Prevalence and Factors Influencing Malnutrition among Children under Five Years of Age in a Peri-Urban Environment in Abidjan

Introduction: Child malnutrition is a major public health problem in Côte d’Ivoire in sub-Saharan Africa. This study aimed to determine the prevalence and factors influencing malnutrition in children under five in the peri-urban area of Abidjan, the economic capital. Patients and Methods: We carried out a prospective cross-sectional analytical study from May 3rd to October 31st 2019 at the General Hospital of Yopougon Attié in a peri-urban district of Abidjan, the economic capital. The study included 522 children aged 0 to 59 months who were received for a consultation, with the informed consent of their parents. The assessment of nutritional status was based on WHO growth standards. Statistical comparisons were made using the Chi-2 test for a significant p-value below 5%. Results: The population was predominantly female (sex ratio of 0.91) with an average age of 8.21 months and overall modest socio-economic conditions. The prevalence of malnutrition was as follows: 3.45% of malnutrition by excess, including 0.57% of obesity, 16.09% of stunting (5.75% severe), 12.07% of underweight (3.45% severe), 8.04% emaciation (1.91% severe). Three risk factors were identified for default malnutrition: age less than 6 months (p = 0.022), low birth weight (p = 0.003), and prematurity (p Conclusion: Malnutrition by deficiency is common in peri-urban areas in Abidjan with the main risk factors being age less than 6 months, low birth weight and prematurity. Fighting against those risk factors could help improve the nutritional status of children under five in the peri-urban environment of Abidjan.

Analysis and Intervention of Severe Acute Malnutrition in Children at an Urban Public School in Mumbai, India

Background: There is a dearth of information regarding trends of malnutrition and weight status in children from rapidly developing economies like India. Objectives: The aim of this study is to analyze the dynamics of malnutrition in a group of school children from India, and then provide interventions for the children that have severe acute malnutrition. Methods: Children that were found to lie between −3 to −4 SD of parameters of BMI, height for age and weight for age were labeled as SAM. Children that were screened for wasting and fell between −2 to −4 SD were also included under the label of SAM. All participants were also given a prototype 1500-calorie diet to follow for the entire duration and 6 weekly sessions were taken for the parents on various topics on nutrition. Results: Quantitative analysis showed a great improvement in weights and heights of severely malnourished children. The average increase in weight of all children that participated in the study was 9.09% and the average increase in height was 1.39%. The weekly sessions given to the parents on various nutrition topics could be the cause of high compliance to the diet given to the children. Conclusion: Malnutrition is still a very big problem in developing countries like India. Basic interventions like an improvement in diet, education about micronutrients and balanced diet, and food-based interventions in severe malnutrition can lead to a great improvement in the health and development status of children.

Prevalence of Malnutrition among Hospitalized Pediatric Patients in a Tertiary Hospital in Jordan: Pilot Study

Introduction: Failure to thrive (FTT) occurs when a child’s growth falls below expected standards, typically due to inadequate nutrient intake. Factors include insufficient oral intake, poor nutrient absorption, and increased metabolic demands. Previous studies have shown high malnutrition rates in hospitalized children due to illness-related metabolic demands, decreased appetite, and inadequate intake. Our objective was to assess the growth and nutritional status of children admitted to King Abdullah University Hospital (KAUH) and identify the prevalence of undernutrition and associated factors. Methods: This prospective, cross-sectional cohort study was conducted at KAUH from July to December 2022. We included children aged 2 months to 16 years, excluding those with conditions altering growth parameters. Data were collected through pediatric data sheets, physical examinations, and laboratory tests. Anthropometric measurements were taken, and growth was assessed using CDC growth charts. Nutritional anemia was defined as hemoglobin 16. Results: A total of 111 patients were included (56.8% male, median age 65 months). Most patients had normal height (82%) and weight (86.5%) upon admission. However, 14.4% were stunted, 11.7% were underweight, 14.4% were overweight, and 3.6% were obese. Growth impairment correlated with higher anemia rates (p = 0.042). Nutritional anemia was present in 12% of patients. No significant relation was found between breastfeeding history and growth retardation, but maternal perception of malnutrition correlated well with actual malnutrition. Conclusion: Our study found a malnutrition prevalence of 19.8%, highlighting the need for systematic nutritional screening in hospitalized children. The study’s limitations include its small sample size and specific patient population, suggesting the need for larger, multicenter studies for more generalizable results.

