Dissertations / Theses: 'Kwashiorkor Children Malnutrition in children'

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Ditebo, Gaeboloke Precious. "Malnutrition in children : the perceptions of mothers in Botswana." Diss., University of Pretoria, 2010. http://hdl.handle.net/2263/31170.

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Malnutrition is one of the serious childhood problems that affect children under five (5) years of age, and is common in developing countries Botswana included. The aim of this study was to explore the perceptions of mothers of children diagnosed with malnutrition in Botswana, specifically at Sekgoma Memorial Hospital, Serowe. The said hospital is a district hospital which renders services to Serowe community and the surrounding villages, as such; participants in this study were from Serowe and other surrounding villages like Mabou, Tshimoyapula, Mmashoro and Mogorosi. Applied research was used as a type of research because it is associated with the researcher’s motivation to assist in solving a particular problem facing a particular community. Collective case study was used as a research design. The researcher explored the perceptions of mothers regarding child malnutrition; through the use of semi-structured interviews. Twelve (12) mothers of children with malnutrition were interviewed using systematic random sampling method and subsequently data was analysed according to Creswell’s model. Literature study was done and the following aspects were discussed: Child malnutrition in developing countries; child malnutrition in Botswana; description of child malnutrition; causes of child malnutrition; symptoms of child malnutrition; treatment of child malnutrition; prevention of child malnutrition; psychosocial implications of child malnutrition on the patient, family and community and social work intervention (therapy and prevention). Literature was also compared with research findings when analysing data. The study revealed that mothers had limited knowledge on malnutrition as a condition, the signs and symptoms thereof; causes; prevention and treatment of child malnutrition. This lack of knowledge made mothers to have wrong perceptions about child malnutrition. It was revealed that mothers did not perceive malnutrition as a serious problem that can result in admission for treatment in a hospital, they expected a different diagnosis. They perceive malnutrition as a secondary diagnosis. The majority of mothers had a Setswana diagnosis for their children’s condition. Mothers perceived the signs and symptoms of malnutrition as those of Thibamo, Phogwana (fontanel), or Ntsana. They interpret malnutrition as a Setswana ailment that can be treated traditionally. Factors that were identified to be contributing to malnutrition among children at Sekgoma Memorial Hospital in Serowe were found to be; lack of knowledge about malnutrition, wrong perceptions of malnutrition by mothers, illiteracy and unemployment, and cultural factors like taking a child to a traditional healer instead of a medical health facility. The study shows that mothers’ social functioning is disrupted by their children’s illness and hospitalization and thus a need for support from the hospital multi-disciplinary team, especially the social worker who is a trained counselor. The social worker should provide ongoing supportive counseling during the process of the child’s illness.
Dissertation (MSW)--University of Pretoria, 2010.
Social Work and Criminology
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Abdulai, Janet Mariama. "The Sierra Leonean rural illiterate mothers' perceptions of the factors related to Kwashiorkor." Virtual Press, 1986. http://liblink.bsu.edu/uhtbin/catkey/459906.

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Twenty Sierra Leonean rural illiterate mothers were querried about their perceptions of the factors related to Kwashiorkor. Demographic data was hand tabulated to determine the frequency of parents' occupations, pregnancies, live and stillbirths, living and dead children, and causes of children's deaths. Chi-square analyses were done to assess the distribution of responses to questions about 19 beliefs which the researcher thought were related to Kwashiorkor. Student t-test was used to determine the differences in the total number and outcome of pregnancies between women who agreed and disagreed about the role of four of the factors which tended to show or showed significance with chi-square analyses.The families were subsistence farmers. In addition, 65 percent or the husbands had other jobs. Combined, the 20 women had 191 pregnancies, 166 live births, (87 percent of pregnancies), 25 (13 percent) stillbirths, 82 living children (43 percent of pregnancies and 49 percent of live births). The women lost through death 84 (50.6 percent) of the 166 live born children.The average woman experienced 9.6 pregnancies, resulting in 8.3 live births, and 1.3 stillbirths, had an average of 4.1 living children and had lost an average of 4.2 live born children. The data indicated that the major problem with infant/child mortality occurred after birth. Protein-Energy Malnutrition accounted for 38.1 percent of the children's deaths.Of the 19 factors about which women were querried in relation to role in Kwashiorkor, to only 4, namely “Witchcraft,” “Religious beliefs,” “Grandmother's advice,” and “Mother-in-law's advice” did less than half of the women agree. The majority of women agreed that 15 of the factors were associated with Kwashiorkor.That indicated the women had supportable understanding of factors truly related to Kwashiorkor.Three constructs, beliefs about “Witchcraft,” “Introduction of other foods,” and “Immunizations,” differentiated incidence and outcome of pregnancy among women. However, belief about the importance of “Immunizations” differentiated infant/child mortality and will be most useful in future research to analyze differences and to identify groups at greatest risk of child mortality.Ball State UniversityMuncie, IN 47306

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Gunnarsson, Hanna, and Nanci Kader. "Prevention of malnutrition for children in South Africa." Thesis, Sophiahemmet Högskola, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-1772.

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Background Malnutrition among children in South Africa is a huge issue, which are causing short- and long-term effects for the children suffering from it. In 64 percent of the cases where children die before the age of five, malnutrition is the underlying cause. Therefore there are non-governmental organizations who are doing preventive work to try to diminish malnutrition so all children have the same chance to a good childhood. Aim The aim of the study was to describe the prevention of malnutrition of children in South Africa. Method A qualitative design with semi-structured interviews with non governmental organzations was used for this study. Data was analysed by content analyse. Findings The findings show that one key intervention is nutritional education to empower people on how to best use the scares resources they have. Therefore the non governmental organizations put a lot of emphasis on educating families about nutrition. Furthermore the stigma and mistaken beliefs about breastfeeding is targeted through education, as it is of vital importance to solely breastfeed as a preventive intervention. Conclusion Early interventions are emphasized due to the importance of preventing malnutrition early in a child’s life. The link between HIV positive women and malnourished children is remarkable and the government of South Africa has promoted breastfeeding for all as a solution.

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Pettersson, Camilla, and Fanny Enström. "Prevention of malnutrition in South Africa among children." Thesis, Sophiahemmet Högskola, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2133.

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Background Malnutrition among children in South Africa is a substantial public health problem. Especially young children are vulnerable and exposed to malnutrition. Children suffering from malnutrition develop many short- and long-term health-consequences. Effective preventative work against this issue is crucial in order for malnutrition to diminish among the children in South Africa. Aim The aim was to describe how the preventative work against malnutrition is being performed among children aged zero to six in South Africa. Method The method used in this study was a qualitative descriptive study with six semi-structured interviews. Interviews were performed with registered nurses and researchers. The interview-data was analyzed based on a grounded theory through substantive coding where the most relevant codes where found, studied and concluded in the results. Results The results showed that both the registered nurses and researchers considered socioeconomic-factors and lack of knowledge about nutrition to be the most important causes for malnutrition among children, and also impacted heavily on the preventative work. It was found that more effective preventative work is needed, but for this to work it needs to be adapted to the social context in the country. Conclusions The preventative work against malnutrition must be able to break through socioeconomic barriers like poverty, misguided cultural beliefs about nutrition, lacking food security and the fact that many mothers to children are HIV positive, which also is strongly connected to malnutrition among young children. Education about nutrition must be further developed and reach out to more people in the country.

