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, , , , , , , , , , , , , , , , , and
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-
1.
Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J; Maternal and Child Undernutrition Study Group , 2008. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371: 243–260.
-
2.
Black RE et al., 2013. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382: 427–451.
-
3.
World Health Organization , 2006. WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva, Switzerland: World Health Organization.
-
4.
National Institute of Population Research and Training, Training, Mitra, Associates, International M , 2018. Bangladesh Demographic and Health Survey, 2017–18. Dhaka, Bangladesh: NIPORT. Available at: https://dhsprogram.com/publications/publication-FR344-DHS-Final-Reports.cfm. Accessed March 31, 2022.
-
5.
Unicef, WHO , 2021. Levels and Trends in Child Malnutrition: Key Findings of the 2021 Edition of the Joint Child Malnutrition Estimates. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/publications/i/item/9789240025257. Accessed March 31, 2022.
-
6.
Rodgers A, Ezzati M, Vander Hoorn S, Lopez AD, Lin R-B, Murray CJL, Collaborating GCRA, 2004. Distribution of major health risks: findings from the Global Burden of Disease study. PLoS Med 1: e27.
-
7.
World Health Organization , 2022. World Child Hunger Facts. Available at: https://www.worldhunger.org/world-child-hunger-facts/. Accessed March 31, 2022.
-
8.
World Health Organization , 2022. WHO Fact Sheet. Malnutrition. Available at: https://www.who.int/news-room/factsheets/detail/malnutrition. Accessed March 31, 2022.
-
9.
Institute of Public Health Nutrition , 2017. National Guidelines for the Facility-Based Management of Children with Severe Acute Malnutrition in Bangladesh. Dhaka, Bangladesh: Ministry of Health and Family Welfare, Bangladesh.
-
10.
Islam MR, Fahim SM, Rasul MG, Raihan MJ, Ali NM, Bulbul MMI, Ahmed T, 2022. Health care providers’ knowledge, attitude, and practice regarding facility-based management of children with severe acute malnutrition in Bangladesh. Food Nutr Bull 43: 465–478.
-
11.
Ashworth A, Huttly S, Khanum S, 1994. Controlled trial of three approaches to the treatment of severe malnutrition. Lancet 344: 1728–1732.
-
12.
Pelletier DL, Frongillo EA Jr., Schroeder DG, Habicht J-P, 1994. A methodology for estimating the contribution of malnutrition to child mortality in developing countries. J Nutr 124: 2106S–2122S.
-
13.
Nahar B, Ahmed T, Brown KH, Hossain MI, 2010. Risk factors associated with severe underweight among young children reporting to a diarrhoea treatment facility in Bangladesh. J Health Popul Nutr 28: 476.
-
14.
Nuzhat S, Shahunja KM, Shahid ASMSB, Khan SH, Islam SB, Islam MR, Ahmed T, Chisti MJ, Hossain MI, Faruque ASG, 2020. Diarrhoeal children with concurrent severe wasting and stunting compared to severe wasting or severe stunting. Trop Med Int Health 25: 928–935.
-
15.
Alam NH, Ashraf H, 2003. Treatment of infectious diarrhea in children. Paediatr Drugs 5: 151–165.
-
16.
Chisti MJ, Salam MA, Ashraf H, Faruque AS, Bardhan PK, Shahid AS, Shahunja K, Das SK, Ahmed T, 2013. Predictors and outcome of hypoxemia in severely malnourished children under five with pneumonia: a case control design. PLoS One 8: e51376.
-
17.
Alou MT, Golden MH, Million M, Raoult D, 2021. Difference between kwashiorkor and marasmus: comparative meta-analysis of pathogenic characteristics and implications for treatment. Microb Pathog 150: 104702.
-
18.
Collins S, Dent N, Binns P, Bahwere P, Sadler K, Hallam A, 2006. Management of severe acute malnutrition in children. Lancet 368: 1992–2000.
-
19.
Bwakura-Dangarembizi M et al., 2021. Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia. Am J Clin Nutr 113: 665–674.
-
20.
Pelletier DL, Frongillo EA Jr., Schroeder DG, Habicht J-P, 1995. The effects of malnutrition on child mortality in developing countries. Bull World Health Organ 73: 443.
-
21.
Black RE, Morris SS, Bryce J, 2003. Where and why are 10 million children dying every year? Lancet 361: 2226–2234.
-
22.
Ezzati M, Lopez AD, Rodgers AA, Murray CJ, 2004. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Geneva, Switzerland: World Health Organization.
-
23.
Chen LC, Chowdhury AA, Huffman SL, 1980. Anthropometric assessment of energy-protein malnutrition and subsequent risk of mortality among preschool aged children. Am J Clin Nutr 33: 1836–1845.
