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Severe malnutrition rct children

Marzia Lazzerini, Humphrey Wanzira
BACKGROUND: In developing countries, diarrhoea causes around 500,000 child deaths annually. Zinc supplementation during acute diarrhoea is currently recommended by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). OBJECTIVES: To evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (the Cochrane Library 2016, Issue 5), MEDLINE, Embase, LILACS, CINAHL, mRCT, and reference lists up to 30 September 2016...
December 20, 2016: Cochrane Database of Systematic Reviews
Paluku Bahwere, Bisimwa Balaluka, Jonathan C K Wells, Chobohwa N Mbiribindi, Kate Sadler, Peter Akomo, Michèle Dramaix-Wilmet, Steve Collins
BACKGROUND: The cost of current standard ready-to-use therapeutic food (RUTF) is among the major obstacles to scaling up community-based management of acute malnutrition (CMAM), an important child survival strategy. Identifying a cheaper alternative is a global public health priority. OBJECTIVE: We sought to compare the efficacy of soya-maize-sorghum RUTF (SMS-RUTF) with that of standard peanut paste-based RUTF (P-RUTF). DESIGN: We used a nonblinded, parallel-group, simple randomized controlled trial along with a day care approach that enrolled 2 groups of children aged 6-23 and 24-59 mo, respectively, with severe acute malnutrition (SAM)...
April 2016: American Journal of Clinical Nutrition
María Rupérez, Raquel González, Ghyslain Mombo-Ngoma, Abdunoor M Kabanywanyi, Esperança Sevene, Smaïla Ouédraogo, Mwaka A Kakolwa, Anifa Vala, Manfred Accrombessi, Valérie Briand, John J Aponte, Rella Manego Zoleko, Ayôla A Adegnika, Michel Cot, Peter G Kremsner, Achille Massougbodji, Salim Abdulla, Michael Ramharter, Eusébio Macete, Clara Menéndez
BACKGROUND: Little is known about the effects of intermittent preventive treatment of malaria in pregnancy (IPTp) on the health of sub-Saharan African infants. We have evaluated the safety of IPTp with mefloquine (MQ) compared to sulfadoxine-pyrimethamine (SP) for important infant health and developmental outcomes. METHODS AND FINDINGS: In the context of a multicenter randomized controlled trial evaluating the safety and efficacy of IPTp with MQ compared to SP in pregnancy carried out in four sub-Saharan countries (Mozambique, Benin, Gabon, and Tanzania), 4,247 newborns, 2,815 born to women who received MQ and 1,432 born to women who received SP for IPTp, were followed up until 12 mo of age...
February 2016: PLoS Medicine
Amanda Maust, Aminata S Koroma, Caroline Abla, Nneka Molokwu, Kelsey N Ryan, Lauren Singh, Mark J Manary
BACKGROUND: Global acute malnutrition (GAM) is the sum of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of different foods and protocols for MAM and SAM treatment can be cumbersome in emergency settings. OBJECTIVE: Our objective was to determine the recovery and coverage rates for GAM of an integrated protocol with a single food product, ready-to-use therapeutic food (RUTF), compared with standard management. METHODS: This was a cluster-randomized controlled trial in Sierra Leone conducted in 10 centers treating GAM in children aged 6-59 mo...
November 2015: Journal of Nutrition
Frank Pega, Sze Yan Liu, Stefan Walter, Stefan K Lhachimi
BACKGROUND: Unconditional cash transfers (UCTs) are a common social protection intervention that increases income, a key social determinant of health, in disaster contexts in low- and middle-income countries (LMICs). OBJECTIVES: To assess the effects of UCTs in improving health services use, health outcomes, social determinants of health, health care expenditure, and local markets and infrastructure in LMICs. We also compared the relative effectiveness of UCTs delivered in-hand with in-kind transfers, conditional cash transfers, and UCTs paid through other mechanisms...
2015: Cochrane Database of Systematic Reviews
Ruchika Kumar, Praveen Kumar, S Aneja, Virendra Kumar, Harmeet S Rehan
World Health Organization-recommended rehydration solution for malnourished children (ReSoMal) for rehydrating severe acute malnourished children is not available in India. In present study, 110 consecutive children aged 6-59 months with severely acute malnourishment and acute diarrhea were randomized to low-osmolarity oral rehydration solution (ORS) (osmolarity: 245, sodium: 75) with added potassium (20 mmol/l) or modified ReSoMal (osmolarity: 300, sodium: 45). In all, 15.4% of modified ReSoMal group developed hyponatremia as compared with 1...