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Fergusson, Pamela Lynne. "Severe acute malnutrition and HIV in children in Malawi." Thesis, University of Chester, 2009. http://hdl.handle.net/10034/93477.

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Sub-Saharan Africa is more affected by the HIV epidemic than any other region of the world. At the same time, malnutrition remains a major public health concern. HIV and malnutrition are interlinked, both epidemiologically and physiologically, contributing to high mortality and poor growth and development of children in sub-Saharan Africa. This thesis aims to explore the impact of HIV on the treatment and care of children with severe acute malnutrition in Malawi. The thesis will investigate mortality and nutritional recovery in HIV-infected and uninfected children with SAM; HIV infection and nutritional status in carers of children with SAM; and caregiver perspectives on quality of care for children with SAM. The study is based on a prospective cohort study of 454 children with SAM and meta-analysis of 17 relevant studies; a cross sectional study of 322 carer-child pairs; and a qualitative study using a grounded theory approach.

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Ungphakorn, Wanchana. "Pharmacometric models of oral ciprofloxacin for children with malnutrition." Thesis, University of Strathclyde, 2012. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=18680.

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Children with severe malnutrition typically suffer from numerous associated complications. Among these, septicaemia, especially with Gram-negative organisms, remains the major concern because it is associated with a high mortality rate. The World Health Organization (WHO) has been releasing standard guidelines for the treatment of bacterial infections for many years; however, it has been found that the mortality rate remains high even if these guidelines are followed. Ciprofloxacin is a fluoroquinolone antimicrobial agent that has been considered as alternative treatment option. However, to date, data around the pharmacokinetics (PK) of ciprofloxacin, as well as other drugs, are limited in malnourished children. The aim of this thesis was to develop pharmacokinetic models for describing and predicting the PK of drugs in such children. A population analysis was performed by using ciprofloxacin concentration-time data obtained from 52 malnourished children. It was found that a one-compartment model, with first-order absorption and a lag, adequately described the data. The final population model included the effect of body weight, high mortality risk and serum sodium concentration on clearance (CL), and the effect of body weight and sodium concentration on volume of distribution (V). Inclusion of these factors reduced inter-individual variability in CL from 50% to 38%, and in V from 49% to 43%. Absorption rate (ka) was poorly estimated and highly variable. Internal validation techniques, including nonparametric bootstrap, a visual predictive check, normalised prediction distribution error and a jackknife analysis, were used to assess the stability and robustness of the final population model. The results of these analyses indicated that the model was stable and had a favourable predictive performance for CL and V. To develop new dosage regimens, the population model was used to perform a 10,000-patient Monte Carlo simulation. The probabilities of achieving the therapeutic target AUC0-24/MIC ratio and the expected population response were then iv determined. The results showed that PK-PD breakpoints were 0.06-0.125 mg/L and 0.25-0.5 mg/L for Gram-negative and Gram-positive organisms, respectively. The overall response with the 30 mg/kg/day dose was 80% for Escherichia coli, Klebsiella pneumoniae and Salmonella species, but <60% for Pseudomonas aeruginosa and Streptococcus pneumoniae. The results suggested that an oral dose of ciprofloxacin 10 mg/kg three times daily (30 mg/kg/day) may be appropriate for the management of septicaemia in severely malnourished children. Discrepancies of susceptibility breakpoints between reference sources were also found, i.e., PK-PD, CLSI and EUCAST, and these discrepancies were most pronounced for P. aeruginosa and S. pneumoniae. The population model was alsmpartment model, with first-order absorption and a lag, adequately described the data. The final population model included the effect of body weight, high mortality risk and serum sodium concentration on clearance (CL), and the effect of body weight and sodium concentration on volume of distribution (V). Inclusion of these factors reduced inter-individual variability in CL from 50% to 38%, and in V from 49% to 43%. Absorption rate (ka) was poorly estimated and highly variable. Internal validation techniques, including nonparametric bootstrap, a visual predictive check, normalised prediction distribution error and a jackknife analysis, were used to assess the stability and robustness of the final population model. The results of these analyses indicated that the model was stable and had a favourable predictive performance for CL and V. o used to determine optimal design for future population PK studies. A number of design options and design variables were examined. The results suggest that the optimal number of groups was three and two for three- and four-sample designs, respectively. When using two groups, it was possible to vary the number of individuals in each group. If permission was given to obtain up to five samples from each patient, one group of participants would be adequate. Only samples taken after the first dose gave sufficient information. The expected coefficient of variation (CV) of all parameters was under 10% with sample sizes of 25 and 40 for five- and four-sample designs, respectively. For three samples, the CV for ka remained above 20%, although the sample size was increased to 100. It was also found that the optimal designs were highly dependent on the prior information, so prior knowledge of drug concentration-time profiles should be used with optimal design methods when designing population PKt model, with first-order absorption and a lag, adequately described the data. The final population model included the effect of body weight, high mortality risk and serum sodium concentration on clearance (CL), and the effect of body weight and sodium concentration on volume of distribution (V). Inclusion of these factors reduced inter-individual variability in CL from 50% to 38%, and in V from 49% to 43%. Absorption rate (ka) was poorly estimated and highly variable. Internal validation techniques, including nonparametric bootstrap, a visual predictive check, normalised prediction distribution error and a jackknife analysis, were used to assess the stability and robustness of the final population model. The results of these analyses indicated that the model was stable and had a favourable predictive performance for CL and V. studies. In order to predict the disposition of other drugs in a malnourished population, whole body physiologically based pharmacokinetic (WBPBPK) models were developed by using ciprofloxacine as a model drug. The WBPBPK model was initially developed for healthy adults and then scaled to healthy and malnourished children. Kp values were calculated using the Poulin method, the Rodgers method and empirical method. The results showed that, for healthy adults and children, the predicted versus observed concentration-time profiles were well described with intravenous (IV bolus v and short infusion) models. Oral predictions were also in good agreement with the data from the literature, but peak concentrations were more rapidly achieved with a higher dose. Unlike the Poulin method, the concentration-time profiles predicted using Kp from the Rodgers method and the empirical methods were similar, and closely resembled the observed data. When models were scaled for malnutrition, inter-individual variability was higher, especially during the absorption phase. However, PK profiles were still adequately described. The models developed in this thesis are useful tools for describing and predicting drug PK in malnourished children. However, due to the scarcity of data, further studies to characterise the alteration of drug kinetics, particularly during the absorption process, might improve the performance of the models. Application of these models to other drugs and data is also required to substantiate the predictive performance of the model.

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Aheto, Justice Moses Kwaku. "Modelling malnutrition among under-five-year-old children in Ghana." Thesis, Lancaster University, 2016. http://eprints.lancs.ac.uk/82143/.

