Volume 9, Issue 3, March – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24MAR1205

Navigating the Clinical Landscape of Severe Acute

Malnutrition in India’s Pediatric Demographic
1 2
Dr. Nazaf Nazir Parol Dr. Sachin Padman,
Junior Consultant in Paediatrics, Director and Consultant Paediatrician,
Sunrise Hospital, Kanhangad, Kerala Sunrise Hospital, Kanhangad, Kerala
3
Dr. Venugopal Reddy I.
Medical Director & Consultant Pediatrician,
Ovum Hospital, Bangalore

Abstract:-  Interpretation & Conclusion:

The study concluded that effective community-based
 Background: program for early detection and treatment, most children
The consequences of malnutrition are increases in with SAM can be cared for by their mothers and families
childhood death and future adult disability, including at home while NRCs are reserved for children with SAM
diet-related non-communicable diseases (NCDs), as well and medical complications.
as enormous economic and human capital costs.
According to UNICEF, one in three malnourished Keywords:- Non-Communicable Diseases, Severe Acute
children in the world is Indian. It is estimated that Malnutrition, Severe Dehydration.
reducing malnutrition could add some 3% to India’s
GDP.4 Combating child malnutrition is of great public I. INTRODUCTION
health importance to the future economic development
and social well-being of countries, but there is very Childhood malnutrition is a significant cause of 35% of
minimal information on the clinical profile and outcome deaths under five years old. It results from poor nutrition in
of SAM. the first 1000 days of a child's life, leading to stunted growth,
impaired cognitive ability, and reduced school and work
 Objectives: performance. Factors such as poverty, maternal BMI, mother
To study the Clinical Profile and Outcome of Severe age at marriage, home environment, feeding practices, hand
Acute Malnutrition in children aged between 6 and 59 washing, and hygiene practices contribute to malnutrition.
months. Low birth weight, diarrhea within the last six months, and
developmental delay are associated with malnutrition (1).
 Methodology:
An Observational hospital-based time bound study The World Health Organization defines malnutrition as
includes 60 children of 6 to 59 months age satisfying a cellular imbalance between the supply of nutrients and
inclusion criteria admitted in BCHI and Chigateri energy and the body's demand for them. Classification of
District Hospital. The children were classified according mild, moderate, or severe undernutrition is based on
to WHO guidelines and managed according to standard anthropometric, biochemistry measurement, and clinical
WHO case management protocol and re-evaluation were assessment. In India, 21% of children under five were
done on a daily basis during the course of hospital stay. underweight, with more than 7.5% suffering from severe
The outcome was assessed in term of improvement, acute malnutrition (SAM).
number of days of hospitalization, residual problems at
discharges, left against medical advice and number of Malnutrition accounts for 33% of global deaths and 45%
deaths. of deaths in under-five children in South Asia and Sub-
Saharan Africa. In India, nearly 57 million children are
 Results: moderate to severely malnourished, accounting for more than
Nearly all the subjects presented with visible wasting 50% of deaths in the 0-4 year age group. (2) 48% of under-
with eight for age <-3SD and MUAC, 11.5 cm. Half of the five children are stunted due to severe malnutrition.
study population had incomplete immunization. Acute
GE and ARI, anemia were the most common In India, over 33% of deaths under five years of age are
comorbidities and severe dehydration was the most associated with malnutrition, possibly due to changes in
complication seen. Majority i.e., 75 (75.8%) were innate and adaptive immunity due to nutrient and
discharged with target weight, 20 (20.2%) were micronutrient deficiencies. Co-morbidities like anemia,
discharged without reaching target weight and 4 (4%) diarrhea, dehydration, hypoglycemia, hypothermia,
were defaulters. electrolyte imbalance, and sepsis also play a major role in
increased mortality.(3)

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Volume 9, Issue 3, March – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24MAR1205