December 2015: Journal of Tropical Pediatrics
Evelyn J Ward, Lisa M Henry, Amanda J Friend, Simone Wilkins, Robert S Phillips
BACKGROUND: It is well documented that malnutrition is a common complication of paediatric malignancy and its treatment. Malnutrition can often be a consequence of cancer itself or a result of chemotherapy. Nutritional support aims to reverse malnutrition seen at diagnosis, prevent malnutrition associated with treatment and promote weight gain and growth. The most effective and safe forms of nutritional support in children and young people with cancer are not known. OBJECTIVES: To determine the effects of any form of parenteral (PN) or enteral (EN) nutritional support, excluding vitamin supplementation and micronutrient supplementation, in children and young people with cancer undergoing chemotherapy and to determine the effect of the nutritional content of PN and EN...
2015: Cochrane Database of Systematic Reviews
Audrey Tonguet-Papucci, Lieven Huybregts, Myriam Ait Aissa, Jean-François Huneau, Patrick Kolsteren
BACKGROUND: Wasting is a public health issue but evidence gaps remain concerning preventive strategies not primarily based on food products. Cash transfers, as part of safety net approach, have potential to prevent under-nutrition. However, most of the cash transfer programs implemented and scientifically evaluated do not have a clear nutritional objective, which leads to a lack of evidence regarding their nutritional benefits. METHODS/DESIGN: The MAM'Out research project aims at evaluating a seasonal and multiannual cash transfer program to prevent acute malnutrition in children under 36 months, in terms of effectiveness and cost-effectiveness in the Tapoa province (Eastern region of Burkina Faso, Africa)...
2015: BMC Public Health
Rajan R Patil
The Indian Council of Medical Research had, on May 31, 2011, called for research proposals on severely acute malnourished (SAM) children to generate evidence for the development of practical and scalable regimens to medically rehabilitate children suffering from SAM, without serious complications, at the home/community level and/or peripheral inpatient facilities. The primary outcomes of the proposed research study are recovery from SAM in the short term, as well as sustenance of recovery (for at least six months after the initiation of treatment)...
July 2015: Indian Journal of Medical Ethics
Kelsey D J Jones, Rehema Ali, Maureen A Khasira, Dennis Odera, Annette L West, Grielof Koster, Peter Akomo, Alison W A Talbert, Victoria M Goss, Moses Ngari, Johnstone Thitiri, Said Ndoro, Miguel A Garcia Knight, Kenneth Omollo, Anne Ndungu, Musa M Mulongo, Paluku Bahwere, Greg Fegan, John O Warner, Anthony D Postle, Steve Collins, Philip C Calder, James A Berkley
BACKGROUND: Ready-to-use therapeutic foods (RUTF) are lipid-based pastes widely used in the treatment of acute malnutrition. Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid (PUFA) content and low n-3 PUFA, with no stipulated requirements for preformed long-chain n-3 PUFA. The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact, with and without fish oil supplementation, on children's PUFA status during treatment of severe acute malnutrition...
April 23, 2015: BMC Medicine
Henrik Friis, Kim F Michaelsen, Jonathan C Wells
There is a need for trials on the effects of food aid products for children with moderate acute malnutrition, to identify how best to restore body tissues and function. The choice of control intervention is a major challenge, with both ethical and scientific implications. While randomized trials are needed, special designs, such as cluster-randomized, stepped-wedged or factorial designs may offer advantages. Anthropometry is widely used as the primary outcome in such trials, but anthropometric traits do not refer directly to specific organs, tissues, or functions...
March 2015: Food and Nutrition Bulletin
Elizabeth Kristjansson, Damian K Francis, Selma Liberato, Maria Benkhalti Jandu, Vivian Welch, Malek Batal, Trish Greenhalgh, Tamara Rader, Eamonn Noonan, Beverley Shea, Laura Janzen, George A Wells, Mark Petticrew
BACKGROUND: Undernutrition contributes to five million deaths of children under five each year. Furthermore, throughout the life cycle, undernutrition contributes to increased risk of infection, poor cognitive functioning, chronic disease, and mortality. It is thus important for decision-makers to have evidence about the effectiveness of nutrition interventions for young children. OBJECTIVES: Primary objective1. To assess the effectiveness of supplementary feeding interventions, alone or with co-intervention, for improving the physical and psychosocial health of disadvantaged children aged three months to five years...
2015: Cochrane Database of Systematic Reviews
Usha Rani Somaraju, Arturo Solis-Moya
BACKGROUND: Most people with cystic fibrosis (80% to 90%) need pancreatic enzyme replacement therapy to prevent malnutrition. Enzyme preparations need to be taken whenever food is taken, and the dose needs to be adjusted according to the food consumed. A systematic review on the efficacy and safety of pancreatic enzyme replacement therapy is needed to guide clinical practice, as there is variability between centres with respect to assessment of pancreatic function, time of commencing treatment, dose and choice of supplements...