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Childhood malnutrition is a real-life and a chronic problem and one of the global major public health challenges, especially in developing countries like Ghana. Several attempts from governmental and non-governmental organizations to address the problem have fallen below expectation. It is recognised that the existing studies and nutrition intervention strategies are inadequate and hence not working to expectation. This thesis examines childhood malnutrition in Ghana using appropriate and advanced statistical methods to help improve the understanding of childhood nutrition and to better inform targeted public health nutrition interventions in the country. In this thesis, we provided solutions to five main problems: (1) investigated the major risk factors for malnutrition; (2) investigated household level variations in nutritional outcomes of children; (3) explored, modelled and illustrated spatial variations in the risk of childhood malnutrition over Ghana; (4) explored, modelled, forecasted and illustrated spatio-temporal variations in the risk of childhood malnutrition over Ghana; (5) jointly modelled weight-for-age Z-score (WAZ) and height-for-age Z-score (HAZ) to improve accuracy and reliability in estimates. To answer the first and the second problems, multilevel models were considered. The results showed strong residual household-level variations in under-fives nutritional outcomes and that child’s age, type of birth, child’s experience of diarrhoeal episodes, size of child at birth and months of breast feeding, mother’s education, current age, BMI and national health insurance status, household toilet facility ownership and wealth status were predictive of under-fives nutrition. To answer the third problem, spatial models were employed. The study found substantial spatial variation in the predicted risk of under-fives malnutrition over Ghana and also showed that Normalised Difference Vegetation Index (a marker for vegetation cover), elevation and rural/urban residence status were predictive of under-fives nutritional outcomes. The study considered spatio-temporal models to answer the fourth problem. The results showed substantial spatio-temporal variation in the risk of under-fives chronic malnutrition over Ghana. Our forecasted map of chronic malnutrition showed substantial spatial variation with children from parts of Northern and Western regions being at the highest risk of malnutrition compared to children from other regions of the country. In our forecast maps, the effect of increasing the level of maternal education was shown to reduce the prevalence of malnutrition throughout Ghana. To answer the fifth problem, multivariate response multilevel models were considered. The study found that the residual household effects for WAZ and HAZ are very strongly correlated and that the correlation was stronger for the residual household effects than the residual child effects. This also suggests that after adjusting for risk factors in our model, it is the same as-yet unidentified factors at household level that influence both WAZ and HAZ. The results also showed that there was more accuracy and reliability in estimates from the multivariate response multilevel model over separate multilevel models and showed that the effect of some important risk factors differed substantially across WAZ and HAZ. The findings from this thesis are intended to help policymakers responsible for the health and nutrition of children to design efficient public health policies and targeted nutrition interventions amidst scarce public health resources available in Ghana to better understand, target and to reduce childhood malnutrition prevalence closer to the level expected in a healthy, well-fed population of children under-fives.

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Kellerhals, Sarah. "Understanding Severe Acute Malnutrition in Children Globally: A Systematic Review." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/624202.

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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Severe acute malnutrition (SAM) affects 13 million children under the age of 5 worldwide, and contributes to 1‐2 million preventable deaths each year. Malnutrition is a significant factor in approximately one third of the nearly 8 million deaths in children who are under 5 years of age worldwide. There have been many revolutions in treatment of SAM over time; however, the exact etiology of this preventable condition is not well understood. This review serves to identify the most common risk factors for the development of SAM in children and to identify the most effective treatment for the disease. There are many factors that contribute to developing and surviving SAM as a child, and this systematic review serves to highlight the most common variables that lead to this cause of mortality. An exhaustive review of PubMed was conducted to complete this review. The literature review demonstrates that the most common risk factor for the development of SAM is low maternal literacy.

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Dale, Anne. "Helicobacter pylori infection and growth in rural Gambian children." Thesis, University of Newcastle Upon Tyne, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.366583.

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Ngianga-Bakwin, Kandala. "Spatial modelling of socio-economic and demographic determinants of childhood undernutrition and mortality in Africa /." Aachen : Shaker, 2002. http://www.loc.gov/catdir/toc/fy0702/2006485828.html.

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Piniel, Abigail. "Factors contributing to severe acute malnutrition among the under five children in Francistown-Botswana." Thesis, University of the Western Cape, 2016. http://hdl.handle.net/11394/5253.

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Magister Artium (Child and Family Studies) - MA(CFS)
Introduction: Malnutrition is the immediate result of inadequate dietary intake, the presence of disease or the interaction between these two factors. It is a complicated problem, an outcome of several etiologies. SAM is one of the leading causes of morbidity and mortality among children under the age of five in developing countries. Although studies in Botswana show some improvement in child malnutrition since the 1980s, severe acute malnutrition still remains a cause for concern in many parts of the country. There is little information on undernourishment situation of children under the age of five years in the urban areas of the country. Aim: The purpose of this study was to determine the risk factors to severe acute malnutrition among children under the age of five years in Francistown, Botswana. The UNICEF conceptual framework was used as a guide in assessing and analysing the causes of the nutrition problem in children and assisted in the identification of appropriate solutions. Methods: The study was conducted on cases who had been admitted and referred at any time between March and July 2015. A quantitative research methodology was used to conduct the study. A case-control study design was utilised. Random selection of cases and controls was done on a ratio of 1:2 case per control. Cases included children under the age of five years admitted to Nyangabgwe Referral Hospital and those referred to the Nutritional Rehabilitation Centre within the hospital in Francistown-Botswana with a diagnosis of severe acute malnutrition. Controls were children of the same age, gender and attending the same Child welfare clinic as the case and with good nutritional status. Data was collected through face-to-face standardised interviews with care-givers. Results: Data collection was done using a combination of a review of records (child welfare clinic registers, and child welfare clinic cards) and structured questionnaires. 52 cases and 104 controls were selected with the primary or secondary care-giver as the respondent. (N=156). Data was collected using a self-developed structured questionnaire and the review of documents. Of all the cases 36.5% (n=19) were diagnosed with MAM, 46.2% (n=24) with SAM, 1.9% (n=1) with moderate PEM and 7.7% (n=4) each for PEM and Severe PEM. All the cases had presented with clinical signs and symptoms of severe acute malnutrition and/or the weight-for-height Z-score of ≤ -3 SD. Following placement of the data in regression models, the factors that were found to be significantly associated with child malnutrition were low birth weight (AOR = 0.437; 95% CI = 0.155-1.231) , exclusive breastfeeding (AOR = 2.741; 95% CI = 0.955-7.866), child illness (AOR = 0.383; 95% CI = 0.137-1.075), growth chart status (AOR =7.680; 95% CI = 1.631-36.157), level of care-giver’s education (AOR = 0.953; 95% CI = 0.277-3.280), breadwinner's work status (AOR = 1.579; 95% CI = 0.293-8.511), mother’s HIV status (AOR = 0.777; 95% CI = 0.279-2.165), alcohol consumption (AOR = 0.127; 95% CI = 0.044-0.369), household having more than one child under the age of five (AOR = 0.244; 95% CI = 0.087-0.682), household food availability (AOR = 0.823; 95% CI = 0.058-11.712), living in a brick type of house (AOR = 13.649; 95% CI = 3.736-49.858), owning a tap (AOR = 1.269; 95% CI = 0.277-5.809) and refuse removed by the relevant authority (AOR= 2.095; 95% CI = 0.353-12.445) were all statistically significantly associated with severe acute malnutrition (p < 0.05). Therefore, all these variables were included in the binary stepwise regression where living in a mud house type was the most significant factor and not being breastfed for at least three months was the least significant. Conclusion: The findings of this study suggested that immediate determinants to SAM were; child born with a low birth weight, appetite and child illness. Underlying contributing factors were; the child not exclusively breastfed for at least three months, growth chart not up to date, care-givers education level, employment status, alcohol consumption, household food availability, type of housing, owning a tap and number of children under the age of five year. Therefore, increasing household food security and strengthening educational interventions for women could contribute to a reduction in the prevalence of SAM in Francistown, Botswana.

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Polaki, Busisiwe. "Caregivers perceptions on factors contributing to their children’s malnutrition." University of the Western Cape, 2018. http://hdl.handle.net/11394/6654.

