American Journal of Pediatrics

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A Comparative Study between SAM with Edema and SAM without Edema and Associated Factors Influencing Treatment, Outcome & Recovery

Received: May 07, 2020    Accepted: Jul. 10, 2020    Published: Nov. 23, 2020
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Abstract

Severe acute malnutrition (SAM) is an established contributor of under-five mortality and morbidity. Achieving desired treatment outcome has proven to be challenging. There is limited data concluding the success of treatments in the study area. Objective: This study was aimed to compare the recovery from severe acute malnutrition with identified medical complications where presence or absence of edema denotes a major predictor among children aged 0-59 months of age. Methods: This was a retrospective observational study on facility based management which was conducted in SAM block of Chattogram Medical College hospital, Chattogram, Bangladesh. Here a total of 485 patients were admitted during the period of 2013-2017 and among them, 266 patients were successfully discharged from the hospital. Based on WHO & National guidelines for management of severely malnourished children in Bangladesh, treatment protocol, admission and discharge criteria were followed. A structured and prescribed data format was prepared and data were collected from the hospital records. Daily observation, monitoring and follow-up notes of the patients were also recorded. After data collection, they were cleaned, edited and stored into excel, EPI-INFO and analyzed by SPSS. Results: More than half of the admitted patients were cured and routinely discharged. 8.04% patients died during this period. 39.7% (193) children recovered according to the set discharge criteria as per guidelines. Mean age of the observed patients was 22.35±15.8607 months. More than half of the admitted patients showed moderate to good weight gain during hospital stay. Mean weight gain was higher in non-edematous patients. 50% of non – edematous patients started to gain weight in 3-5 days while 76% of edematous patients required 6-10 days to start weight gain. 4.3% patients did not gain weight during hospital stay. Both descriptive and analytic analyses were executed. P value<0.05 was considered as statistically significant Conclusions: The mean duration of hospital stay (in days) of the patients with oedema (15.64±SD 7.133 days) was higher than that of the patients without oedema (9.47±SD 5.881 days). But greater portion of patients with edema were cured. Independent-Sample T Test revealed the difference statistically significant, where t=(438,485)=-9.878, p=0.002.

DOI 10.11648/j.ajp.20200604.24
Published in American Journal of Pediatrics ( Volume 6, Issue 4, December 2020 )
Page(s) 468-475
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Severe Acute Malnutrition (SAM), Edema, MUAC, WHZ, WLZ, Weight Gain

References
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[3] WHO, UNICEF, WFP (2007) Community-based management of severe acute malnutrition? Geneva, Switzerland.
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[5] National facility based inpatient care guideline 3rd edition June 2017.
[6] World Health Organization, World Food Program, United Nations System Standing Committee on Nutrition and United Nations Children’s Fund (2007). Community-based management of severe acute malnutrition. Geneva: World Health Organization; Rome: World Food Program; Geneva: United Nations System Standing Committee on Nutrition; New York: United Nations Children’s Fund.
[7] FMOH (2007). Protocol for the management of severe acute malnutrition. Addis Ababa, Ethiopia: FMOH.
[8] WHO (2013)? Guideline: updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization.
[9] Management of severe malnutrition: a manual for physisians and other senior health workers. Geneva, WHO, 1999.
[10] Collins S et al. Management of severe acute malnutrition in children. Lancet, 2006, 368: 1992–2000.
[11] Linneman Z et al. A large-scale operational study of home-based therapy with ready-to-use therapeutic food in childhood malnutrition in Malawi. Maternal & Child Nutrition, 2007, 3: 206–215.
[12] Ciliberto MA et al. Home-based therapy for oedematous malnutrition with ready-to-use therapeutic food. Acta Paediatrica, 2006, 95: 1012–1015.
[13] Sandige H et al. Home-based treatment of malnourished Malawian children with locally produced or imported ready-to-use food. Journal of Pediatric Gastroenterology and Nutrition, 2004, 39: 141–146.
[14] Gaboulaud V et al. Could nutritional rehabilitation at home complement or replace centre-based therapeutic feeding programmes for severe malnutrition? Journal of Tropical Pediatrics, 2007, 53: 49–51.
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[18] Roberfroid D et al. Background review. Utilization of mid-upper arm circumference versus weight-for-height in nutritional rehabilitation programmes. 2013.
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[20] Nielsen J Valentiner-Branth P, Martins C, Cabral F, Aaby P. Malnourished children and supplementary feeding during the war emergency in Guinea-Bissau in 1998–1999. Am. J. Clin. Nutr. 2004; 80: 1036–42.
[21] Ciliberto M et al. 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. Am. J. Clin. Nutr. 2005, 81: 864–70.
[22] Roberfroid D et al. Background review. Management of oedematous malnutrition in infants and children aged > 6 months: a systematic review of evidence. 2013 (www.who.int/nutrition/publications/guidelines/updates_management_SAM_infantandchildren_reviewpaper2.pdf).
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    Zabeen Choudhury, Dhiman Chowdhury, Tanjina Hoq, Morjina Begum, Mohammad Shamsul Alam. (2020). A Comparative Study between SAM with Edema and SAM without Edema and Associated Factors Influencing Treatment, Outcome & Recovery. American Journal of Pediatrics, 6(4), 468-475. https://doi.org/10.11648/j.ajp.20200604.24

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    Zabeen Choudhury; Dhiman Chowdhury; Tanjina Hoq; Morjina Begum; Mohammad Shamsul Alam. A Comparative Study between SAM with Edema and SAM without Edema and Associated Factors Influencing Treatment, Outcome & Recovery. Am. J. Pediatr. 2020, 6(4), 468-475. doi: 10.11648/j.ajp.20200604.24