-
24.
Aylward GP, Pfeiffer SI, Wright A, Verhulst SJ, 1989. Outcome studies of low birth weight infants published in the last decade: a metaanalysis. J Pediatr 115: 515–520.
-
25.
Ntenda PAM, 2019. Association of low birth weight with undernutrition in preschool-aged children in Malawi. Nutr J 18: 1–15.
-
26.
Groer MW, Luciano AA, Dishaw LJ, Ashmeade TL, Miller E, Gilbert JA, 2014. Development of the preterm infant gut microbiome: a research priority. Microbiome 2: 1–8.
-
27.
Unger S, Stintzi A, Shah P, Mack D, O’Connor DL, 2015. Gut microbiota of the very-low-birth-weight infant. Pediatr Res 77: 205–213.
-
28.
Rodríguez L, Cervantes E, Ortiz R, 2011. Malnutrition and gastrointestinal and respiratory infections in children: a public health problem. Int J Environ Res Public Health 8: 1174–1205.
-
29.
Dobner J, Kaser S, 2018. Body mass index and the risk of infection–from underweight to obesity. Clin Microbiol Infect 24: 24–28.
-
30.
Chisti MJ, Hossain MI, Malek MA, Faruque AS, Ahmed T, Salam MA, 2007. Characteristics of severely malnourished under‐five children hospitalized with diarrhoea, and their policy implications. Acta Paediatr 96: 693–696.
-
31.
Sayasone S, Utzinger J, Akkhavong K, Odermatt P, 2015. Multiparasitism and intensity of helminth infections in relation to symptoms and nutritional status among children: a cross-sectional study in southern Lao People’s Democratic Republic. Acta Trop 141: 322–331.
-
32.
Ramachandran P, Gopalan HS, 2009. Undernutrition & risk of infections in preschool children. Indian J Med Res 130: 579–583.
-
33.
Wyrick S, Hester C, Sparkman A, O’Neill KM, Dupuis G, Anderson M, Cordell J, Bogie A, 2013. What role does body mass index play in hospital admission rates from the pediatric emergency department? Pediatr Emerg Care 29: 974–978.
-
34.
Nandy S, Irving M, Gordon D, Subramanian S, Smith GD, 2005. Poverty, child undernutrition and morbidity: new evidence from India. Bull World Health Organ 83: 210–216.
-
35.
Mahmud I, Das S, Khan SH, Faruque A, Ahmed T, 2020. Gender disparity in care-seeking behaviours and treatment outcomes for dehydrating diarrhoea among under-5 children admitted to a diarrhoeal disease hospital in Bangladesh: an analysis of hospital-based surveillance data. BMJ Open 10: e038730.
-
36.
Black RE, Merson MH, Eusof A, Huq I, Pollard R, 1984. Nutritional status, body size and severity of diarrhoea associated with rotavirus or enterotoxigenic Escherichia coli. J Trop Med Hyg 87: 83–89.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1664 | 541 | 110 |
| Full Text Views | 256 | 57 | 0 |
| PDF Downloads | 126 | 33 | 0 |
Inpatient Morbidity and Mortality of Severely Underweight Children Was Comparable to That of Severely Wasted Children in Dhaka, Bangladesh
Md Ridwan Islam
Md Ridwan Islam
Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
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Sharika Nuzhat
Sharika Nuzhat
Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
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Jinat Alam
Jinat Alam
Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
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Sayeeda Huq
Sayeeda Huq
Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
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Mohammod Jobayer Chisti
Mohammod Jobayer Chisti
Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
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Tahmeed Ahmed
Tahmeed Ahmed
Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
Office of the Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
Office of the Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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ABSTRACT.
Both wasting and undernutrition are responsible for multiple morbidities and increased mortality in younger children hospitalized for acute illnesses. The question of whether children who are suffering from severe underweight are as vulnerable as children suffering from severe wasting needs to be researched further. We aimed to compare the morbidity and mortality of severely underweight but not severely wasted (SU-nSW) children with that of severely wasted (SW) children admitted to inpatient wards of a hospital. Data from 12,894 children aged < 5 years were collected using cross-sectional methods from Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh between March 2019 and December 2021. After exclusion of non-desired populations (N = 8,834), comparisons between SU-nSW (N = 1,876) and SW (N = 2,184) children were observed. The risk of morbidities and mortality among SU-nSW and SW children was analyzed after adjusting for age and sex. Inpatient morbidities were mostly similar among children with sepsis (adjusted odds ratio [aOR]: 0.90; 95% CI: 0.69, 1.19; P = 0.472) and convulsions (aOR: 0.84; 95% CI: 0.51, 1.37; P = 0.475). Dehydration (aOR: 0.71; 95% CI: 0.62, 0.81; P < 0.001) and hypokalemia (aOR: 0.58; 95% CI: 0.42, 0.79; P = 0.001) were more likely associated with SW children than with SU-nSW children. Pneumonia/severe pneumonia was more likely to affect SU-nSW children (aOR: 1.24; 95% CI: 1.02, 1.48; P = 0.018). Death was comparable between the two groups (aOR: 1.32; 95% CI: 0.70, 2.49; P = 0.386). This study underscores the importance of implementing present treatment guidelines for severe acute malnutrition in the facility-based management of severely underweight children as well.