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Magister Artium (Social Work) - MA(SW)
Complex factors contribute to child malnutrition. These include various factors for example stress, trauma, cognitive abilities and education, poverty, environmental and cultural practices. Caregivers’ situations and perceptions regarding these factors are of utmost importance in child malnutrition. Lesotho has a high incidence of malnourished children irrespective of various interventions to address the problem. The research question that the researcher wanted to answer is: What are caregivers’ perceptions on factors contributing to their children’s malnutrition? This was the question as caregivers’ environments and perceptions influence child malnutrition and they are the ones that accompany the children to the hospital where this research was done. The research goal was to get an understanding of caregivers’ perceptions on factors contributing to malnutrition. In order to reach the goal. the objectives were: To explore the factors contributing to malnutrition; to describe the factors contributing to malnutrition and to give recommendations to social workers and the multi-disciplinary team in order to address the factors contributing to malnutrition as preventative measures.

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Sarr, Sallah Mariama. "Pharmacology of artemether in children with protein energy malnutrition in The Gambia." Thesis, University of Liverpool, 2014. http://livrepository.liverpool.ac.uk/2008886/.

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Malaria and malnutrition are causes of high morbidity and mortality in developing countries especially in sub-Saharan Africa and Asia. Malnourished children are at higher risk of developing malaria, a problem compounded by the fact that malnutrition affects the metabolism of different antimalarials including chloroquine and quinine. Emerging resistance to chloroquine, which was the drug of choice, has led to the widespread use of artemisinin combination therapy in the population including children. To date, no studies have been undertaken on the pharmacokinetics of artemisinin compounds in malnourished children. This thesis aims to fill this evidence gap by studying patients with uncomplicated malaria of different nutritional status in The Gambia. Analysis of the nutritional status of 97 children in The Gambia with uncomplicated malaria showed that 30% were both underweight and wasting, while 28% were categorised into stunting. This was much higher than the national average which has been estimated to be 17.4%, 9.5% and 23% for underweight, wasting and stunting, respectively, demonstrating a potential relationship between malaria and Protein energy malnutrition. In-vitro studies showed that although pre-treatment of HL-60 cells with the iron chelator (DFO) did not affect the bioactivation of artesunate, there was a 20% increase in cell viability with IC50 increasing from 7.0 ± 4.3 to 33.3 ± 2.9. This is believed to be as a result of DFO chelating the toxic iron generated as a result of artesunate bioactivation which increased from 0.32 ± 0.6 ng/mol in the control incubations to 0.84 ± 0.1ng/mol at 100 μmol artesunate concentration. In light of the fact that iron was important in the mechanism of action of these compounds, and the fact that iron deficiency is commonly in malnourished children, the effect of both PEM and anaemia on plasma drug levels of artemether and DHA was also studied. LC-MS/MS method was optimised and validated for the simultaneous analysis of artemether and DHA in plasma with ≥80% precision and accuracy. Plasma artemether and DHA concentration analysed 2h post first dose was 138.4 ± 80.9 ng/ml and 58.8 ± 43.7 ng/ml respectively. Severely wasted and wasted children had the highest artemether (156.5 ±69.6 ng/ml) and DHA (84.1 ±62.6) plasma concentrations respectively but values were not statistically significant. Anaemic status of children did not have an influence on drug plasma concentration with anaemic children having artemether and DHA plasma concentration of 138.5 ± 73.7 and 57.9 ± 36.6, respectively, and 138.43 ± 85.3 and 59.3 ± 46.8 for non-anaemic children respectively. However, conclusive results were limited by sample size. In conclusion, this thesis has demonstrated a relationship between malaria and Protein energy malnutrition, and highlighted the possible effects pathophysiological changes as a result of protein energy malnutrition can have on drug pharmacology and therapeutic effects in these children. There is a need for further studies in larger cohorts of children with protein energy malnutrition to determine whether therapeutic efficacy of artemisinin combination therapy is affected in an adverse manner, and whether there is a need for changes in dosing recommendations.

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Carey, Aoife. "An investigation into the prevalence and identification of malnutrition in hospitalised children." Thesis, Ulster University, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.673814.

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Malnutrition can be defined as a state of deficiency, excess or imbalance of nutrition which has an adverse effect on bodily function, composition or clinical outcome. Despite justifiable concerns regarding the increasing prevalence of over-nutrition in children, under-nutrition remains an underlying issue in paediatric hospitals. Under-nutrition is commonly seen in hospitalised patients as a result of decreased dietary intake, an inability to absorb nutrients or increased metabolic requirements. Apart from the well-recognised detrimental metabolic and clinical consequences, the long term effects of under-nutrition on foetal, infant and childhood growth have been acknowledged to predispose a child to an increased risk of chronic disease in adulthood. General estimates suggest that 9-47% of hospitalised children are at risk of under nutrition. Apart from certain disease states known to predispose to under-nutrition, such as cystic fibrosis, cardiology and oncology conditions, prevalence estimates are highly dependent on the indices used to define under-nutrition. Suggested indices for the assessment of acute under-nutrition include weight-for-height, weight-for-age and BMI-forage, while height-for-age is suggested for the assessment of chronic under-nutrition. At present, there is a lack of universally acceptable criteria by which to define under-nutrition. The recent emergence of paediatric specific nutrition screening tools for use in hospitals, including STAMp© and PYMS in the UK and Strongkids in the Netherlands, has increased interest in under-nutrition in hospitalised children. These tools aim to identify under nutrition in order to initiate effective referral for treatment and thus potentially reduce the detrimental effects on growth and clinical outcomes. Their use in infants, however, has been largely overlooked. This thesis considers the identification and prevalence of malnutrition in hospitalised children.

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Navaratnarajah, Paramalingam Kandasamy. "Child malnutrition mortality at St Barnabas Hospital is high - is it due to practices and attitudes of staff?: a study in a rural district hospital." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&amp.

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The case fatality rate for malnutrition at St Barnabas Hospital over the past years has been around 38%. The rates in other district hospitals in the Eastern Cape province were found to be in excess of 30%. In June 2000, the Eastern Cape Department of Health introduced a protocol for in-patient management of children with severe malnutrition, with the aim of reducing case fatality rate below 10%. St Barnabas Hospital introduced the Eastern Cape protocol in August 2003. An evaluation was done in November 2003 to assess the protocol's impact on the case fatality rate. The rate remained high, at 37.5%. This study descibed the current practices and attitudes of the nurses as St Barnabas Hospital paediatric ward, in the management of severely malnourished childen.

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Khanum, Parveen A. Gray Alan Noel. "Nutritional status of children in Khulna and Sylhet divisions in Bangladesh : a comparative analysis from the Bangladesh demographic and health survey 1996-97 /." Abstract, 1999. http://mulinet3.li.mahidol.ac.th/thesis/2542/42E-ParveenA.pdf.

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Hoare, Simon. "Determinants of catch-up growth following diarrhoeal disease in West African children." Thesis, University of Newcastle Upon Tyne, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.341780.

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Ackatia-Armah, Robert Samuel. "Community-based management of acute malnutrition in Malian children: a cluster randomized trial." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12704.

