunting of linear growth of children younger ...
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Current (1999) World Health Organization guidelines recommend giving routine antibiotics (AB) for all children with severe acute malnutrition (SAM), even if they have uncomplicated disease with no clinically obvious infections. We examined the evidence behind this recommendation.
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#1Michael H. N Golden (Aberd.: University of Aberdeen)H-Index: 43
Wasting, kwashiorkor and stunting are not usually due to either protein or energy deficiency. Treatment based upon this concept results in high mortality rates, and failure of treated children to return physiologically to normal. They become relatively obese with insufficient lean tissue. Preventive strategies have also failed. Wasting and stunting are primarily due to deficiency of type II nutrients and kwashiorkor probably due to deficiency of several type I nutrients that confer resistance to...
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Background In 2006, the Medecins sans Frontieres nutritional program in the region of Maradi (Niger) included 68,001 children 6–59 months of age with either moderate or severe malnutrition, according to the NCHS reference (weight-for-height<80% of the NCHS median, and/or mid-upper arm circumference<110 mm for children taller than 65 cm and/or presence of bipedal edema). Our objective was to identify baseline risk factors for death among children diagnosed with severe malnutrition using the newly...
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In Huascar (a low-income periurban community in eastern Lima) Peru a study followed 131 low birth infants ( 6 month olds 299 vs. 342 kJ/kg body weight) (p < 0.001). In fact when the researchers controlled for age body weight and the presence of specific symptoms of illness intraindividual total energy intakes were almost 15% less on days of reported anorexia. Energy intake from non-breast milk sources was about 25-35% less in both age groups on days of reported anorexia (p < 0.01). The researche...
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