Assessment of Japanese healthy children’s nutritional status using Waterlow classification

Malnutrition is associated with an increased risk of morbidity and mortality, and may case an undesirable effect on the growth and development in children. There have been several reports about the prevalence of malnutrition in hospitalized children, but reports about malnutrition in a large number of healthy children are quite limited. The aim of this study was to evaluate the prevalence of likelihood of malnutrition in Japanese healthy children. We retrospectively reviewed data of height and weight at a regular health check in 7517 healthy children (age 3 - 17;3747 boys, 3770 girls) during 2008 and 2010 in Nara city, Japan. The data were evaluated using Waterlow classification, i.e., weight-for-height (W/H) and height-for-age (H/A). The prevalence of under-nutrition, as estimated by the values of W/H less than 90% and H/A less than 95%, were 20.1% and 8.3%, respectively, and this prevalence of malnutrition risk tended to vary substantially with age. The peak levels of the prevalence were found to be at around 12 years old for both sexes in W/H, and at around 11 years old for boys and at around 10 years old for girls in H/A. We have clearly demonstrated the existence of certain percentages of the likelihood of malnutrition at different ages in healthy children. These findings suggest that when we want to evaluate the nutritional status using Waterlow classification in hospitalized children, we should be careful by taking such reference values into account.

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Background: The community based management of severe acute malnutrition (CMAM) was introduced in Ghana in 2008 to manage cases of severe acute malnutrition (SAM) recorded at the community level. This study estimated the economic cost of the CMAM programme for children under-five in the Agona west municipality of Ghana. Methods: A retrospective cross sectional study that used a cost analysis design was employed to estimate the economic cost of the programme from the societal perspective. Household cost data from caregivers were obtained using a semi-structured questionnaire. That of programme cost data was obtained from document reviews as well as the use of semi-structured questionnaires and subsequent discussions with key personnel of the Ghana Health Service, Food and Nutrition Technical Assistance and UNICEF. One and multi-way sensitivity analyses were conducted to test how sensitive the cost estimates are to certain variations in the cost profiles. Results: The economic household cost of CMAM was estimated as $1905.32 ($47.63 per household) of which 79% was attributed to direct cost while the remaining 21% made up indirect cost. Programme economic cost of CMAM was estimated as $27633.5 (96% recurrent and 4% capital), with refresher training constituting majority of the cost (34%). The constituents of the total economic cost of the programme, estimated as $32214.56 are programme cost (86%), household costs (6%) and community volunteer cost (8%). Therefore, the economic cost of treating one SAM case using the CMAM protocol was estimated as $805.36. Conclusion: Although CMAM has proven to be an effective tool for the management of SAM, its associated costs are quite enormous when coverage levels (geographic) are high yet small number of cases are detected and treated. Therefore, it is prudent to implement several cost saving strategies such as a reduction in the number of days spent on trainings in order to reduce these costs.

Chinese guidelines for the assessment and provision of nutrition support therapy in critically ill children

Background This document represents the first evidence-based guidelines to describe best practices in nutrition therapy in critically ill children (>1 month and <18 years), who are expected to require a length of stay more than 2 or 3 days in a Pediatric Intensive Care Unit admitting medical patients domain. Methods A total of 25,673 articles were scanned for relevance. After careful review, 88 studies appeared to answer the pre-identified questions for the guidelines. We used the grading of recommendations, assessment, development and evaluation criteria to adjust the evidence grade based on the quality of design and execution of each study. Results The guidelines emphasise the importance of nutritional assessment, particularly the detection of malnourished patients. Indirect calorimetry (IC) is recommended to estimate energy expenditure and there is a creative value in energy expenditure, 50 kcal/kg/day for children aged 1–8 years during acute phase if IC is unfeasible. Enteral nutrition (EN) and early enteral nutrition remain the preferred routes for nutrient delivery. A minimum protein intake of 1.5 g/kg/day is sug-gested for this patient population. The role of supplemental parenteral nutrition (PN) has been highlighted in patients with low nutritional risk, and a delayed approach appears to be beneficial in this group of patients. Immune-enhancing cannot be currently recommended neither in EN nor PN. Conclusion Overall, the pediatric critically ill population is heterogeneous, and an individualized nutrition support with the aim of improving clinical outcomes is necessary and important.