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Thesis (Ph.D.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
Acute malnutrition (AM), characterized by wasting, affects 55 million children under five years of age in developing countries. In Mali, the prevalence of AM exceeds 15% in some seasons. There is currently no consensus on the most effective dietary treatment strategy for children with moderate AM (MAM). Twelve health centers in rural Mali were randomly assigned to provide children with MAM (defined as mid-upper arm circumference (MUAC) < 12.5 and ≥ 11.0 cm or weight-for-length Z-score (WLZ) <-2.0 WHO standard and >70% NCHS reference median) 1 of 4 dietary regimens: 1) lipid-based, ready-to-use supplementary food (Supplementary Plumpy, SP); 2) special corn soy blend for MAM (CSB++); 3) locally processed, fortified food (Misola, MI); or 4) locally milled flours (millet and cowpea) plus oil, sugar and micronutrient powder (HFM). 1264 non-edematous children aged 6-35 months with MAM were offered ~500 kcal/d of assigned diet in addition to their usual food intake for 12 weeks. Hemoglobin (Hb) was measured in 1154 children, and plasma ferritin and transferrin receptor were measured in a subset of 452 children. 1178 children (93.2%) completed the study and attendance at weekly/bi-weekly follow-up visits was >85% in all groups. The adjusted mean (95% CI) change in weight in kg from baseline was greater with SP and CSB++ than other regimens (1.16 (1.08, 1.24), 1.04 (0.96, 1.13), 0.91 (0.82, 0.99), 0.83 (0.74, 0.92) for the respective study groups, p<0.001 ANOVA). MUAC changes followed a similar pattern. For length, SP and CSB++ differed significantly from HFM only. Recovery from MAM (defined as WLZ>-2.0, MUAC> 12.5cm) was higher with SP than the three other regimens (73%, 68%, 61%, 58% respectively, p less than O.OOO1). Total cost per treatment based on median time to recovery was $2.20 for SP, $1.43 for CSB++, $1.83 for MI and $1.65 for HFM. Anemia rates remained high (>81 %) in all groups after treatment. SP generally provided greater improvement in iron status compared to MI while CSB++ and HFM had intermediate effects. SP was more effective than other dietary regimens for the treatment of MAM and improvement of iron status; however, the benefits must be considered in relation to product costs and availability.

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Simpamba, Mica Mutuna. "Risk factors for severe malnutrition in children with cerebral palsy in Lusaka, Zambia." University of the Western Cape, 2017. http://hdl.handle.net/11394/5941.

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Magister Public Health - MPH (Public Health)
Over 80% of children with Cerebral Palsy (CP) present with feeding difficulties which consequently result in about 40-50% of them being malnourished. Many children with CP in low resource countries like Zambia, present with severe malnutrition and the extent of this problem remains unknown. The aim of this study was to identify the main risk factors associated with severe malnutrition in children with CP.

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Jensen, Kayla Camille. "Malnutrition and Handgrip Strength in Hospitalized and Non-Hospitalized Children 6-14 Years Old." BYU ScholarsArchive, 2016. https://scholarsarchive.byu.edu/etd/6307.

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Malnutrition is concerning in children because it effects proper growth and development. Handgrip Strength (HGS) has been identified as a diagnostic indicator for identifying pediatric malnutrition but normal reference ranges have not yet been established; therefore, HGS can be used to identify malnutrition but not quantify the degree of malnutrition: mild, moderate, or severe. The aim of this study was to determine if HGS differed between hospitalized and non-hospitalized children and to describe the association between HGS and several parameters including height, weight, body mass index (BMI), and mid-upper arm circumference (MUAC). One hundred nine hospitalized and 110 non-hospitalized pediatric patients ages 6-14 years participated in this cross sectional, nonequivalent control group design study. Nutrition status was evaluated using BMI z scores and MUAC z scores, and HGS was evaluated within 48 hours of hospital admission or at a well-child appointment. According to BMI z scores, 24.8% of hospitalized and 18.3% of non-hospitalized participants were malnourished. Mean HGS of hospitalized participants was not significantly different from non-hospitalized participants (p=.2053). HGS was found to be associated with age, height, dominant hand, and MUAC z scores in all participants. The difference in HGS measurements was not statistically significant between hospitalized and non-hospitalized children using a one-time HGS measurement. Further research examining HGS measurements over time as well as comparing HGS measurements to the degree of malnutrition deficit in pediatrics is needed.

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James, Kulanathan, and Emma Lindberg. "Caring for Children Who Suffer from Malnutrition Nurses‟ experiences in the highlands of Papua." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-16417.

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This study was carried out during the spring of 2009 in the highlands of Papua, Indonesia on a Minor Field Study (MFS) scholarship funded by the Swedish International Development Cooperation Agency (SIDA). Indonesia is a developing country with Papua as a province in the most eastern part of the country. Mountains and jungles cover Papua, which makes health care hard for people to reach. Half of the child deaths in the world are connected to malnutrition and most of the suffering children live in developing countries. The authors had been informed about the high rate of malnutrition and child diseases among Papuans in the highlands and that the nurses who work in the highlands were faced with challenges when working to improve the health among children who suffer from malnutrition and their families. The aim of the study is to describe nurses‟ experience of working with children who suffer from malnutrition.A qualitative approach was chosen for the study and by using an open-ended interviewing method seven interviews were collected. Seven nurses were asked about their experience working with children who suffer from malnutrition. The interviews were collected at one specific hospital in the highlands of Papua and the respondents were of both gender. The interviews were transcribed and analyzed according to the qualitative content analysis. The result was presented in themes and sub-themes, where these three main areas were found: “Hindrance of health”, “Improving health”, and “Challenges”. The result shows that Papuans belief in spirits and traditional treatment and also lack of trust in the western medicine is a major problem for nurses who give care to the children suffering from malnutrition. The result is discussed in relation to background where relevant literature is referred to.
Program: Sjuksköterskeutbildning

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Muwalo, Blessings Gandalale Chale. "Risk factors for malnutrition in children aged 0 to 5 Years in Lilongwe district, Malawi." University of the Western Cape, 2013. http://hdl.handle.net/11394/4273.

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>Magister Scientiae - MSc
The Malawi Multiple Indicator Cluster Survey (MICS) in 2007 indicated that the prevalence of underweight in Lilongwe District was 29%, stunting was 49% and Global Acute Malnutrition was 11%. The aim of the study therefore was to determine the risk factors for malnutrition amongst children aged 0 to 5 years in Lilongwe district in Malawi. Study design It was a case-control study, conducted in randomly selected Community Therapeutic Care (CTC) Sites (Nutrition Rehabilitation Units (NRUs)) and Under-five Clinics at health facilities of the district. The study sample was comprised of 50 underweightfor- age children (25 girls and 25 boys) aged 0 to 5 years from NRUs of the district selected randomly. The controls were comprised of 44 normal weight-for-age children (22 girls and 22 boys) randomly selected within the same age group, routinely attending under-five growth monitoring and immunization sessions during the same period as the cases. The cases and controls were identified using the NRU and under-five clinic registers respectively. Data Collection There was a face to face interview with the mother/guardians of the children, conducted by trained NRU nurse specialists, the researcher and a research assistant, using a structured questionnaire. Questions about socio-economic status of the mother/caregiver, child feeding practices, nutritional status and diseases of the child were asked. Analysis of results Data was analyzed using EpiInfo 2002 software. Ethical approval for the study was requested from the Ethical committee of the University of the Western Cape. Informed written consent was obtained from all the participants.

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Leung, Ho-kin Vincent, and 梁浩堅. "The effectiveness of the use of "ready-to-use" therapeutic food (RUTF) in treating malnourished children in developing countries and the way forward." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193780.