Malnutrition in children is the leading cause of death in  Type of Study: Hospital-based observational, time-
35% of children under 5 years of age. This is due to limited study.
malnutrition in the first 1000 days of the child's life; This  Research Period: March 2021 - August 2022
results in slowed growth, cognitive impairment, and  Number of Samples: 60 patients (99 patients in total)
decreased school and work performance. Factors such as
poverty, mother's body weight, mother's age at marriage, B. Inclusion Criteria:
home environment, diet, hand washing and hygiene can
contribute to poor food consumption. Low birth weight,  Children of 6 to 59 months of age with severe acute
diarrhea in the last six months, and slow growth are associated malnutrition satisfying following criteria were included.
with malnutrition (1).  Weight for height/length < -3 SD and/or
 Visible severe wasting and/or
The World Health Organization defines malnutrition as
 Mid upper arm circumference (MUAC) < 11.5 cm and/or
an imbalance between nutrients and energy and the body's
 Edema of both feet.
needs for them. Classification of mild, moderate and severe
malnutrition is based on anthropometric, biochemical and
C. Exclusion Criteria:
clinical evaluations. In India, 21% of children under five
years of age are underweight and more than 7.5% of them
 Cases of Severe Acute Malnutrition due to Cleft lip, Cleft
suffer from malnutrition (SAM).
palate, GERD, Pyloric Stenosis and other Surgical
conditions, Chronic Renal Failure, Congenital Heart
Malnutrition is responsible for 33% of deaths worldwide
and 45% of deaths among children under five in South Asia Diseases, Liver Disorders, Asthma, Mental Retardation,
and Sub-Saharan Africa. Approximately 57 million children Cerebral Palsy, suspected case of Inborn Errors of
Metabolism etc.
in India are moderately to severely malnourished; This
accounts for more than 50% of deaths in the 0-4 age group.  Children of less than 6 month of age and more than 5 years
(2) 48% of children under five years of age are stunted due to age.
malnutrition. In India, more than 33% of deaths among
children under five are related to malnutrition, which can be III. METHOD
caused by changes in the body's immune system or diseases
caused by malnutrition. and micronutrient deficiency. The study included children aged 6 to 59 months
Diseases such as diabetes, diarrhea, dehydration, attending BCHI and Chigateri Regional Hospital. Parents
hypoglycemia, hypothermia, electrolyte deficiency and sepsis gave written informed consent and a detailed medical record
also play an important role in increasing mortality. (3) was obtained. (6) Perform standard medical examinations,
including anthropometric measurements, and conduct related
There are two main clinical areas of malnutrition: research. Children are classified according to World Health
edematous and non-edematous (food deficiency) Organization guidelines and managed according to standard
malnutrition. Although there are many explanations for the procedures. Results; They were evaluated in terms of
pathophysiology of malnutrition-related edema, mortality is recovery, length of stay, remaining complications at
still high in children with malnutrition. Addressing child discharge, noncompliance with treatment instructions, and
malnutrition is critical for future economic development and number of deaths. Data were collected and compiled in MS
societal health. (4) Excel and descriptive statistics were used to present the data.
The critical level is fixed at 5%. (7).
II. METHODOLOGY
A. Sample Size Estimation
A. Source of Data:
The children were admitted to the pediatric unit  Sample Size Calculation:
affiliated with J.J.M. Serious cases were diagnosed at
Davangere Medical College (Department of Bapuji Child Sample Size = {Z1-α 2*(p)*(q)}/Δ2
Health Institute and Research Center, Chigateri District
Hospital, Davangere).

Table 1: Required Sample Size Required for the Health Survey

P Prevalence of severe acute malnutrition in Karnataka 0.105*
1-α Confidence level 0.95
Z Z value associated with confidence 1.96
Δ Absolute precision 0.08
n Minimum sample size 57
Sample size is rounded to 60

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Volume 9, Issue 3, March – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24MAR1205

Thus, the minimum sample size required is 60 to Reference: International Institute for Population
conduct the study. Sciences (IIPS) and ICF. 2017. National Family Health
Survey (NFHS-4), 2015-16: India. Mumbai: IIPS. Available
at http://rchiips.org/nfhs/nfhs-4Reports/India.pdf

IV. RESULTS

Table 2: Distribution of the Study Participants According to their Age Group

Age Frequency N Percentage %
6-12 months 42 42.4
1-3 years 54 54.5
>3years 3 3.0

Most of the participants in the study were in the 1-3 age 12 months age group and 3 (3%) in the > 3 age group. The
group (54, 54.5%), followed by 42 people (42.4%) in the 61- average age of the study participants was 16.47 + 7.976 years.