Nutritional status and nutritional therapy in inflammatory bowel diseases

Underweight and specific nutrient deficiencies are frequent in adult patients with inflammatory bowel disease(IBD).In addition,a significant number of children with IBD,especially Crohn's disease(CD) have impaired linear growth.Nutrition has an important role in the management of IBD.In adults with CD,enteral nutrition(EN) is effective in inducing clinical remission of IBD,although it is less efficient than corticosteroids.Exclusive EN is an established primary therapy for pediatric CD.Limited data suggests that EN is as efficient as corticosteroids for induction of remission.Additional advantages of nutritional therapy are control of inflammation,mucosal healing,positive benefits to growth and overall nutritional status with minimal adverse effects.The available evidence suggests that supplementary EN may be effective also for maintenance of remission in CD.More studies are needed to confirm these findings.However,EN supplementation could be considered as an alternative or as an adjunct to maintenance drug therapy in CD.EN does not have a primary therapeutic role in ulcerative colitis.Specific compositions of enteral dietselemental diets or diets containing specific components-were not shown to have any advantage over standard polymeric diets and their place in the treatment of CD or UC need further evaluation.Recent theories suggest that diet may be implicated in the etiology of IBD,however there are no proven dietary approaches to reduce the risk of developing IBD.

富马酸亚铁联合营养支持对营养不良儿童营养、免疫及血液指标的影响

目的探讨富马酸亚铁联合营养支持对营养不良儿童营养、免疫及血液指标的影响。方法前瞻性选取2020年1月至2023年6月烟台市烟台山医院收治100例的营养不良的患儿,按照随机数字方法分为对照组及研究组,各50例。研究组在营养支持基础上口服富马酸亚铁,对照组采用单纯营养支持,连续治疗4周。比较两组患儿治疗后临床疗效及不良反应,以及营养指标、血液指标及免疫指标水平。结果研究组患儿临床有效率(86.00%)明显高于对照组(68.00%),差异有统计学意义(χ^(2)=4.574,P=0.033)。治疗后,研究组患儿体质量指数(BMI)、转铁蛋白(TRF)及前清蛋白(PAB)、白蛋白、前白蛋白、血清铁(SI)、血红蛋白(Hb)及网织红细胞(Ret)水平明显高于对照组(P<0.05);IgA、IgG、IgE明显高于对照组(t=4.602,3.393,2.772,P<0.05),IgM水平明显低于对照组(t=3.805,P=0.001);两组患儿不良反应比较差异无统计学意义(P>0.05)。结论富马酸亚铁联合营养支持可显著提高营养不良患儿营养状态及免疫功能,改善铁代谢障碍及提高血红蛋白含量,且不良反应少,安全性较高,值得应用。

儿童肿瘤患者营养筛查量表的应用和筛选

营养不良降低儿童肿瘤患者的生命质量,增加其术后医院感染的风险。针对这一问题,尽早对儿童肿瘤患者进行营养筛查,并对存有营养不良风险的患儿采取干预措施,对预防营养不良及相关并发症极为重要。在我国,儿童肿瘤患者营养不良率相对较高,而肿瘤的类型、分期及治疗方案的个体差异性等多重因素,增加了评估儿童肿瘤患者是否营养不良的复杂性。目前,多数研究采用国外的营养风险评估量表,不同量表之间的结果难以统一和比较。因此,制订一套针对性强、适用于我国国情的临床营养筛查量表成为迫切需求。本文通过对比国内外当前儿童营养筛查量表的筛查目标、适用人群、评估内容、评分标准、实际应用、使用限制及效果评估方面的异同,归纳总结各自的优缺点,提出对现有量表的改进建议及制订适用于我国儿童肿瘤患者营养筛查量表的意见,旨在推进我国儿童肿瘤患者营养筛查量表的制订和应用。