- Supplemental Materials (PDF 243.74 KB)
Author Notes
Financial support: This research was funded by core donors who provided unrestricted support to
Data were extracted from the electronic database of patients’ records at the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Approval was obtained from the institutional review board of icddr,b (the Research Review Committee and Ethical Review Committee) for data analysis and publication. Data related to this manuscript are available upon request for researchers who meet the criteria for access to confidential data, who may contact Armana Ahmed (armana@icddrb.org) for the Research Administration of icddr,b (http://www.icddrb.org/).
Authors’ addresses: Md Ridwan Islam, Jinat Alam, and Sayeeda Huq, Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: ridwan.islam@icddrb.org, jinat.alam@icddrb.org, and sayeeda@icddrb.org. Sharika Nuzhat and Mohammod Jobayer Chisti, Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: sharika.nuzhat@icddrb.org and chisti@icddrb.org. Tahmeed Ahmed, Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, and Office of the Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mail: tahmeed@icddrb.org.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J; Maternal and Child Undernutrition Study Group , 2008. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371: 243–260.
-
2.
Black RE et al., 2013. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382: 427–451.
-
3.
World Health Organization , 2006. WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva, Switzerland: World Health Organization.
-
4.
National Institute of Population Research and Training, Training, Mitra, Associates, International M , 2018. Bangladesh Demographic and Health Survey, 2017–18. Dhaka, Bangladesh: NIPORT. Available at: https://dhsprogram.com/publications/publication-FR344-DHS-Final-Reports.cfm. Accessed March 31, 2022.
-
5.
Unicef, WHO , 2021. Levels and Trends in Child Malnutrition: Key Findings of the 2021 Edition of the Joint Child Malnutrition Estimates. Geneva, Switzerland: World Health Organization. Available at: https://www.who.int/publications/i/item/9789240025257. Accessed March 31, 2022.
-
6.
Rodgers A, Ezzati M, Vander Hoorn S, Lopez AD, Lin R-B, Murray CJL, Collaborating GCRA, 2004. Distribution of major health risks: findings from the Global Burden of Disease study. PLoS Med 1: e27.
-
7.
World Health Organization , 2022. World Child Hunger Facts. Available at: https://www.worldhunger.org/world-child-hunger-facts/. Accessed March 31, 2022.
-
8.
World Health Organization , 2022. WHO Fact Sheet. Malnutrition. Available at: https://www.who.int/news-room/factsheets/detail/malnutrition. Accessed March 31, 2022.
-
9.
Institute of Public Health Nutrition , 2017. National Guidelines for the Facility-Based Management of Children with Severe Acute Malnutrition in Bangladesh. Dhaka, Bangladesh: Ministry of Health and Family Welfare, Bangladesh.
-
10.
Islam MR, Fahim SM, Rasul MG, Raihan MJ, Ali NM, Bulbul MMI, Ahmed T, 2022. Health care providers’ knowledge, attitude, and practice regarding facility-based management of children with severe acute malnutrition in Bangladesh. Food Nutr Bull 43: 465–478.
-
11.
Ashworth A, Huttly S, Khanum S, 1994. Controlled trial of three approaches to the treatment of severe malnutrition. Lancet 344: 1728–1732.
-
12.
Pelletier DL, Frongillo EA Jr., Schroeder DG, Habicht J-P, 1994. A methodology for estimating the contribution of malnutrition to child mortality in developing countries. J Nutr 124: 2106S–2122S.
-
13.
Nahar B, Ahmed T, Brown KH, Hossain MI, 2010. Risk factors associated with severe underweight among young children reporting to a diarrhoea treatment facility in Bangladesh. J Health Popul Nutr 28: 476.
-
14.
Nuzhat S, Shahunja KM, Shahid ASMSB, Khan SH, Islam SB, Islam MR, Ahmed T, Chisti MJ, Hossain MI, Faruque ASG, 2020. Diarrhoeal children with concurrent severe wasting and stunting compared to severe wasting or severe stunting. Trop Med Int Health 25: 928–935.
-
15.