Table 3: Distribution of the Study Participants According to their Gender

Gender Frequency N Percentage %
Male 49 49.5
Female 50 50.5

Majority of the study participants were females (50, 50.5%) with males contributing to (49, 49.5%) of study population.

Table 4: Distribution of Locality among Study Subjects

LOCALITY FREQUENCY PERCENT
RURAL 68 68.7
URBAN 31 31.3

Majority i.e., 68 (68.7%) belonged to rural area and 31 (31.3%) belonged to urban area.

Table 5: Distribution of the Study Participants According to their Chief Complaints

CHIEF COMPLAINTS FREQUENCY N PERCENTAGE %
Normal 72 72.7
APETITE Poor 23 23.2
No appetite 4 4.0
YES 17 17.2
VOMITING
NO 82 82.8
YES 22 22.2
DIARRHEA
NO 77 77.8
YES 9 9.1
EDEMA
NO 90 90.9
YES 41 41.4
FEVER
NO 58 58.6
YES 15 15.2
COUGH
NO 84 84.8

In the present study, 41 (41.4%) had fever followed by (15.2%), edema in 9 (9.1%), poor apetite was present in 23
diarrhea in 22 (22.2%), vomiting in 17 (17.2%), cough in 15 (23.2%) and no apetite was present in 4 (4%).

Table 6: Distribution of Subjects According to Birth Weight among Study Subjects

BIRTH_WEIGHT FREQUENCY PERCENT
NORMAL 62 62.6
LBW 35 35.4
LGA 2 2.0

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ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24MAR1205

35 (35.4%) subjects were low birth weight and 2 (2%) were low birth weight for gestational age. 62 (62.6%) had normal birth
weight.

Table 7: Neonatal Period

NEONATAL PERIOD FREQUENCY PERCENT
Hospitalized 54 54.5
Normal 45 45.5
Majority i.e., 54 (54.5%) were hospitalized and 45 (45.5%) were normal.

Table 8: Ever Breast Fed

EVER BREAST FED FREQUENCY PERCENT
Yes 99 100.0
No 0 0.0
All the subjects i.e., 99 (100%) had breast fed.

Table 9: Currently Breast Fed

CURRENTLY BREASTFEEDING FREQUENCY PERCENT
Yes 58 58.6
No 41 41.4
58 (58.6%) subjects were currently breast feeding.

Table 10: Other Milk

OTHER MILK FREQUENCY PERCENT
Given 96 97.0
Not given 3 3.0
96 (97%) were given other milk and 3 (3%) were not given other milk.

Table 11: Type of other milk

TYPE FREQUENCY PERCENT
Animal 44 44.4
Commercial formula 55 55.6
Other milk for 44 (44.4%) was animal milk and 55 (55.6%) were given commercial formula.

Table 12: Mode of Feeding

MODE OF FEEDING FREQUENCY PERCENT
Cup and spoon 5 5.1
Paladai 16 16.2
Glass 3 3.0
Bottle 75 75.8

Majority i.e., 75 (75.8%) were bottle fed, 16 (16.2%) fed by using cup and spoon and 3 (3%) were fed milk through
were given other given milk through paladai, 5 (5.1%) were glass.

Table 13: Age at Starting Complementary Feeds

COMPLIMENTARY FEED DURATION FREQUENCY PERCENT
< 6 months 53 53.5
6-8 months 38 38.4
8 months – 1year 7 7.1
> 1 year 1 1.0

For majority i.e., 53 (53.5%) complementary feed was to 1 year and for only 1 (1%) subject it was started at > 1year
started at < 6 months, for 38 (38.4%) subjects, it was started age.
at 6-8 months, for 7 (7.1%) subjects, it was started at 8 months

Table 14: Type of Complementary Feed

TYPE OF COMPLIMENTARY FEED FREQUENCY PERCENT
Home available 73 73.7
Commercial feed 26 26.3

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For majority i.e., 73 (73.75) subjects, home available complementary feed was given and for 26 (26.3%) subjects. Commercial
feed was given.

