CO-MORBIDITIES ASSOCIATED WITH SEVERE ACUTE MALNUTRITION IN CHILDREN ATTENDING A TERTIARY CARE CENTRE OF JHARKHAND.
Main Article Content
Keywords
Malnutrition, SAM, Children, Co-morbidities etc.
Abstract
Introduction-Childhood under nutrition is a foremost worldwide health issue and may lead to severe acute malnutrition (SAM) backing to upraised risk of co-morbidities and mortality in the children due to reasonably defective immunity. There is lack of data concerning collective outcomes in SAM so this study was done to identify the co-morbidities in SAM children.
Material and Methods-This study was a hospital-based descriptive type observational study done on the children of the age group 6months-5years diagnosed with SAM based on WHO criteria in a tertiary care hospital in Palamu, Jharkhand over a span of 6 months.
Result-Major clinical comorbidity associated with SAM children was found to be diarrhoea and acute respiratory tract infections (ARTI) and due to micronutrient deficiency it was anaemia and vitamin D deficiency.
Conclusion- Mortality in SAM highly depends on the co-morbidities and socio-demographic status of the SAM children so educating people regarding risk factors and timely diagnosis of the related comorbidities can ensure appropriate treatment and better prognosis of the disease.
References
1. WHO-Country Office India, NRHM. Facility Based Care of Severe Acute Malnutrition. New Delhi: WHO-Country Office for India, NRHM; 2011. p. 33-35
2. WHO. Malnutrition, Water Sanitation and Health.
3. M. J. Gibney et al, Clinical Nutrition, Wiley Blackwell (2005).
4. Okposio MM, Onyiriuka AN, Abhulimhen-Iyoha BI. Point-of-admission serum electrolyte profile of childrenless than five years old with dehydration due to acute diarrhoea. Trop Med Health 2015;43;247-52.
5. Richards L, Claeson M, Pierce NF. Management of acute diarrhea in children: Lessons learned. Pediatr Infect Dis J 1993;12:5-9.
6. World Health Organization, Country Office for India; National Rural Health Mission (IN). Facility Based Care of Severe Acute Malnutrition: Participant Manual. (New Delhi): World Health Organization, Country Office for India. 2011;119.
7. Amsalu S, Tigabu Z. Risk factors for severe acute malnutrition in children under the age of five: A case control study. Ethiop J Health Dev. 2008;22:21-5.
8. World Health Organization and UNICEF, Global Strategy for Infant and Young Child Feeding, WHO, Geneva, 2003, , accessed January 2007
9. World Health Organization, Management of Severe Malnutrition: A manual for physicians and other senior health workers, WHO, Geneva, 1999, < www. who.int/nutrition/ publications / en/ manage_severe_ malnutrition_eng.pdf>, accessed January 2007
10. UNO. Millennium development goals. New York: United Nations Organization 2012.
11. World Health Organization. Country Office for India; National Rural Health Mission (IN). Facility Based Care of Severe Acute Malnutrition: Participant Manual. (New Delhi): World Health Organization, Country Office for India. 2011;119.
12. Bwakura-Dangarembizi M, Amadi B, Bourke CD, Robertson RC, Mwapenya B, Chandwe K, et al. Health outcomes, pathogenesis and epidemiology of severe scute malnutrition (HOPE-SAM): Rationale and methods of a longitudinal observational study. BMJ Open 2019;9:e023077
13. Black RE, Victora CG, Walker SP, Butta ZA, Christain P, de Onis M et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382:427-51
14. Black R E, Cousens S, Johnson H L, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. The Lancet 375 (2010): 1969-1987.
15. Rakeshkumar, Jyotisingh, Karan joshi, et al. Co-morbidities in Hospitalized Children with Severe Acute Malnutrition (2013).
16. World Health Organization. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. World Health Organization (1998)
17. Ravi Kumar BP. Kuppuswamy’sSocioEconomic Status Scale - a revision of economic parameter for 2012. International Journal of Research & Development of Health 1 (2013): 2-4.
18. Vinod k Paul, ArvindBagga. Essential pediatrics, National immunization programmme (2017).
19. Caulfield LE, de Onis M, Blossner M, Black RE. Under nutrition as an underlying cause of child death associated with diarrhoea, pneumonia and measles. Am J ClinNutr 2004;80:193-8.