Alam NH, Ashraf H, 2003. Treatment of infectious diarrhea in children. Paediatr Drugs 5: 151–165.
-
16.
Chisti MJ, Salam MA, Ashraf H, Faruque AS, Bardhan PK, Shahid AS, Shahunja K, Das SK, Ahmed T, 2013. Predictors and outcome of hypoxemia in severely malnourished children under five with pneumonia: a case control design. PLoS One 8: e51376.
-
17.
Alou MT, Golden MH, Million M, Raoult D, 2021. Difference between kwashiorkor and marasmus: comparative meta-analysis of pathogenic characteristics and implications for treatment. Microb Pathog 150: 104702.
-
18.
Collins S, Dent N, Binns P, Bahwere P, Sadler K, Hallam A, 2006. Management of severe acute malnutrition in children. Lancet 368: 1992–2000.
-
19.
Bwakura-Dangarembizi M et al., 2021. Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia. Am J Clin Nutr 113: 665–674.
-
20.
Pelletier DL, Frongillo EA Jr., Schroeder DG, Habicht J-P, 1995. The effects of malnutrition on child mortality in developing countries. Bull World Health Organ 73: 443.
-
21.
Black RE, Morris SS, Bryce J, 2003. Where and why are 10 million children dying every year? Lancet 361: 2226–2234.
-
22.
Ezzati M, Lopez AD, Rodgers AA, Murray CJ, 2004. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Geneva, Switzerland: World Health Organization.
-
23.
Chen LC, Chowdhury AA, Huffman SL, 1980. Anthropometric assessment of energy-protein malnutrition and subsequent risk of mortality among preschool aged children. Am J Clin Nutr 33: 1836–1845.
-
24.
Aylward GP, Pfeiffer SI, Wright A, Verhulst SJ, 1989. Outcome studies of low birth weight infants published in the last decade: a metaanalysis. J Pediatr 115: 515–520.
-
25.
Ntenda PAM, 2019. Association of low birth weight with undernutrition in preschool-aged children in Malawi. Nutr J 18: 1–15.
-
26.
Groer MW, Luciano AA, Dishaw LJ, Ashmeade TL, Miller E, Gilbert JA, 2014. Development of the preterm infant gut microbiome: a research priority. Microbiome 2: 1–8.
-
27.
Unger S, Stintzi A, Shah P, Mack D, O’Connor DL, 2015. Gut microbiota of the very-low-birth-weight infant. Pediatr Res 77: 205–213.
-
28.
Rodríguez L, Cervantes E, Ortiz R, 2011. Malnutrition and gastrointestinal and respiratory infections in children: a public health problem. Int J Environ Res Public Health 8: 1174–1205.
-
29.
Dobner J, Kaser S, 2018. Body mass index and the risk of infection–from underweight to obesity. Clin Microbiol Infect 24: 24–28.
-
30.
Chisti MJ, Hossain MI, Malek MA, Faruque AS, Ahmed T, Salam MA, 2007. Characteristics of severely malnourished under‐five children hospitalized with diarrhoea, and their policy implications. Acta Paediatr 96: 693–696.
-
31.
Sayasone S, Utzinger J, Akkhavong K, Odermatt P, 2015. Multiparasitism and intensity of helminth infections in relation to symptoms and nutritional status among children: a cross-sectional study in southern Lao People’s Democratic Republic. Acta Trop 141: 322–331.
-
32.
Ramachandran P, Gopalan HS, 2009. Undernutrition & risk of infections in preschool children. Indian J Med Res 130: 579–583.
-
33.
Wyrick S, Hester C, Sparkman A, O’Neill KM, Dupuis G, Anderson M, Cordell J, Bogie A, 2013. What role does body mass index play in hospital admission rates from the pediatric emergency department? Pediatr Emerg Care 29: 974–978.
-
34.
Nandy S, Irving M, Gordon D, Subramanian S, Smith GD, 2005. Poverty, child undernutrition and morbidity: new evidence from India. Bull World Health Organ 83: 210–216.
-
35.
Mahmud I, Das S, Khan SH, Faruque A, Ahmed T, 2020. Gender disparity in care-seeking behaviours and treatment outcomes for dehydrating diarrhoea among under-5 children admitted to a diarrhoeal disease hospital in Bangladesh: an analysis of hospital-based surveillance data. BMJ Open 10: e038730.
-
36.
Black RE, Merson MH, Eusof A, Huq I, Pollard R, 1984. Nutritional status, body size and severity of diarrhoea associated with rotavirus or enterotoxigenic Escherichia coli. J Trop Med Hyg 87: 83–89.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1664 | 541 | 110 |
| Full Text Views | 256 | 57 | 0 |
| PDF Downloads | 126 | 33 | 0 |