儿童营养不良的危险因素及营养指导方法探讨

目的 分析儿童营养不良的危险因素及营养指导方法。方法 采取抽样调查的方法对某地区的800例学龄前儿童的营养不良情况进行调查,对3~6岁儿童的睡眠、运动、饮食、营养摄入的情况以及造成营养不良的危险因素进行分析,制定合理的营养指导对策。结果 800例儿童均采取了体格检查,回收了800份调查问卷。其中,营养不良儿童105例,发生率为13.13%。男性儿童的营养不良发生率高于女性儿童, 5岁儿童的营养不良发生率高于其他年龄儿童,但对比无差异(P>0.05)。营养不良与非营养不良儿童的饮食习惯、是否喜欢运动、就读学校等级、家庭收入情况、居住环境对比,有差异(P<0.05)。通过Logistic回归分析可知:饮食习惯(不喜欢吃肉鱼虾)、家庭收入低、居住环境差是儿童营养不良的独立危险因素(OR=8.149、8.457、4.586, P<0.05)。结论 通过对儿童营养不良的危险因素进行分析,动物蛋白摄入不足、家庭收入低、居住环境差都是重要的原因,因此要针对这些原因制定合理的管理对策,从而减少儿童营养不良的发生,保障儿童健康发育成长。

小儿营养不良保健指导方法对儿童睡眠质量及营养情况的影响分析

目的:结合儿童营养不良的实际保健要点及常规方式,讨论小儿营养不良保健指导的可行性。方法:选取2021年6月至2023年5月沂源县人民医院儿童保健科收治的营养不良患儿60例作为研究对象,按照双盲法原则分为观察组和对照组,每组30例。观察组给予小儿营养不良保健指导方法,对照组给予常规干预,比较2组的干预评价、情绪变化、睡眠质量。结果:干预后,观察组营养指数、睡眠时间的改善情况及监管下各项保健工作流程的科学性均高于对照组,差异均有统计学意义(均P<0.05);干预后,观察组相关保健任务的完成情况及面对各类事件时的情绪稳定性均优于对照组,差异均有统计学意义(均P<0.05);干预后,观察组经睡眠情况的阶段性质量监测均值及交流中的精神表现力均高于对照组,差异均有统计学意义(均P<0.05)。结论:小儿营养不良保健指导方法有利于改善患儿营养状态与睡眠质量,在持续营养中可优化干预质量,稳定患儿情绪。

中国5岁以下儿童营养不良现状及其变化趋势的研究

目的分析中国5岁以下儿童的营养不良状况及变化趋势。方法采用多阶段分层整群随机抽样的方法,按照东、中、西三类地区和城市、农村的分层原则,在全国选取17 607名5岁以下儿童,测量儿童的身高(长)和体重。结果2006年中国5岁以下儿童生长迟缓率为9.9%,低体重率为5.9%,消瘦率为2.2%;儿童生长迟缓率农村是城市的5.3倍,低体重率农村是城市的4.6倍,差异有显著性(P<0.05);中、西部地区儿童营养不良率显著高于东部地区(P<0.05);与2002年相比,2006年儿童生长迟缓率下降了30.8%,儿童低体重率下降了24.4%。结论中国5岁以下儿童营养不良率逐年下降,下降速度城市高于农村。西部地区农村儿童营养不良问题仍有待改善,同时中部地区农村儿童的营养不良状况也应得到充分关注。

西藏地区3岁以下儿童营养状况分析

目的 了解西藏地区 3岁以下儿童的营养状况。方法 采用横断面调查设计与分层多阶段随机抽样法 ,获取样本 ,以身长和体重作为衡量儿童营养状况的基本指标 ,利用WHO/NCSH参考标准对儿童的营养状况进行评价。结果 调查获得 16 5 5对母与子 ,与WHO/NCHS标准分布比较 ,该地区 3岁以下儿童整体营养状况较差 ,以身长减低为突出 ,提示为长期的慢性营养不良。生长迟缓、低体重和消瘦的总患病率分别为 :39 0 % ,2 3 7% ,5 6 % ,农村高于城市 ,牧区高于农区。海拔是影响该地区儿童体格发育的重要因素 ,对身长的影响尤为明显。结论 西藏地区 3岁以下儿童的整体营养状况差 ,中重度营养不良的患病率高 。