20. Jena, P., Rath, S., Nayak, M. K., &Satapathy, D. (2019). Study of social and demographic determinants of severe acute malnutrition in children aged 6-59 months in a tertiary care centre of Odisha, India. International Journal of Contemporary Pediatrics, 6(1), 46-51
21. Aguayo VM, Jacob S, Badgaiyan N, Chandra P, Kumar A, Singh K, et al. Providing care for children with severe acute malnutrition in India: New evidence from jharkhand. Public Health Nutr 2014;17:206-11.
22. Kumar R, Singh J, Joshi K, Singh HP, Bijesh S. Co-morbidities in Hospitalized Children with Severe Acute Malnutrition. Indian Pediatr 2014;51:125-7.
23. Choudhary M, Sharma D, Nagar RP, Gupta BD, Nagar T, Pandita A. Clinical profile of severe acute malnutrition in Western Rajasthan: A prospective observational study from India. J Pediatr Neonatal Care 2015;2:57.
24. Singh K, Badgaiyan N, Ranjan A, Dixit HO, Kaushilk A, Kushwaha KP, et al. Management of children with severe acute malnutrition: Experience of nutrition rehabilitation centres in Uttar Pradesh, India. Indian Pediatr. 2014;51:21- 5.
25. Das, K., Swain, A., Nayak, A. S., Behera, S., &Satpathy, S. K. (2017). Clinical profile and outcome of children with severe acute malnutrition. Int J Pediatr Res, 4, 350-356.
26. Ubesie, A. C., Ibeziako, N. S., Ndiokwelu, C. I., Uzoka, C. M., &Nwafor, C. A. (2012). Under- five protein energy malnutrition admitted at the University of in Nigeria teaching hospital, Enugu: a 10 year retrospective review. Nutrition journal, 11(1), 1-7.
27. Tariq AS, Naik SA, Rafiq AW, Saleem R. Demographic, clinical profile of severe acute malnutrition and our experience of nutrition rehabilitation centre at children hospital Srinagar Kashmir. Int J ContempPediatr 2015;2:233-7.
28. Lal RS, Lal BS, Meena P, Kumar N. Clinico-laboratory profile and outcome of edematous severe acute malnutrition in children aged 6 months to 5 years. Int J ContempPediatr 2016;3:954-9
29. Shah RH, Javdekar BB. Management of children with severe acute malnutrition: Experience of nutrition rehabilitation centre at Baroda, Gujarat. Int J ContempPediatr 2014;1:3-6.
30. Prasot RM, Verma SK, Kashyap S, et al. An epidemiological study of protein energy malnutrition (PEM) among 1-6 years children in rural Lucknow, Uttar Pradesh, India. IOSR Journal of Dental and Medical Sciences 2014;13(3):10-14.
31. Sood A, Sood A. Protein energy malnutrition and its association with common morbidities among 1-5 years aged children in a district of central Uttar Pradesh: a cross-sectional study. Int J Health Sci Res 2015;5(11):47-52.
32. Jindal, S. K., Agarwal, R., Aggarwal, A. N., Behera, D., Jindal, A., Raoof, S,, Shankar, P. S., Chhabra, S. K., Salvi, S., Sehgal, I. S., &Shafiq, N. Jaypee Brothers.
33. Saka AO, Saka MJ, Ojuawo A, et al. Haematological profile in children with protein energy malnutrition in north central Nigeria. Global Journal of Medical Research 2012;12(4):8-14.
34. S. Chakraborty, S.B.Gupta, B. Chaturvedi. A study of protein energy malnutrition in children in a rural population of Jhansi district (U.P.). Indian Journal of community medicine. 2006;31:4
35. Rasania SK, Sachdev TR. Nutritional status and feeding practices of children attending MCH centre. Indian J Community Med 2001;26:7-9.
36. Hossain MM, Hassan MQ, Kabir AR, Hannan AH, Rahman A. Hospital management of severely malnourished children: Comparision of locally adapted protocol with WHO protocol 2007. Indian J Pediatr 2009;46:213-7.