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WHO and UNICEF recommend the use of “ready-to-use therapeutic food” (RUTF) in the treatment of severely acute malnourished (SAM) children with no complicated medical background. This research paper aims to review the evidence on the use of RUTF in the treatment of SAM children, explore the potential issues with the use of RUTF, and provide suggestions for future research. A total of 7 studies were included for the review on the effectiveness of RUTF treatment. Evidences showed a general improvement in the health outcomes of SAM children, yet failed to yield high-quality evidences to prove its benefits. Potential problems with the reliance on RUTF were identified, further research on the use of RUTF are required.
published_or_final_version
Public Health
Master
Master of Public Health

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Bates, Katie. "Double or divergent? : stuntingoverweightness among children and the 'burden' of malnutrition : a study of Albania." Thesis, London School of Economics and Political Science (University of London), 2014. http://etheses.lse.ac.uk/998/.

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Today, researchers and policy makers alike are increasingly concerned about the “double burden of malnutrition” in low and middle income countries (LMICs). This ‘double burden’ is understood to be the coexistence of under- and overnutrition within one population. The definition of a ‘double burden’ relies upon the existence of chronic undernutrition among children (indicated by stunting – where children are shorter than expected for their age) and the existence of overnutrition in children or adults (child overweightness as indicated by a greater weight than expected for a given height and adult overweightness/obesity as indicated by a greater weight than height). However, research has failed to consider that children can be concurrently stunted and overweight – known here as ‘stuntingoverweightness’. In failing to consider stuntingoverweightness, the prevalence of stunting and overweightness among children has been overestimated at the population level. Stuntedoverweight children have been ‘double counted’ – once as stunted and once as overweight. This has severe implications for our understanding of malnutrition in LMICs today. The polarisation of malnutrition among children of under- and overnutrition has been exaggerated and a whole group of children have become hidden – the stuntedoverweight. This research addresses this issue. Recalculating stunting and overweightness prevalence accounting for stuntingoverweightness this research shows that, today in LMICs, up to 10.42% of children under-five are stuntedoverweight – yet no policies or programmes exist to understand the determinants of stuntingoverweightness, its effects or how to alleviate them. An individual level analysis of Albania shows stuntedoverweight children are a separate socioeconomic group and should thus be targeted for interventions separately from their stunted and overweight peers. Furthermore, failing to recognise stuntingoverweightness has led to overestimations of the burden of stunting by up to 88.54% (in Albania) and of overweight by up to 295.26% (in Benin) and skewing our understanding of the ‘burden of malnutrition’ in LMICs. The thesis shows that for nutritional strategies to be effective – research needs to consider the diverse burden of malnutrition observed in LMICs today.

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SILVA, Carolina Bastos Gasparinho Antero da. "Malnutrition and enteric infections in children in Bengo province, Angola-a four-arm experimental study." Doctoral thesis, Instituto de Higiene e Medicina Tropical, 2019. http://hdl.handle.net/10362/82951.

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Introdução: À semelhança de outros países de baixo-médio rendimento, em Angola, a malnutrição e a doença diarreica estão entre as principais causas de mortes em crianças menores de cinco anos, nomeadamente na província do Bengo. Objectivos: i) identificar a etiologia da diarreia e fatores associados em crianças menores de cinco anos atendidas no Hospital Geral do Bengo (HGB); ii) fornecer informações sobre a caracterização molecular de rotavírus, antes da introdução da vacina; iii) fornecer uma caracterização molecular de Giardia lamblia; e iv) investigar se o tratamento de parasitas intestinais (com ou sem diagnóstico prévio) em dois níveis diferentes (individual ou a nível do agregado familiar) tem impacto sobre o estado nutricional de crianças de 2-5 anos, após seguimento de dois anos no Bengo. Métodos: Um estudo transversal (ET) foi implementado para investigar a presença de vírus, bactérias e parasitas nas fezes diarreicas de 344 crianças atendidas no HGB (2012- 2013), recolhendo dados sociodemográficos, nutricionais e clínicos, explorados por modelos de regressão logística simples e múltipla. Posteriormente, realizaram-se métodos moleculares para identificação dos genótipos circulantes de rotavírus e genótipos e subgenótipos de G. lamblia. Entre 2013 e 2017, um estudo longitudinal e experimental (RCT) com quatro braços em paralelo foi realizado em crianças infetadas com pelo menos um parasita intestinal patogénico (ISRCTN-72928001). As 121 crianças com critérios de inclusão foram distribuídas aleatoriamente (1:1:1:1) - Braço1: albendazol anual a nível individual; Braço2: albendazol anual ao agregado familiar; Braço3: diagnóstico e tratamento quadrimestral de parasitas intestinais a nível individual; Braço4: diagnóstico e tratamento quadrimestral de parasitas intestinais ao nível do agregado familiar. No início do estudo, aos 4, 8, 12, 16, 20 e 24 meses de acompanhamento avaliou-se: a altura, o peso, estatura-para-idade, peso-para-altura e peso-para-idade em Z-score. A análise por intenção-de-tratar foi realizada seguindo as diretrizes CONSORT, após a análise de valores omissos (IBM SPSS). Dada a falha dos pressupostos da análise paramétrica de medidas repetidas, uma abordagem não paramétrica (nparLD) e os modelos LMM e GEE foram explorados no programa R. Resultados: Nos dois estudos, as crianças viviam principalmente em áreas urbanas (>90%) e mais de 20% não tinha latrina. A água mais usada para beber provinha do rio, da torneira no quintal e de tanques. A desnutrição crónica ocorreu em 38% (ET) e 31% (RCT) das crianças. No ET, 67% das crianças estavam infetadas por um agente enteropatogénico, principalmente por Cryptosporidium spp. (30%), rotavírus (25%) e G. lamblia (22%). Cryptosporidium spp. e rotavírus foram mais frequentes em menores de 12 meses. Os principais genótipos circulantes de rotavírus foram: G1P [8] (47%), G1P [6] (29%) e G2P [4] (13%). O genótipo B de G. lamblia foi predominante em relação ao genótipo A. No RCT, no início do estudo, as crianças estavam infetadas principalmente com G. lamblia (57%) e Ascaris lumbricoides (26%). Diferentes modelos não forneceram nenhuma evidência ou fraca evidência do efeito das intervenções nas medições antropométricas, embora tenha ocorrido uma evolução temporal significativa. Contudo, nota-se uma redução da desnutrição ligeira ao longo do estudo, apesar de, em média, as crianças permaneceram com valores padronizados (z-scores) negativos para os índices antropométricos.Conclusão: Várias infeções entéricas foram identificados nos dois estudos. No RCT, nenhuma das estratégias de tratamento de parasitoses intestinais se destacou com efeito significativo nos indicadores antropométricos estudados. A duração do RCT e o tamanho da amostra podem não ter sido suficientes para observar diferenças significativas. Por outro lado, realça-se a importância de uma abordagem multifatorial integrada com vista à melhoria do estado nutricional (e.g., WASH, educação, alimentação adequada e acesso a cuidados de saúde).
Background: Similar to other low- and middle-income countries, in Angola, malnutrition and diarrhoeal disease are among the major causes of deaths in children under-five, namely in Bengo province. Aims: i) identify the aetiology of diarrhoea and associated factors in under-five children attending the Bengo General Hospital (HGB); ii) provide information on the molecular characterization of rotavirus, before the vaccine introduction; iii) provide a molecular characterization of Giardia lamblia; and iv) investigate if treatment of intestinal parasites (with or without previous diagnosis) in two different levels (individual or household) impacts on nutritional status of children 2-5 years, after a two-year follow-up in Bengo. Methods: A cross-sectional study (CSS) was conducted to investigate the presence of virus, bacteria and parasites in diarrhoeal stools of 344 children attending HGB (2012-2013), collecting sociodemographic, nutritional and clinical data, analysed by simple and multiple logistic regression models. Then, molecular methods were performed for the identification of rotavirus circulating genotypes and G. lamblia assemblages and subassemblages. Between 2013 and 2017, a four-arm randomised controlled trial (RCT, registration ISRCTN-72928001) was conducted longitudinally in children infected with at least one pathogenic intestinal parasite. 121 children meeting inclusion criteria were randomly assigned (1:1:1:1) - Arm1: annual albendazole at individual level; Arm2: annual albendazole at household level; Arm3: four-monthly screening and treatment of intestinal parasites at individual level; Arm4: four-monthly screening and treatment of intestinal parasites at household level. Height, weight, height-for-age, weight-for-height, and weight-for-age Z-score were assessed at baseline, 4, 8, 12, 16, 20, and 24 months of follow-up. Intention-to-treat analysis was performed following CONSORT guidelines, after a missing value analysis (IBM SPSS). Given the failure of assumptions for parametric repeated measurements, nonparametric rank-based method (nparLD), LMM and GEE models were performed in R program. Results: In both studies, children lived mainly in urban areas (>90%) and more than 20% did not have a latrine. The most commonly drinking water sources were the river, the tap in the yard and tank. Near 38% (CSS) and 31% (RCT) of children were stunted. In the CSS, 67% of children were infected with an enteropathogen, mostly with Cryptosporidium spp. (30%), rotavirus (25%) and G. lamblia (22%). Cryptosporidium spp. and rotavirus were more frequent in children under 12 months. The main rotavirus circulating genotypes were: G1P[8] (47%), G1P[6] (29%) and G2P[4] (13%). G. lamblia assemblage B was predominant compared with assemblage A. In the RCT, at baseline, children were mainly infected with G. lamblia (57%) and Ascaris lumbricoides (26%). Different models provided no evidence or weak evidence of the effect of interventions on anthropometric measurements, although a significant temporal effect occurred. A reduction in mild malnutrition occurred throughout the study, although, on average, children remained with negative z-scores for anthropometric indices. Conclusion: Several enteric infections were identified in both studies. In the RCT, none of the treatment strategies targeting intestinal parasites stood out with significant effect on the anthropometric indices studied. The duration of the RCT and the sample size may not have been sufficient to observe significant differences. On the other hand, it highlights the importance of an integrated multifactorial approach to improving nutritional status (eg, WASH, education, adequate food and access to health care).

