¹JR, ²Professor, ³Professor & HOD, Upgraded Department of Pediatrics, Patna Medical College and Hospital, Patna, Bihar, INDIA.

Email: anshumanshivraj@gmail.com, neelamverma@hotmail.com

RESULTS

Out of 144 SAM children 69 (47.9%) children belongs to age groups 6-12 month while 45 (31.25%) belongs to age group 13-24 Month and rest 30 (20.9%) children of age group more than 24 month.

Table 1: Prevalence of severe acute malnutrition in different age group

The mean age of presentation in 6-12 month, 13-24 month and > 24 month was 9.21 month 19.31 month and 40.76 month respectively while the average mean age of presentation in study population was 18.94 month.

Table 2: Mean age of presentation in different age group

A total of 79 children (54.86%) were male while 65 children (45.14%) were female.

Table 3: Sex wise distribution in SAM children

A total of 119 cases (82.63%) had their weight for height/length below – 3 SD. 43 cases (30%) had visible severe wasting and 30 cases (20.83%) had bilateral pedal edema. All the SAM cases in study population had MUAC < 11.5 cm (100%).

Table 4: Study population fulfilling different criteria for diagnosis of SAM

Only 38.20 % of patient (55 cases) had received exclusive breast feeding upto to 6 month of age while 89 cases (61.80%) had received partial breast feeding. In the partial breast feeding group almost all (89) children received feeding by bottle. Almost all of bottle feeding baby received diluted cow milk

Table 5: Frequency of breastfeeding practice in SAM population

A total of 84 cases (58.3%) had received complete immunization according to their age while 60 cases (41.7%) had received only partial immunization.

Table 6: Status of immunisation in SAM population

The families of around 78% SAM children belongs to lower socio-economic status (below poverty line) while 22% cases belongs to above poverty line.

Table 7: Ssocio-economic status of the SAM population

Diarrhoea was found to be most common complication associated with severe acute malnutrition. 42.4% (61 cases) SAM children had Diarrhoea. Pneumonia was found second most common complication. 34.72% (50 Cases) had Pneumonia. Tuberculosis was found third most common complication 29.9 % (43 case) In the nutritional deficiency Anemia was found in 86.11% population. A total of 124 cases had different degree of Anemia.

Table 8: Prevalence of complication of SAM population

Out of Total 144 children 123 children (85.4%) discharged successfully, no. of defaulter case was 15 (10.4%) and total no. of death was 6 (4.1%) respectively.

Table 9: Outcome of study

DISCUSSION

Severe Acute Malnutrition affects nearly twenty million under five children, and contributes to one million child deaths yearly.⁴ The mortality rate of children with complicated SAM that receive treatment in inpatient setups has remained unacceptably high.⁵ Such high mortality in inpatient units has been attributed to complication such as infections, fluid overload, dehydration micronutrient deficiencies and severe anaemia with oedema.⁶ Age plays an important role in etiology of Severe         acute malnutrition. Due to lack of exclusive breastfeeding and improper complementary feeding, the nutrition deficiencies start at an early age. In our study we recorded highest prevalence of SAM in age group of 6 months to 12 months(47.91%) followed by 13 to 24 months age group. This results correlates well with the findings of the study done by Kumar et al., where 59.6% of SAM children were in the age group of 6 months to 12 months.⁹ Also in a study done by Suman RL et al., majority of the patients (82%) were in the age group of 6 to 24 months.¹⁰ The mean age of presentation was 18.94 months which also correlates with study of Suman RL et al.¹⁰ (16.54 months), Kumar et al..⁹ (14.30 months) and Dr. Tarachand Saini¹¹ (19.7 month). Male dominance was reported among SAM patients in study by Suman RL et al..¹⁰ (52% males), Tarachand Saini¹¹ (68.53% male). Similar results were noted in present study. Study by Kumar et al.,⁹ and Thapa A et al.¹² however reported a higher incidence in Females 51.9% and 51.7% respectively. This may be due to a sense of relative negligence by the parents towards the female child in the society regarding breast feeding, Immunization and other feeding practices. Study by Kumar et al., which shows weight for height <- 3SD in 75.8% cases, severe visible wasting in 24.03% cases and bilateral pitting oedema in 27% cases.⁹A study by Suman RL et al. shows edema in 100% cases because his study was only on edematous children. ¹⁰ Exclusive breast feeding and proper breast-feeding practices play a very important role in nutritional status of a child. In our study population 38.20% children were exclusively breast fed up to 6 months of age. This is much higher than the incidence of exclusive breast feeding as reported by study of Kumar et al..⁹ The more breastfeeding percentage in our study may be due to increased awareness of people about exclusive breastfeeding over the years. The NFHS-4 (2015-16) report of Bihar for general population however shows that exclusive breastfeeding upto 6 months is 53.5% in Bihar. This indicates that lack of exclusive breastfeeding is one of the major contributor in development of malnutrition. Socio-economic status of a family has a major impact on child nutrition. Children with lower socio-economic background have more chances of developing malnutrition because lack of nutritious food, lack of awareness, unhygienic living conditions, poor feeding practices and lack of health seeking behaviour. Overlapping nature of protein-energy malnutrition and micronutrient deficiencies were well understood and it is seen that lack of one micronutrient is typically associated with deficiency of others.¹³ Anemia (86.11%) the common micronutrient deficiency associated with malnutrition in our study, and this is consistent with the previous reports by Kumar et al.⁹ (88.3%), Suman RL et al.¹⁰ (74%). In our study out of 144 children 123 (85.4%) children discharged successfully, while defaulter case were 15 (10.4%) and total no. of death was 6 (4.1%). In a another study by Dhanalakshmi K¹⁴ shows cure rate 81% death rate 6.52% and defaulter 12.09%. While Rajendra P Nagar¹⁵ shows 84% discharged rate and 1.3% mortality, which is very near to our study. The Indian government and a number of nongovernmental organizations (NGOs) are currently implementing various initiatives that address SAM across the country. Although the principal strategy being deployed remains inpatient care through Nutritional Rehabilitation Centres and Malnutrition Treatment Centres, there is a growing consensus within India that the adoption of community-based management of acute malnutrition (CMAM)¹⁶ is crucial to achieving widespread effective coverage and treatment of all children with SAM. Undernutrition generally decreases with increasing mother’s schooling, better nutritional status of the mother, and larger child’s size at birth. Stunting and underweight are higher in rural areas than in urban areas.³ Malnutrition and infection often makes vicious cycle. Prevention and appropriate treatment of diarrhea, Pneumonia, TB, Measles and other infections in infancy are important to reduce malnutrition rates. Also, prevention and timely treatment of severe malnutrition significantly reduce the incidence of infectious diseases in children. Infectious diseases like diarrhea, Pneumonia, TB and other infections are more common in malnourished children than their well- nourished counterparts.

CONCLUSION

Most of the malnourished child are in the age group of 6 to 12 months with poor socio-economic background. Diarrhea and anemia were most common complications followed by Pneumonia and tuberculosis. In order to prevent the development of SAM and their complication we need to focus on exclusive breastfeeding till 6 month of age, timely and complete immunization, timely introduction of complementary feeding, nutritional rehabilitation and early identification and treatment of complication like diarrhoea, pneumonia anaemia, in malnourished children so as to break undernutrition-disease cycle.

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