37. Nube M, Assenso-Okyere WK. Large differences in nutritional status between fully weaned and partially breastfed children beyond the age of 12 months. Eur J ClinNutr 1966;50:171-7
38. Talbert A, Thuo N, Karisa J, et al. Diarrhoea complicating severe acute malnutrition in Kenyan children: A prospective descriptive study of risk factors and outcome. PLoS One 7 (2012): 1.
39. Irena AH, Mwambazi M, Mulenga V. Diarrhea is a major killer of children with severe acute malnutrition admitted to inpatient set-up in Lusaka, Zambia. Nutrition J 10 (2011): 110.
40. Berkowitz FE. Infections in children with severe proteinenergy malnutrition. Pediatr Infect Dis J 11 (1992): 750-759.
41. Munthali T, Jacobs C, Sitali L, et al. Mortality and morbidity patterns in under-five children with severe acute malnutrition (SAM) in Zambia: a five-year retrospective review of hospital-based records (2009- 2013). Arch Public Health 2015;73(1):23.
42. Gupta RK, Nagori GL, Nagori P, et al. Pattern of Comorbidities in children with severe acute malnutrition admitted in MTC of a teaching hospital of South East Rajasthan. J Pharm Biomed Sci 2015;5(5):403-407
43. Sunguya BF, Koola JI, Atkinson S. Infections associatedwith severe malnutrition among hospitalised children in East Africa. Tanzania Health Research Bulletin 8 (2006): 189-192.
44. Berti A, Bregani ER, Manenti F, Pizzi C. Outcome of severely malnourished children treated according to UNICEF 2004 guieline: A one year experience in a zone hospital in rural Ethiopia. Trans R Soc Trop Med Hyg 2008;102:939-44.
45. Bhaskaram P. Measles and malnutrition. Indian J Med Res 102 (1995): 195-99.
46. Ejaz MS, Latif N. Stunting and micronutrient deficiencies inmalnourished children. J Pak Med Assoc 60 (2010): 543-547.
47. Bernal, C., Velasquez, C., Alcaraz, G. et al. Treatment of severe malnutrition in children:
experience in implementing the WHO guidelines in Turbo, Colombia. J PedGastrNutr. 2008;46:322-328.8
2. WHO. Malnutrition, Water Sanitation and Health.
3. M. J. Gibney et al, Clinical Nutrition, Wiley Blackwell (2005).
4. Okposio MM, Onyiriuka AN, Abhulimhen-Iyoha BI. Point-of-admission serum electrolyte profile of childrenless than five years old with dehydration due to acute diarrhoea. Trop Med Health 2015;43;247-52.
5. Richards L, Claeson M, Pierce NF. Management of acute diarrhea in children: Lessons learned. Pediatr Infect Dis J 1993;12:5-9.
6. World Health Organization, Country Office for India; National Rural Health Mission (IN). Facility Based Care of Severe Acute Malnutrition: Participant Manual. (New Delhi): World Health Organization, Country Office for India. 2011;119.
7. Amsalu S, Tigabu Z. Risk factors for severe acute malnutrition in children under the age of five: A case control study. Ethiop J Health Dev. 2008;22:21-5.
8. World Health Organization and UNICEF, Global Strategy for Infant and Young Child Feeding, WHO, Geneva, 2003, , accessed January 2007
9. World Health Organization, Management of Severe Malnutrition: A manual for physicians and other senior health workers, WHO, Geneva, 1999, < www. who.int/nutrition/ publications / en/ manage_severe_ malnutrition_eng.pdf>, accessed January 2007
10. UNO. Millennium development goals. New York: United Nations Organization 2012.
11. World Health Organization. Country Office for India; National Rural Health Mission (IN). Facility Based Care of Severe Acute Malnutrition: Participant Manual. (New Delhi): World Health Organization, Country Office for India. 2011;119.
12. Bwakura-Dangarembizi M, Amadi B, Bourke CD, Robertson RC, Mwapenya B, Chandwe K, et al. Health outcomes, pathogenesis and epidemiology of severe scute malnutrition (HOPE-SAM): Rationale and methods of a longitudinal observational study. BMJ Open 2019;9:e023077
13. Black RE, Victora CG, Walker SP, Butta ZA, Christain P, de Onis M et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382:427-51
14. Black R E, Cousens S, Johnson H L, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. The Lancet 375 (2010): 1969-1987.