Table 15: Development among Study Subjects

DEVELOPMENT FREQUENCY PERCENT
Normal 44 44.4
Global development 8 8.1
Motor delay 44 44.4
Speech delay 3 3.0
Majority i.e., 44 (44.4%) had motor delay, 8 (8.1%) subjects had global development and 3 (3%) had speech delay.

Table 16: Immunization among Study Subjects

IMMUNIZATION FREQUENCY PERCENT
Appropriate for age 52 52.5
Incomplete 47 47.5
For 52 (52.5%) immunization was appropriate for age and for 47 (47.5%) immunization was incomplete.

Table 17: SE Status among Study Subjects

SE STATUS FREQUENCY PERCENT
Upper middle 1 1.0
Lower middle 10 10.1
Upper lower 60 60.6
Lower 28 28.3

Majority i.e., 60 (60.6%) belonged to upper lower socio- (10.1%) belonged to lower middle class and 1 (1%) belonged
economic status, 28 (28.3%) belonged to lower SES, 10 to upper middle class.

Table 18: Visible Wasting among Study Subjects

VISIBLE WASTING FREQUENCY PERCENT
Yes 97 98.0
No 2 2.0

Majority i.e., 97 (98%) had visible wasting.

Table 19: Distribution of Height among Study Subjects

HEIGHT/AGE FREQUENCY PERCENT
+2 SD to -2 SD 45 45.5
-2 SD to -3 SD 35 35.4
<-3 SD 19 19.2

Majority i.e., 35 (35.4%) belonged had height for age between +2 SD to -2 SD and 19 (19.2%) had height for age
between -2 SD to -3 SD, 45 (45.5%) belonged had height <-3 SD.

Table 20: Weight for Age Among Study Subjects

WEIGHT/AGE FREQUENCY PERCENT
+2 to -2 0 0.0
-2 to 3 0 0.0
<-3 99 100.0
All the subjects i.e., 99 (100%) had height for age <-3 SD.

Table 21: Weight for Height Among Study Subjects

WEIGHT/HEIGHT FREQUENCY PERCENT
+2 to -2 0 0.0
-2 to 3 0 0.0
<-3 99 100.0
All the subjects i.e., 99 (100%) had height for age <-3 SD.

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Table 22: MUAC among Study Subjects

MUAC FREQUENCY PERCENT
<11.5 cm 99 100.0
All the patients i.e., 99 (100%) had MUAC <11.5 cm.

Table 23: Head Circumference Among Study Subjects

HEAD CIRCUMFERENCE FREQUENCY PERCENT
Normal 99 100.0
All the patients i.e., 99 (100%) had normal head circumference.

Table 24: Organic Disease Among Study Subjects

ORGANIC DISEASE FREQUENCY PERCENT
Yes 26 26.3
No 73 73.7
26 (26.3%) subjects had organic disease.

Table 25: Type of Anemia Among Study Subjects

TYPEOF ANEMIA FREQUENCY PERCENT
Iron Deficiency 24 24.2
Dimorphic 7 7.1
Majority i.e., 24 (24.25) had iron deficiency anemia and 7 (7.1%) had dimorphic anemia.

Table 26: Sepsis Among Study Subjects

SEPSIS FREQUENCY PERCENT
Yes 13 13.1
No 86 86.9
13 (13.1%) subjects had sepsis.

Table 27: ARI among Study Subjects

ACUTE RESPIRATORY INFECTION FREQUENCY PERCENT
Yes 54 54.5
No 45 45.5
54 (54.5%) had ARI.

Table 28: Acute GE among Study Subjects

ACUTE GASTROENTERITIS FREQUENCY PERCENT
Yes 74 74.7
No 25 25.3
Majority i.e., 74 (74.7%) had acute GE.

Table 29: Dehydration among Study Subjects

DEHYDRATION FREQUENCY PERCENT
No 25 25.3
Severe 74 74.7
Majority i.e., 74 (74.7%) had severe dehydration.

