Browsing by Subject "Malnutrition"

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    Mortality after fluid bolus in children with shock due to sepsis or severe infection: a systematic review and meta-analysis
    (Public Library of Science, 2012) Ford, Nathan; Hargreaves, Sally; Shanks, Leslie
    Introduction Sepsis is one of the leading causes of childhood mortality, yet controversy surrounds the current treatment approach. We conducted a systematic review to assess the evidence base for fluid resuscitation in the treatment of children with shock due to sepsis or severe infection. METHODS: We searched 3 databases for randomized trials, quasi-randomized trials, and controlled before-after studies assessing children with septic shock in which at least one group was treated with bolus fluids. The primary outcome was mortality at 48 hours. Assessment of methodological quality followed the GRADE criteria. Relative risks (RRs) and 95% confidence intervals (CI) were calculated and data pooled using fixed-effects method. RESULTS: 13 studies met our inclusion criteria. No bolus has significantly better mortality outcomes at 48 hours for children with general septic shock (RR 0.69; 95%CI 0.54-0.89), and children with malaria (RR 0.64; 95%CI 0.45-0.91) when compared to giving any bolus. This result is largely driven by a single, high quality trial (the FEAST trial). There is no evidence investigating bolus vs no bolus in children with Dengue fever or severe malnutrition. Colloid and crystalloid boluses were found to have similar effects on mortality across all sub-groups (general septic shock, malaria, Dengue fever, and severe malnutrition). CONCLUSIONS: The majority of all randomized evidence to date comes from the FEAST trial, which found that fluid boluses were harmful compared to no bolus. Simple algorithms are needed to support health-care providers in the triage of patients to determine who could potentially be harmed by the provision of bolus fluids, and who will benefit.
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    Plasma vitamin A and zinc levels in HIV-infected adults in Cape Town, South Africa
    (2003) Visser, M E; Maartens, G; Kossew, G; Hussey, G D
    A cross-sectional study of 132 adults attending an HIV clinic in Cape Town, South Africa, was conducted to determine predictors of low plasma vitamin A and Zn levels. No patients were on antiretroviral therapy. The possible confounding effect of the acute-phase response was controlled by including C-reactive protein levels in multivariate analysis and by excluding active opportunistic infections. Retinol levels were low (< 1.05 μmol/l) in 39% of patients with early disease (WHO clinical stages I and II) compared with 48 and 79 % of patients with WHO stage III and IV respectively (P<0.01). Plasma Zn levels were low (< 10.7 μmol/l) in 20% of patients with early disease v. 36 and 45 % with stage III and IV disease respectively (P< 0.05). C-reactive protein levels were normal in 63 % of subjects. Weak, positive associations were found between CD4+lymphocyte count and plasma levels of retinol (r 0.27; 95 % CI 0.1, 0.43) and Zn (r 0.31; 95% CI 0.25, 0.46). Multivariate analysis showed the following independent predictors of low retinol levels: WHO stage IV (odds ratio 3.4; 95 % CI 2.1, 5.7) and body weight (odds ratio per 5 kg decrease 1.15; 95% CI, 1-08, 1.25), while only body weight was significantly associated with low Zn levels (OR per 5 kg decrease 1.19; 95% CI 1.09, 1.30). CD4+lymphocyte count <200/μl was not significantly associated with either low retinol or Zn levels. In resource-poor settings, simple clinical features (advanced disease and/or weight loss) are associated with lowered blood concentrations of vitamin A and/or Zn. The clinical significance of low plasma retinol and/or Zn levels is unclear and more research is required to establish the role of multiple micronutrient intervention strategies in HIV disease.
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    Prevalence and determinants of stunting and overweight in 3-year-old black South African children residing in the Central Region of Limpopo Province, South Africa
    (2005) Mamabolo, Ramoteme L; Alberts, Marianne; Steyn, Nelia P; Delemarre-van de Waal, Henriette A; Levitt, Naomi S
    OBJECTIVES: To determine the prevalence of stunting, wasting and overweight and their determinants in 3-year-old children in the Central Region of Limpopo Province, South Africa. DESIGN: Prospective cohort study. SETTING: Rural villages in the Central Region of the Limpopo Province, South Africa. SUBJECTS: One hundred and sixty-two children who were followed from birth were included in the study. Anthropometric measurements and sociodemographic characteristics of the children were recorded. RESULTS: Height-for-age Z-scores were low, with a high prevalence of stunting (48%). The children also exhibited a high prevalence of overweight (22%) and obesity (24%). Thirty-one (19%) children were both stunted and overweight. Gaining more weight within the first year of life increased the risk of being overweight at 3 years by 2.39 times (95% confidence interval (CI) 1.96-4.18) while having a greater length at 1 year was protective against stunting (odds ratio (OR) 0.41; 95% CI 0.17-0.97). Having a mother as a student increased the risk for stunting at 3 years by 18.21 times (95% CI 9.46-34.74) while having a working mother increased the risk for overweight by 17.87 times (95% CI 8.24-38.78). All these factors also appeared as risks or as being protective in children who were both overweight and stunted, as did living in a household having nine or more persons (OR 5.72; 95% CI 2.7-12.10). CONCLUSION: The results of this study highlight the importance of evaluating anthropometric status in terms of both stunting and overweight. Furthermore, it is important to realise the importance of normal length and weight being attained at 1 year of age, since these in turn predict nutritional status at 3 years of age.