15. Rakeshkumar, Jyotisingh, Karan joshi, et al. Co-morbidities in Hospitalized Children with Severe Acute Malnutrition (2013).
16. World Health Organization. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. World Health Organization (1998)
17. Ravi Kumar BP. Kuppuswamy’sSocioEconomic Status Scale - a revision of economic parameter for 2012. International Journal of Research & Development of Health 1 (2013): 2-4.
18. Vinod k Paul, ArvindBagga. Essential pediatrics, National immunization programmme (2017).
19. Caulfield LE, de Onis M, Blossner M, Black RE. Under nutrition as an underlying cause of child death associated with diarrhoea, pneumonia and measles. Am J ClinNutr 2004;80:193-8.
20. Jena, P., Rath, S., Nayak, M. K., &Satapathy, D. (2019). Study of social and demographic determinants of severe acute malnutrition in children aged 6-59 months in a tertiary care centre of Odisha, India. International Journal of Contemporary Pediatrics, 6(1), 46-51
21. Aguayo VM, Jacob S, Badgaiyan N, Chandra P, Kumar A, Singh K, et al. Providing care for children with severe acute malnutrition in India: New evidence from jharkhand. Public Health Nutr 2014;17:206-11.
22. Kumar R, Singh J, Joshi K, Singh HP, Bijesh S. Co-morbidities in Hospitalized Children with Severe Acute Malnutrition. Indian Pediatr 2014;51:125-7.
23. Choudhary M, Sharma D, Nagar RP, Gupta BD, Nagar T, Pandita A. Clinical profile of severe acute malnutrition in Western Rajasthan: A prospective observational study from India. J Pediatr Neonatal Care 2015;2:57.
24. Singh K, Badgaiyan N, Ranjan A, Dixit HO, Kaushilk A, Kushwaha KP, et al. Management of children with severe acute malnutrition: Experience of nutrition rehabilitation centres in Uttar Pradesh, India. Indian Pediatr. 2014;51:21- 5.
25. Das, K., Swain, A., Nayak, A. S., Behera, S., &Satpathy, S. K. (2017). Clinical profile and outcome of children with severe acute malnutrition. Int J Pediatr Res, 4, 350-356.
26. Ubesie, A. C., Ibeziako, N. S., Ndiokwelu, C. I., Uzoka, C. M., &Nwafor, C. A. (2012). Under- five protein energy malnutrition admitted at the University of in Nigeria teaching hospital, Enugu: a 10 year retrospective review. Nutrition journal, 11(1), 1-7.
27. Tariq AS, Naik SA, Rafiq AW, Saleem R. Demographic, clinical profile of severe acute malnutrition and our experience of nutrition rehabilitation centre at children hospital Srinagar Kashmir. Int J ContempPediatr 2015;2:233-7.
28. Lal RS, Lal BS, Meena P, Kumar N. Clinico-laboratory profile and outcome of edematous severe acute malnutrition in children aged 6 months to 5 years. Int J ContempPediatr 2016;3:954-9
29. Shah RH, Javdekar BB. Management of children with severe acute malnutrition: Experience of nutrition rehabilitation centre at Baroda, Gujarat. Int J ContempPediatr 2014;1:3-6.
30. Prasot RM, Verma SK, Kashyap S, et al. An epidemiological study of protein energy malnutrition (PEM) among 1-6 years children in rural Lucknow, Uttar Pradesh, India. IOSR Journal of Dental and Medical Sciences 2014;13(3):10-14.
31. Sood A, Sood A. Protein energy malnutrition and its association with common morbidities among 1-5 years aged children in a district of central Uttar Pradesh: a cross-sectional study. Int J Health Sci Res 2015;5(11):47-52.
32. Jindal, S. K., Agarwal, R., Aggarwal, A. N., Behera, D., Jindal, A., Raoof, S,, Shankar, P. S., Chhabra, S. K., Salvi, S., Sehgal, I. S., &Shafiq, N. Jaypee Brothers.
33. Saka AO, Saka MJ, Ojuawo A, et al. Haematological profile in children with protein energy malnutrition in north central Nigeria. Global Journal of Medical Research 2012;12(4):8-14.