October 13, 2014: Cochrane Database of Systematic Reviews
Martin A Crook
Refeeding syndrome (RFS) broadly encompasses a severe electrolyte disturbance (principally low serum concentrations of intracellular ions such as phosphate, magnesium, and potassium) and metabolic abnormalities in undernourished patients undergoing refeeding whether orally, enterally, or parenterally. RFS reflects the change from catabolic to anabolic metabolism. RFS sometimes is undiagnosed and unfortunately some clinicians remain oblivious to its presence. This is particularly concerning as RFS is a life-threatening condition, although it need not be so and early recognition reduces morbidity and mortality...
November 2014: Nutrition
Kelsey D J Jones, Barbara Hünten-Kirsch, Ahmed M R Laving, Caroline W Munyi, Moses Ngari, Jenifer Mikusa, Musa M Mulongo, Dennis Odera, H Samira Nassir, Molline Timbwa, Moses Owino, Greg Fegan, Simon H Murch, Peter B Sullivan, John O Warner, James A Berkley
BACKGROUND: Environmental enteric dysfunction (EED) is an acquired syndrome of impaired gastrointestinal mucosal barrier function that is thought to play a key role in the pathogenesis of stunting in early life. It has been conceptualized as an adaptive response to excess environmental pathogen exposure. However, it is clinically similar to other inflammatory enteropathies, which result from both host and environmental triggers, and for which immunomodulation is a cornerstone of therapy...
August 14, 2014: BMC Medicine
Nchafatso Obonyo, Kathryn Maitland
Management of shock in children with severe malnutrition remains controversial. To date, the evidence supporting either benefit or harm of fluid resuscitation or rehydration is weak. This issue, however, is not unique to children with severe malnutrition; pediatric guidelines worldwide have a weak level of evidence and remain unsupported by appropriate clinical studies. In this review we give an overview of the current recommendations in other pediatric populations and appraise the strength of evidence supporting these...
June 2014: Food and Nutrition Bulletin
Kelsey D Jones, Johnstone Thitiri, Moses Ngari, James A Berkley
BACKGROUND: Undernutrition in childhood is estimated to cause 3.1 million child deaths annually through a potentiating effect on common infectious diseases, such as pneumonia and diarrhea. In turn, overt and subclinical infections, and inflammation, especially in the gut, alter nutrient intake, absorption, secretion, diversion, catabolism, and expenditure. OBJECTIVE: A narrative overview of the current understanding of infections, inflammation, and antimicrobials in relation to childhood malnutrition...
June 2014: Food and Nutrition Bulletin
Anjana Gulani, Harshpal S Sachdev
BACKGROUND: Otitis media is inflammation of the middle ear and is usually caused by infection. It affects people of all ages but is particularly common in young children. Around 164 million people worldwide have long-term hearing loss caused by this condition, 90% of them in low-income countries. As zinc supplements prevent pneumonia in disadvantaged children, we wanted to investigate whether zinc supplements could also prevent otitis media. OBJECTIVES: To evaluate whether zinc supplements prevent otitis media in adults and children of different ages...
2014: Cochrane Database of Systematic Reviews
Fernanda Marchetto da Silva, Ana Carolina Gouvea Bermudes, Ivie Reis Maneschy, Graziela de Araújo Costa Zanatta, Rubens Feferbaum, Werther Brunow de Carvalho, Uenis Tannuri, Artur Figueiredo Delgado
OBJECTIVE: To assess the impact of early introduction of enteral nutrition therapy in reducing morbidity and mortality in pediatric intensive care unit. METHODS: Search in the literature of the last 10 years, in English and the target population of individuals aged 1 month to 18 years admitted to pediatric intensive care units in the databases PubMed, Lilacs and Embase using the keywords: Critical Care, Nutritional Support and Nutrition Disorders or Malnutrition...
November 2013: Revista da Associação Médica Brasileira
Stephen MacGillivray, Tom Fahey, William McGuire
BACKGROUND: Young children with acute diarrhoea, typically due to infectious gastroenteritis, may temporarily stop producing lactase, the intestinal enzyme that digests lactose. This means they may not digest lactose, the main sugar in milk, and this may worsen or prolong the diarrhoeal illness. However, there is uncertainty whether avoiding lactose-containing milk or milk products helps young children recover from acute diarrhoea more quickly. OBJECTIVES: To assess if avoiding or reducing intake of lactose-containing milk or milk products shortens the duration and severity of illness in young children with acute diarrhoea...
October 31, 2013: Cochrane Database of Systematic Reviews
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