云南省儿科住院患儿营养风险筛查与营养状况调查

目的对儿科住院患儿进行营养风险筛查及调查营养不良发生率,为进行临床营养支持提供依据,为建立营养风险筛查制度提供数据支持.方法采用STAMP营养风险筛查工具对2015年9月入住昆明医科大学附属儿童医院的754例患儿进行营养风险筛查,并通过体格测量进行营养评估,对存在高营养风险的患儿进行再次评估.结果 754例住院患儿中15.9%的患儿(120例)存在高度营养风险,57.6%的患儿(434例)存在中度营养风险.营养不良检出率为13.4%(101例),其中重度营养不良检出率1.9%(14例),轻中度营养不良检出率11.5%(87例).高营养风险患儿营养不良检出率(34.2%)高于中度营养风险患儿营养不良检出率(13.8%).血液肿瘤、腹部手术、慢性肝病、慢性肾病、先天性心脏病等疾病较其他疾病营养风险高、营养不良检出率高(P<0.05).少数民族患儿高度营养风险检出率、营养不良检出率高于汉民族(P<0.05).存在营养风险的患儿再次筛查后营养风险评分增加率为25.8%,腹部手术疾病增加最为明显.结论儿科住院患儿存在较高营养风险及营养不良发生率.STAMP评分法评估住院患儿营养风险,能早期发现住院患儿营养不良以及可能恶化的患儿,利于全面营养评估与及时合理的营养支持,改善营养结局.

儿科患者入院时营养状况评价

目的调查评价儿科住院患者的营养状况,了解其营养不良的患病率。方法上海交通大学医学院附属新华医院、附属上海儿童医学中心及附属儿童医院共2274例患儿入院时进行体格测量,以世界卫生组织儿童生长量表为参考标准,根据Z值评分法,分别计算年龄别身高Z值(height for age Z-score,HAZ)、年龄别体重Z值(weight for ageZ-score,WAZ)和身高别体重Z值(weightforheightZ-score,WHZ),评价住院儿科患者的营养状况。结果患儿营养不良的发生率分别为:生长迟缓(HAZ<-2)7.1%,低体重(WAZ<-2)5.5%,消瘦(WHZ<-2)5.2%;营养风险的发生率分别为:生长迟缓(-2≤HAZ<-1)13.5%,低体重(-2≤WAZ<-1)16.8%,消瘦(-2≤WHZ<-1)16.3%。先天性心脏病患儿生长迟缓、低体重和消瘦的发生率均较高;泌尿外科和骨科患儿生长迟缓的发生率较高。结论住院患儿具有较高的营养不良及营养风险发生率,有必要对全体儿科住院患者进行常规营养状况筛查。

先天性心脏病患儿围手术期营养评价

目的:通过对先天性心脏(CHD)病患儿术前、术后进行营养评价,为手术方案的选择及营养支持干预提供参考依据。方法:收集河北医科大学附属第一医院心外科5～10岁CHD患儿62例,于入院后2～3 d和手术后7～14 d进行体格测量和实验室检测,记录各项客观营养评价指标,进行营养评价。结果:营养正常者37例,低体重者18例,轻度营养不良者6例,中度营养不良者1例。患儿中5、6和10岁男童实际身高和5岁男童实际体重、5～10岁女童实际身高和6～10岁女童实际体重均明显低于正常同年龄组儿童的标准身高体重(P<0.01)。术后体重、头围、上臂围、肱三头肌皮褶厚度、血清白蛋白和淋巴细胞计数均低于术前(P<0.05～P<0.01)。结论:CHD患儿较正常发育儿童,营养不良的发生率更高,患儿术前、术后自身比较,营养状况有所下降。根据营养评价结果,采取针对性的营养干预措施,可以促进术后恢复。