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    A study of the relationship between maternal obesity and child under-nutrition in African women attending a child health clinic in Khayelitsha, Cape Town
    (1999) Mvo, Ntombizodumo; Hoffmann, Margaret; Bourne, Lesley; Lombard, Carl
    Background: Malnutrition, manifesting as obesity in women and under-nutrition in children, is a major public health problem in South Africa. There is a multitude of epidemiological evidence reflecting the extent and health effects of these problems, specifically among the African communities. However, at a family level, there is a paucity of information regarding the relationship between obesity in mothers and under-nutrition in children. Studies set to explore this relationship and determinants of body size and nutrition from a cultural perspective are long overdue. Such studies would assist in identifying intervention strategies that are appropriate and effective for the population at risk. Objective: This study, therefore, investigated the relationship between the child's nutritional status and that of the mother in a peri-urban African community. It further explored knowledge, attitudes and perceptions of body size as possible determinants of obesity and under-nutrition. This will make information available for further screening and planning of culturally sensitive nutrition interventions for the population under study. Methods: The study was conducted in two phases. The first phase was an exploratory qualitative design used mainly to develop a questionnaire for the second phase. In-depth interviews were conducted with 10 obese African mothers, whose children were categorised on the 'Road-to-Health' card, as underweight. The interviews provided an understanding of the African women's' perceptions of their body sizes and nutrition regarding the child. The second phase utilised a cross-sectional analytic study design to investigate the relationship between the mother's weight and the child's weight. It further investigated the knowledge, attitudes and perceptions found in the first phase in a larger sample using appropriate statistical techniques. A systematic sample of 365 mother-child pairs attending a child health clinic over a two-month period, starting from August 1997, was selected. The sample included women between the ages of 16 and 49 years old and their children between the ages of 2 and 5 years old attending a child health clinic in Khayelitsha, a peri-urban area outside Cape Town. Anthropometric measurements of children and mothers were taken and a structured questionnaire was administered to the mothers. Findings: The qualitative study showed attitudes and perceptions of body size that were tolerant of a 'big' body image. There was a lack of knowledge regarding causes of obesity and effective ways of reducing weight, preventing chronic diseases of lifestyle and what constitutes 'good' nutrition for the child. All these findings were confirmed in the second phase of the study. The main study showed that less than half (42%) of the mothers were able to estimate their body weights. These mothers underestimated their weights, on average, by 5 kg (p=0.0001 CI: 3.5-6.8). In the total sample, 37.3% of the mothers were obese (BMI> 30kg/m2) and 33.4 % were overweight (25 2 weight-for-height. The main finding is that, overall, no relationship was found between the mother's weight and that of the child. The mother's BMI showed a weak positive correlation with the weight-for-age zscore. The relationship between BMI and height-for-age z-score or weight-for-height was not statistically significant. However, most importantly, subgroup analysis showed that mothers' perceptions of their own body size and that of the child were significantly related to BMI and weight-for-age z-scores. Furthermore, a higher proportion of obese mothers (47.1 %) were unhappy about their body size than non-obese mothers (35.4 %). Consequently, a lesser proportion of obese mothers (36%) chose an overweight body image as 'attractive' compared with non-obese mothers (40.2%). Conclusions: Although there was no relationship found between obesity in mothers and under-nutrition in children, this study confirmed the high prevalence of both problems in the study group. Furthermore, it provided new evidence on the relationship between nutritional status of mothers and the resultant attitudes and perceptions to body size. This crucial information could be used in planning appropriate intervention strategies for the study population. More studies of this nature are needed for specific target populations in order to direct effective interventions.
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    The association of early childhood nutrition and growth with the intestinal microbiome and pneumonia
    (2025) Budree, Shrish; Zar, Heather; Nicol, Mark
    Background Malnutrition and pneumonia contribute significantly to under-5 mortality. The gut microbiome is associated with development of malnutrition and pneumonia. However, data on longitudinal growth, infant feeding practices, and the microbiome in children with malnutrition and pneumonia in low and middle-income countries (LMIC) are scarce. This work aimed to investigate growth in early childhood, and associations of the microbiome with growth and pneumonia in an LMIC. Methods A prospective study of growth, pneumonia, and the microbiome was performed in the Drakenstein Child Health Study (DCHS), a birth cohort in a low-income setting in South Africa. Mothers enrolled antenatally, and mother-child pairs were followed through birth and early childhood. Comprehensive health, socio-demographic, nutritional, and psychosocial data were collected longitudinally from birth through 3 years. Anthropometry was measured by trained study staff. Dietary information was collected using food-frequency questionnaires. Active surveillance for World Health Organization (WHO)-defined pneumonia was undertaken. Longitudinal stool samples were collected at study visits and during pneumonia episodes. WHO z-scores were calculated, and malnutrition classified as stunted, wasted, or overweight/obese. Dietary data were analysed using WHO infant and young child feeding indicators. Microbiome 16S ribosomal RNA (rRNA) gene amplicon sequencing was performed and bioinformatic analysis conducted in QIIME2 and Phyloseq (R packages). Results Subsets of children in the DCHS were analysed. Growth analysis among 792 infants (50% female; 15% preterm) showed that birth weight was a significant determinant of growth (p<0.001). Stunting was highly prevalent (17% and 13% at 2 and 12 months, respectively). Feeding practices evaluated in 1076 infants (50% female, 17% preterm) showed low exclusive breastfeeding rates (13%), and high consumption of inappropriate foods (high sugar or high-fat food) at 1 year (91%). Microbiome analysis of 138 children aged 1–40 months (49% females) included 90 children with pneumonia (10% hospitalised) and 48 non-pneumonia controls. Stunted children had low diversity (p=0.009) and significant depletion in Ruminococcus (q=0.03). Compared with age-matched controls, dysbiosis was found during pneumonia episodes and before the onset of pneumonia, characterised by significant enrichment in (Escherichia coli) E. coli (q=0.04). 6 Conclusion Malnutrition and poor infant feeding practices were highly prevalent despite strong primary healthcare programs. Correction of microbiome disruption may improve outcomes in pneumonia and malnutrition.