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Khatib, Ibrahim Mahmud Dib. "Role of zinc-supplemented diets in the prevention of the early linear growth deficiency in Jordanian children." Thesis, University of London, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.244278.

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Zwane, Dudu Elizabeth. "Caregivers' views on the contributing factors of malnutrition among children benefiting from the Child Support Grant." Diss., University of Pretoria, 2015. http://hdl.handle.net/2263/53479.

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The scourge of malnutrition in children under the age of five remains a worldwide problem resulting in deaths that could have been prevented with a proper paediatric diet. Despite various national nutrition and primary health care programmes in South Africa over the last 10 years, recent studies show that child malnutrition has contributed to the deteriorating health of children below the age of five. At national level, stunting and underweight remain the common nutritional disorders affecting one out of five children in South Africa. Very limited research has been done on the role of caregivers in reducing the scourge of malnutrition. The study focused on exploring and describing the views of caregivers on the contributing factors of malnutrition among children who are under the age of five benefiting from the Child Support Grant. A qualitative, explorative study was conducted, with the following objectives: · To conceptualise malnutrition as a social phenomenon and to explore strategies of alleviating malnutrition with specific emphasis on the Child Support Grant. · To determine caregivers understanding of malnutrition among children
Mini Dissertation (MSW)--University of Pretoria, 2015.
Social Work and Criminology
MSW
Unrestricted

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Benyera, Oscar. "Outcomes in malnourished children at a tertiary hospital in Swaziland : post implementation of the WHO treatment guidelines." Diss., University of Pretoria, 2013. http://hdl.handle.net/2263/33347.

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Background. Swaziland adopted the World Health Organization’s (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007 to reduce case -fatality rates for childhood malnutrition. However, no follow-up studies have been conducted to determine the reduction in the case -fatality rate post-implementation of the guidelines. Objectives. To determine the case -fatality rate for childhood malnutrition post-implementation of the WHO treatment guidelines and determine the level of adherence to the guidelines at Mbabane Government Hospital. Methods. A retrospective observational study was undertaken. All children under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 had their demographic-, anthropometric- and clinical characteristics recorded and analysed, as well as the outcome of admission. Results. Of the 227 children admitted during the study period, 179 (64.6%) were severely malnourished and 98 (35.4%) had moderate malnutrition. One-hundred-and-eleven children died during admission, an overall case -fatality rate of 40.1%. Mortality was significantly higher among severely malnourished children compared to those with moderate malnutrition, (46.9% vs 27.6%, OR 3.0 (95% CI 1.7 to 5.3)). Comorbid pneumonia and gastroenteritis were significant predictors of mortality – , OR 2.0 (95% CI 1.2 to 3.4) and 1.9 (95% CI 1.1 to 3.2) respectively. Conclusion. Case -fatality rates for childhood malnutrition remain high, despite adoption of the WHO treatment guidelines. A need exists for improved adherence to the WHO guidelines and periodic clinical audits to reduce deaths from childhood malnutrition to meet the WHO mortality target of less than 5% and improve child survival.
Dissertation (MSc)--University of Pretoria, 2013.
gm2014
Clinical Epidemiology
unrestricted

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Zingwari, Jebson. "Prevalence of malnutrition in HIV positive infants (age<18months) attending a clinic in Windhoek, Namibia." Thesis, University of the Western Cape, 2010. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=gen8Srv25Nme4_3482_1362394243.

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Background-Namibia has a high HIV and malnutrition burden. HIV increases the risk of
malnutrition and malnutrition results in rapid progression of the disease and worsening malnutrition. Nutrition plays an important role in the management of an HIV positive child. Optimal nutrition delays disease progression, improves immune function and the effectiveness of antiretroviral drugs thereby improving the quality of life of the child. Early identification of children at risk of malnutrition is therefore essential to prevent malnutrition in HIV positive children. Methodology-The study sought to determine the prevalence and the risk factors for malnutrition in 88 HIV positive children less than 18 months attending Hospital Paediatric ARV Clinic (HPAC). The study used quantitative methods. A questionnaire was administered to the child&rsquo
s caregiver to assess infant, caregiver and socio-economic risk factors for malnutrition after written consent had been obtained. The history of the patient was extracted from the HIV patient care booklet. Nutritional status was assessed using WHO standard growth charts in children and body mass index (BMI) in adults. Results- The study showed that 56.8% of children were wasted (14.8% had severe wasting), 52.3% were stunted (18.2% had severe stunting) and 69.3% underweight (20.5% were severely underweight). This level of malnutrition is much higher than the rates of 8% wasting, 29% stunting and 17% underweight in the general paediatric population. Malnutrition in children was associated with fewer number of working adults per family, frequent illnesses in the child, low level of caregiver education, caregiver unemployment, low household income and lack of adequate food in the family. Children of malnourished caregiver were more likely to be underweight. Conclusions- The results showed a high prevalence of malnutrition (56.8%wasting, 52.3%stunting and 69.3% underweight) among HIV positive infants attending the HPAC. The study showed that poverty and food insecurity were strongly associated with malnutrition in children. This therefore
highlights the urgent need to address poverty to reduce malnutrition in the community. Although the study did not show any statistically significant association between feeding practices and malnutrition in children, health workers should encourage HIV positive mothers to breastfeed their infants as per the WHO and Namibian antiretroviral therapy guidelines (2010). Recommendations - There is need to train health workers to identify and manage malnourished children early. Linkages with social services must be improved and strengthened to help reduce poverty in the community.