Table 30: Worm Infestation Among Study Subjects

WORM INFESTATION FREQUENCY PERCENT
Yes 22 22.2
No 77 77.8
22 (22.2%) had worm infestation.

Table 31: Urinary Tract Infection among Study Subjects

URINARY TRACT INFECTION FREQUENCY PERCENT
Yes 22 22.2
No 77 77.8
22 (22.2%) had UTI.

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Table 32: Measles among Study Subjects

MEASLES FREQUENCY PERCENT
Yes 4 4.0
No 95 96.0
4 (24%) had measles.

Table 33: Skin Infection among Study Subjects

SKIN INFECTION FREQUENCY PERCENT
Yes 11 11.1
No 88 88.9
11 (11.1%) had skin infection.

Table 34: Tuberculosis among Study Subjects

TUBERCULOSIS FREQUENCY PERCENT
Yes 6 6.1
No 93 93.9
6 (6.1%) had tuberculosis.

Table 35: Retroviral Infection among Study Subjects

RETROVIRAL FREQUENCY PERCENT
No 99 100.0
None had retroviral infection.

Table 36: Meningitis among Study Subjects

MENINGITIS FREQUENCY PERCENT
No 99 100.0
None had meningitis.

Table 37: Outcome among Study Subjects

OUTCOME FREQUENCY PERCENT
DISCHARGED WITH TARGET WEIGHT 75 75.8
DISCHARGED WITHOUT REACHING TARGET WEIGHT 20 20.2
DEFAULTER 4 4.0

Majority i.e., 75 (75.8%) were discharged with target The majority of the subjects were low birth weight (35,
weight, 20 (20.2%) were discharged without reaching target 35.4%), with 62 (62.6%) having normal birth weight. Most of
weight and 4 (4%) were defaulters. the subjects were hospitalized (54.5%), and all were breastfed
(99, 100%). The majority of the subjects were currently
V. DISCUSSION breastfeeding (58.6%), and supplementary milk was given
(96, 97%) or other milk (44, 44%). The most commonly used
The study aimed to investigate the prevalence of SAM supplementary food was over-diluted cow milk (92%).
among pregnant women in India. The majority of participants
were aged between 1-3 years, with a mean age of This study aims to investigate the prevalence of SAM
16.47+7.976 months. The majority of the participants were among pregnant women in India. Most participants were
males (50, 50.5%), with a similar distribution to previous between 1 and 3 years old, and the average age was 16.47 +
studies by Tariq et al., Tiwari et al., and Choudhary et al. The 7.976 months. The majority of participants were male (50,
majority of the participants belonged to lower socio- 50.5%), a similar distribution to previous studies by Tariq et
economic status (60, 60.6%), lower middle class (28.3%), and al, Tiwari et al, and Choudhary et al. The majority of people
below poverty line (64.8%). (8) involved in the economy are low (60 years old, 60.6%),
lower-middle (28.3%), and below the poverty line (64.8%).
The majority of the participants were from rural areas (8)
(68.7%), while 31 (31.3%) were from urban areas (68.7%).
The majority of the participants had fever, diarrhea, vomiting, The majority of the participants were from rural areas
cough, edema, poor appetite, and no appetite (4%). The most (68.7%), and 31 (31.3%) were from urban areas (68.7%).
common presenting symptoms on admission were weight Most participants experienced fever, diarrhea, vomiting,
loss, fever, and loss of appetite. (9) cough, edema, loss of appetite, and loss of appetite (4%). The
most common presenting symptoms are weight loss, fever
and loss of appetite. (9)