34. S. Chakraborty, S.B.Gupta, B. Chaturvedi. A study of protein energy malnutrition in children in a rural population of Jhansi district (U.P.). Indian Journal of community medicine. 2006;31:4
35. Rasania SK, Sachdev TR. Nutritional status and feeding practices of children attending MCH centre. Indian J Community Med 2001;26:7-9.
36. Hossain MM, Hassan MQ, Kabir AR, Hannan AH, Rahman A. Hospital management of severely malnourished children: Comparision of locally adapted protocol with WHO protocol 2007. Indian J Pediatr 2009;46:213-7.
37. Nube M, Assenso-Okyere WK. Large differences in nutritional status between fully weaned and partially breastfed children beyond the age of 12 months. Eur J ClinNutr 1966;50:171-7
38. Talbert A, Thuo N, Karisa J, et al. Diarrhoea complicating severe acute malnutrition in Kenyan children: A prospective descriptive study of risk factors and outcome. PLoS One 7 (2012): 1.
39. Irena AH, Mwambazi M, Mulenga V. Diarrhea is a major killer of children with severe acute malnutrition admitted to inpatient set-up in Lusaka, Zambia. Nutrition J 10 (2011): 110.
40. Berkowitz FE. Infections in children with severe proteinenergy malnutrition. Pediatr Infect Dis J 11 (1992): 750-759.
41. Munthali T, Jacobs C, Sitali L, et al. Mortality and morbidity patterns in under-five children with severe acute malnutrition (SAM) in Zambia: a five-year retrospective review of hospital-based records (2009- 2013). Arch Public Health 2015;73(1):23.
42. Gupta RK, Nagori GL, Nagori P, et al. Pattern of Comorbidities in children with severe acute malnutrition admitted in MTC of a teaching hospital of South East Rajasthan. J Pharm Biomed Sci 2015;5(5):403-407
43. Sunguya BF, Koola JI, Atkinson S. Infections associatedwith severe malnutrition among hospitalised children in East Africa. Tanzania Health Research Bulletin 8 (2006): 189-192.
44. Berti A, Bregani ER, Manenti F, Pizzi C. Outcome of severely malnourished children treated according to UNICEF 2004 guieline: A one year experience in a zone hospital in rural Ethiopia. Trans R Soc Trop Med Hyg 2008;102:939-44.
45. Bhaskaram P. Measles and malnutrition. Indian J Med Res 102 (1995): 195-99.
46. Ejaz MS, Latif N. Stunting and micronutrient deficiencies inmalnourished children. J Pak Med Assoc 60 (2010): 543-547.
47. Bernal, C., Velasquez, C., Alcaraz, G. et al. Treatment of severe malnutrition in children:
experience in implementing the WHO guidelines in Turbo, Colombia. J PedGastrNutr. 2008;46:322-328.8
Article Sidebar
Published
Apr 30, 2025
Article Details
How to Cite
Dr Sanjay Kumar, Dr Nutan, Dr Bimal Kumar, & Dr Vijay Kumar. (2025). CO-MORBIDITIES ASSOCIATED WITH SEVERE ACUTE MALNUTRITION IN CHILDREN ATTENDING A TERTIARY CARE CENTRE OF JHARKHAND . Journal of Population Therapeutics and Clinical Pharmacology, 32(3), 1193-1201. https://doi.org/10.53555/fqy39z48
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Author Biographies
Dr Sanjay Kumar
Assistant Professor, Department of Pediatrics, Laxmi Chandravansi Medical College and
Hospital, Palamu, India
Dr Nutan
Assistant Professor, Department of Pediatrics, Laxmi Chandravansi Medical College and
Hospital, Palamu, India
Dr Bimal Kumar
Associate Professor, Department of Pediatrics, Madhubani Medical College and Hospital,
Madhubani, India
Dr Vijay Kumar
Professor, Department of Community Medicine, Laxmi Chandravansi Medical College and
Hospital, Palamu, India
How to Cite
Dr Sanjay Kumar, Dr Nutan, Dr Bimal Kumar, & Dr Vijay Kumar. (2025). CO-MORBIDITIES ASSOCIATED WITH SEVERE ACUTE MALNUTRITION IN CHILDREN ATTENDING A TERTIARY CARE CENTRE OF JHARKHAND . Journal of Population Therapeutics and Clinical Pharmacology, 32(3), 1193-1201. https://doi.org/10.53555/fqy39z48