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    AMA Style

    Zabeen Choudhury, Dhiman Chowdhury, Tanjina Hoq, Morjina Begum, Mohammad Shamsul Alam. A Comparative Study between SAM with Edema and SAM without Edema and Associated Factors Influencing Treatment, Outcome & Recovery. Am J Pediatr. 2020;6(4):468-475. doi: 10.11648/j.ajp.20200604.24

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  • @article{10.11648/j.ajp.20200604.24,
      author = {Zabeen Choudhury and Dhiman Chowdhury and Tanjina Hoq and Morjina Begum and Mohammad Shamsul Alam},
      title = {A Comparative Study between SAM with Edema and SAM without Edema and Associated Factors Influencing Treatment, Outcome & Recovery},
      journal = {American Journal of Pediatrics},
      volume = {6},
      number = {4},
      pages = {468-475},
      doi = {10.11648/j.ajp.20200604.24},
      url = {https://doi.org/10.11648/j.ajp.20200604.24},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajp.20200604.24},
      abstract = {Severe acute malnutrition (SAM) is an established contributor of under-five mortality and morbidity. Achieving desired treatment outcome has proven to be challenging. There is limited data concluding the success of treatments in the study area. Objective: This study was aimed to compare the recovery from severe acute malnutrition with identified medical complications where presence or absence of edema denotes a major predictor among children aged 0-59 months of age. Methods: This was a retrospective observational study on facility based management which was conducted in SAM block of Chattogram Medical College hospital, Chattogram, Bangladesh. Here a total of 485 patients were admitted during the period of 2013-2017 and among them, 266 patients were successfully discharged from the hospital. Based on WHO & National guidelines for management of severely malnourished children in Bangladesh, treatment protocol, admission and discharge criteria were followed. A structured and prescribed data format was prepared and data were collected from the hospital records. Daily observation, monitoring and follow-up notes of the patients were also recorded. After data collection, they were cleaned, edited and stored into excel, EPI-INFO and analyzed by SPSS. Results: More than half of the admitted patients were cured and routinely discharged. 8.04% patients died during this period. 39.7% (193) children recovered according to the set discharge criteria as per guidelines. Mean age of the observed patients was 22.35±15.8607 months. More than half of the admitted patients showed moderate to good weight gain during hospital stay. Mean weight gain was higher in non-edematous patients. 50% of non – edematous patients started to gain weight in 3-5 days while 76% of edematous patients required 6-10 days to start weight gain. 4.3% patients did not gain weight during hospital stay. Both descriptive and analytic analyses were executed. P value<0.05 was considered as statistically significant Conclusions: The mean duration of hospital stay (in days) of the patients with oedema (15.64±SD 7.133 days) was higher than that of the patients without oedema (9.47±SD 5.881 days). But greater portion of patients with edema were cured. Independent-Sample T Test revealed the difference statistically significant, where t=(438,485)=-9.878, p=0.002.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - A Comparative Study between SAM with Edema and SAM without Edema and Associated Factors Influencing Treatment, Outcome & Recovery
    AU  - Zabeen Choudhury
    AU  - Dhiman Chowdhury
    AU  - Tanjina Hoq
    AU  - Morjina Begum
    AU  - Mohammad Shamsul Alam
    Y1  - 2020/11/23
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ajp.20200604.24
    DO  - 10.11648/j.ajp.20200604.24
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 468
    EP  - 475
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20200604.24
    AB  - Severe acute malnutrition (SAM) is an established contributor of under-five mortality and morbidity. Achieving desired treatment outcome has proven to be challenging. There is limited data concluding the success of treatments in the study area. Objective: This study was aimed to compare the recovery from severe acute malnutrition with identified medical complications where presence or absence of edema denotes a major predictor among children aged 0-59 months of age. Methods: This was a retrospective observational study on facility based management which was conducted in SAM block of Chattogram Medical College hospital, Chattogram, Bangladesh. Here a total of 485 patients were admitted during the period of 2013-2017 and among them, 266 patients were successfully discharged from the hospital. Based on WHO & National guidelines for management of severely malnourished children in Bangladesh, treatment protocol, admission and discharge criteria were followed. A structured and prescribed data format was prepared and data were collected from the hospital records. Daily observation, monitoring and follow-up notes of the patients were also recorded. After data collection, they were cleaned, edited and stored into excel, EPI-INFO and analyzed by SPSS. Results: More than half of the admitted patients were cured and routinely discharged. 8.04% patients died during this period. 39.7% (193) children recovered according to the set discharge criteria as per guidelines. Mean age of the observed patients was 22.35±15.8607 months. More than half of the admitted patients showed moderate to good weight gain during hospital stay. Mean weight gain was higher in non-edematous patients. 50% of non – edematous patients started to gain weight in 3-5 days while 76% of edematous patients required 6-10 days to start weight gain. 4.3% patients did not gain weight during hospital stay. Both descriptive and analytic analyses were executed. P value<0.05 was considered as statistically significant Conclusions: The mean duration of hospital stay (in days) of the patients with oedema (15.64±SD 7.133 days) was higher than that of the patients without oedema (9.47±SD 5.881 days). But greater portion of patients with edema were cured. Independent-Sample T Test revealed the difference statistically significant, where t=(438,485)=-9.878, p=0.002.
    VL  - 6
    IS  - 4
    ER  - 

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Author Information
  • Department of Pediatrics, Chattogram Medical College, Chattogram, Bangladesh

  • Department of Pediatrics, Chattogram Medical College, Chattogram, Bangladesh

  • Department of Pediatrics, Chattogram Medical College Hospital, Chattogram, Bangladesh

  • Out Patient Department, Sadar Hospital, Feni, Bangladesh

  • Department of Forensic Medicine, North East Medical College, Sylhet, Bangladesh

  • Section