小儿营养不良应用临床护理路径的价值初步分析与报告

目的:研究并探讨小儿营养不良患者应用临床护理路径模式进行护理干预的价值。方法:于2012年1月-2015年12月,选取该阶段内本院收治的100例小儿营养不良患者作为此次研究的对象,采取随机数字表法分为两组,每组50例。所有患者均接受常规治疗,对照组在常规治疗的同时实施常规护理干预,观察组在常规治疗的同时采取临床护理路径模式进行护理干预。护理结束后,比较两组患者的临床总有效率,比较两组患者干预前后的白蛋白、前白蛋白、转铁蛋白,并对两组患者家长的焦虑评分、疾病不确定感评分以及护理满意度进行比较。结果:观察组的临床总有效率为96%,较对照组明显更高(P<0.05)。干预后,两组患者的白蛋白、前白蛋白、转铁蛋白均明显提高(P<0.05),且两组比较差异均有统计学意义(P<0.05)。干预后,两组家长焦虑评分、疾病不确定感评分均明显降低(P<0.05),且两组比较差异均有统计学意义(P<0.05)。观察组家长对护理服务的满意度为94%,较对照组家长明显更高(P<0.05)。结论:在小儿营养不良的临床治疗过程中,实施临床护理路径模式护理干预可保证临床治疗效果,改善患者的营养状况,同时还能有效缓解患者家长的负性情绪,提高患者家长对护理服务的满意程度。

住院儿童营养风险筛查

目的对住院患儿进行营养风险筛查,了解营养高风险比例。方法采用横断面调查,以西安市儿童医院2017年1月1至31日的1个月内所有新入院患儿为研究对象,应用儿科评估营养不良的筛选工具(STAMP)进行营养风险评分,以≥4分为高风险患儿(共9分)。结果在入选的5 292名患儿中,年龄为0~15岁,高风险的比例为14.1%,风险最高的前五名科室为儿童危重监护病房(PICU)、新生儿监护病房(NICU)、新生儿外科、肾脏科、神经外科。内外科系统高风险检出率差异无统计学意义(χ2=1.069,P>0.05)。住院患儿营养不良发生率为9.8%(519/5 292)。结论住院患儿高营养风险主要分布在PICU、NICU、新生儿外科、肾脏科、神经外科,因此应加强以上科室的营养管理,加强医护合作。

湖南省学龄前儿童营养不良状况调查分析

[目的]分析2002年全国营养调查湖南省学龄前儿童营养不良状况,为卫生行政部门及相关政府部门制定政策提供依据。[方法]体格测量数据由Anthro软件计算按年龄身高(HAZ)、年龄体重(WAZ)、身高体重(WHZ)的Z评分值。数据分析由SPSS软件完成。[结果]身高、体重、体型Z评分均值分别为-0.90、-0.55和0.06;其中城市分别为:-0.11、0.29和0.52;农村分别为:-1.23、-0.9和-0.13。城市无低体重率和消瘦率发生,农村各年龄组消瘦率在2.27%～9.23%之间,低体重率在14.25%～28%之间,身高矮小率城乡差别很大,城市各年龄组身材矮小率在10%以内,农村各年龄组身材矮小率在20%～39%之间。[结论]城乡间学龄前儿童营养不良存在差距;学龄前儿童的身高和体重可通过膳食营养科学化、合理化得到更加充分的发育。

利用STAMP对恶性肿瘤儿童进行营养风险评估及临床结局相关性分析

目的利用儿科营养不良评估筛查工具(STAMP)筛查恶性肿瘤儿童的营养风险,探讨营养风险与临床结局之间相关性。方法采用STAMP对146例肿瘤患儿进行营养风险筛查,并分析营养风险与肿瘤治疗结局的关联性。结果66例(45.2%)存在高度营养风险,77例(52.8%)存在中度营养风险,3例(2.0%)存在低度(无)营养风险。11~18岁组高营养风险发生率59.6%,高于其他年龄组,差异具有统计学意义。血红蛋白、血清白蛋白、肌酐、尿素氮等营养相关指标随STAMP评分升高呈下降趋势,其中血红蛋白差异具有统计学意义(P<0.05);平均住院时间、住院药品费用、特限级抗菌药物使用率、血液制品使用率及肠外营养使用率随STAMP评分升高呈增加或升高趋势,差异均无统计学意义。结论STAMP对恶性肿瘤患儿的筛查结果提示多数肿瘤患儿存在中、高度营养不良风险且临床结局不佳,应给予营养支持治疗。