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Most people have low birth weight (35 people, 35.4%), The most common infection with PEM is
while 62 people (62.6%) have low birth weight. Most patients gastrointestinal infection (60%), followed by respiratory tract
were hospitalized (54.5%) and all were breastfed (99, 100%). infection (52%). The most common infection was respiratory
The majority of subjects were currently breastfeeding tract infection, followed by diarrhea (31.75%) and anemia
(58.6%) and taking milk (96, 97%) or other milk (44, 44%) (74.12%). Anemia (80%), diarrhea (59%) and pneumonia
supplements. The most commonly used supplement is excess (29%) were the most common comorbidities. (16)
milk (92%).
Most patients reached their target weight at discharge;
Most subjects started complementary foods at less than The recovery rate was 75.8%, mortality was 0.68% and
6 months of age; most people started complementary foods at defaulters were 1.36%. These results are consistent with
6-8 months (38.4%) and 8 months to 1 month. Annual growth national standards, which is important because the main goal
is 7.1%. Only 53% of babies were introduced to solid foods of the National Reproductive Center (NRC) is to reduce the
after 6 months. (10) 73 (73.75%) people were given mortality rate of children with SAM. (17,18)
supplementary food at home, and 26 (26.3%) people were
given commercial feed. VI. CONCLUSION

Most of the subjects had bradykinesia (44.4%), general In this study, most of the subjects who developed SAM
development (8.1%) and speech delay (3.3%). Vaccination were in the 1-3 age group, and the proportions of males and
was up to date in 89% of patients (Dhanlakshmi K et al., 11). females were equal. , diarrhea, vomiting and edema. and no
Most patients lost weight (98%), although this rate was 58.1% appetite. Most are born with low birth weight and are
in Chiabi et al.'s study and less in this study. exclusively breastfed. Complementary feeding was started
before 6 months for almost half of the study population,
The age and height of most of the subjects were between although half of them were fed foods already available at
-2 SD and -3 SD (35.4%); The height of 45 of them (45.5%) home.
was between +2 SD and -2 SD (19.2%). Head circumference
(99, 100%) and MUAC (muscle circumference) of all patients All subjects were very thin; 8 of them were <-3SD in
were <11.5 cm (85.45%). (12) age and 11.5 cm in MUAC height. Half of the subjects were
missing vaccinations. In acute GE and ARI, anemia is the
Other side effects in SAM patients include most common symptom and severe dehydration is the most
gastrointestinal infections (30%), followed by respiratory common problem. Most of them, namely 75 (75.8%), were
distress (26.3%), sepsis (15%), urinary tract infections (2%). released while reaching the target weight, 20 (20.2%) were
7), meningitis is included. (2%), measles (3.8%) and released before the target weight was reached, and 4 (4%)
tuberculosis (4%). Dehydration occurred in 31.5% of were in default.
patients; this was a reduction compared to previous studies.
(13) The spectrum analysis found in this study is comparable
to other studies in the literature. NRC provides lifesaving care
Rinki H. Shah et al. A study conducted by. It was to children with SAM, as evidenced by its high survival rate
observed that the most common complication in SAM program.
patients was dehydration, followed by sepsis. In a study
conducted in Colombia, 68.4% of malnourished children had Community care for children without SAM should be an
diarrhea at presentation and 9% had sepsis. The main integral part of the continuum of care for children with SAM.
complications were anemia (53%), LRTI (33%), and Many children with SAM can be treated in their own
intestinal inflammation (29%). 5 percent of children have communities because their SAM does not occur easily and
sepsis and 4 percent have tuberculosis. Cases of meningitis, they can eat energy-dense foods. 14 International evidence
measles, skin diseases, rickets and vitamin A deficiency have shows that nutritious, ready-to-eat foods are effective in
been confirmed in 2% of children. (14) promoting rapid growth in children with SAM15 and can be
used effectively in community-based programs. 13 With
Dhanalakshmi K and colleagues found that 35.75% of effective detection and treatment in the community, most
children with SAM suffered from gastrointestinal disease and children with SAM can be cared for at home by their mothers
28.49% suffered from respiratory disease. Mathur et al. In the and families, while feeding centers (NRCs) are reserved for
study, it was determined that 54 percent of children with SAM children with SAM and medical problems.
had diarrhea and 27.9 percent had respiratory tract infections.
Chow et al. It was observed that the most serious disease in
45 patients (25.1%) was respiratory tract infections, followed
by malaria with 15.1%. (15) Among 32 children with known
HIV infection, the human immunodeficiency virus (HIV) rate
was 43.75%. Dehydration was the most common
complication, occurring in 29.6% of patients.

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