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Palupi, Eny [Verfasser]. "Double burden malnutrition of preschool children and its association with brain development and milk consumption / Eny Palupi." Kassel : Universitätsbibliothek Kassel, 2015. http://d-nb.info/1075390338/34.

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Van, Der Kam Saskia. "Does a short term nutritional supplementation prevent malnutrition in ill children? Effectiveness of nutritional supplementation (ready-to-use therapeutic food and multi micronutrients) of 2 weeks in preventing malnutrition in children 6-59 months with infection (malaria, pneumonia, diarrhoea)." Doctoral thesis, Universite Libre de Bruxelles, 2017. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/242533.

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It has been generally recognised that sick children have an increased risk on malnutrition. An activated immune system requires more nutrients while illness is often associated with a lower absorption and decreased consumption because of lack of appetite. When these increased needs are not balanced with an adequate availability of nutrients, the sick child is at higher risk of developing malnutrition.Médecins Sans Frontières investigated the question whether this process is mitigated by simple short term nutritional supplementation given to sick children alongside medical treatment. Three Randomised Controlled Trials (RCT’s) were conducted. The first, in Democratic Republic of Congo, was a pilot; 180 children with malaria were randomised in 2 arms: 1 group receiving 2 weeks of ready to use therapeutic food (RUTF) and a control group. The children were followed for a period of 4 weeks. Children in the RUTF group showed a higher weight gain in the first 14 days compared to the control group, at day 28 the weight gain in both groups was similar.Thereafter, 2 RCT’s were implemented in Uganda and Nigeria using a similar methodology. Children with malaria, lower respiratory tract infection or diarrhoea (sample size of 2202) were randomised in three groups: supplemented with 2 weeks of RUTF, supplemented with 2 weeks of micronutrient powder (MNP), and not receiving supplementation after each disease episode. The incidence of malnutrition was compared after an observation period of 6 months. The trial in Uganda showed a reduction in malnutrition in the RUITF group with 31%, while in Nigeria, there was no significant reduction in the RUTF group. The MNP group did not show reduction in malnutrition in any site. In the group of moderate malnourished children the RUTF and MNP supplementations were not effective in preventing deterioration to severe malnutrition. However, when the studies were combined the RUTF group showed a lower mortality compared to the MNP group.Multi-variate analysis did not show a reduction of incidence of malnutrition in the supplementation groups. A strong association with morbidity was found. A higher frequency of diarrhoea was associated with an increased incidence of malnutrition. The association with malaria episodes was mixed; it was associated with a higher incidence of malnutrition in Kaabong, but in Goronyo a higher frequency of malaria decreased the incidence of malnutrition. In addition, a more frequent monitoring of the children and treatment of their illnesses was associated with a decreased incidence of malnutrition.The difference in effectiveness of supplementation between the sites can be explained by differences in food security and level of morbidity. It is argued that the fragile food security in Kaabong limits the supply of nutrients, and therefore supplementation with RUTF was effective. In Goronyo the high frequency of morbidity limits convalescence and therefore supplementation was not effective.It is likely that malnutrition is more effectively prevented when several interventions are combined like water and sanitation to prevent diarrhoea, malaria chemoprophylaxis and preventative and curative health and nutrition interventions.This dissertation will present the background, the methods of the trials and the results, followed by a discussion on the implications for programming and research.
Doctorat en Santé Publique
info:eu-repo/semantics/nonPublished

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Chitete, Lusungu. "Uptake of HIV testing among acutely malnourished children in dowa district of Malawi." University of Western Cape, 2013. http://hdl.handle.net/11394/3928.

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Magister Public Health - MPH
Aim: This study sought to investigate service-related factors that affect uptake of HIV testing among children enrolled in CMAM. This was a descriptive study that used mixed quantitative and qualitative methods. To assess uptake of HIV testing records were reviewed of number of children tested as a percentage of number of children enrolled in CMAM over 12-month period in a sample of health facilities. Face to face in-depth interviews were conducted of CMAM and HTC focal persons to investigate factors affecting uptake. Information from interviews was analyzed using a thematic approach.

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Jalloh, Neneba Adama. "Differences in the effect of protein intake on the nutritional status of children whose mothers did or did not participate in the food and agriculture organization program in Koinadugu district of Sierra Leone." Virtual Press, 1991. http://liblink.bsu.edu/uhtbin/catkey/770953.

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The high rate of malnutrition (180/1000 live births) in Sierra Leone (U N Demographic Year Book, 1985) has become a major concern to the government, development agencies, medical and nutritional personnel. This study was designed to determine whether there were any significant differences between the nutritional status of the children women who participated in an FAO project and those who did not and was conducted in six villages in the Koinadugu District of Sierra Leone.By referring to a list of local protein rich foods, three-day recall of food frequency was done to estimate the protein intake. Anthropometric measures were collected and body mass index was determined. All measures were compared with standards for African-American population.The weight-for-age was significantly greater for the the 50th percentile than that of the non-project children (NPC). Protein intake less than the average of 57 grams, were seen among older children with lower weight-for -height percentile, suggesting that total food intake was inadequate for the older children. This researcher believes that the FAO project should continue but that nutrition education should be an important component of the program.
Department of Home Economics

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Ibekwe, Vivian Egeolu. "The effect of fermentation of a soybean supplement on zinc and iron bioavailability and status during rehabilitation in malnourished Nigerian children." Thesis, University of Aberdeen, 2004. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=238453.

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Severe malnutrition in children is unacceptable. Rising malnutrition and household food insecurity are common. The problems of hunger and malnutrition in Nigeria are more severe than before. It has been estimated that the percentage of Nigerian households that are food insured was 40% in 1998 increasing from 18% in 1986. Malnutrition is widespread and its prevalence is high. ,The incidence of malnutrition has increased as a result of economic hardships facing the country. It is the children who suffer most. Their energy needs are never met and they remain hungry and wasted. UNICEF, 1998, published the number of malnourished under-five Nigerian children between 1990-1997 as 48% underweight, 9% wasted and 43% stunted. Families are unable to provide animal protein for the growing needs of the children. The use of soybean to augment meals lacking in animal protein is becoming popular. The Kersey Nutrition Rehabilitation Centre (KNRC) uses soybean as its mainstay in the rehabilitation of malnourished children. Reduction of soybean's high concentratioI1S of phytic acid will greatly enhance the crop's nutritional value, especially zinc and iron whose supplementation in the malnourished has greatly improved the management and achieved better weight gain. Up to now, the malnourished children in the world wait for deliverance from their burden. It is hoped that fermented soy supplements will reach out to these children more than ever.

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Zivkovich, Caitlin J. "An Evaluation of a Supplemental Snack Feeding Program on Growth in School-aged Children Living in Rural Tanzania, East Africa." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1302883411.

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OriÃ, Reinaldo Barreto. "APOE genotyping and its association with cognitive deficits in children with diarrhea and malnutrition in the Northeast-Brazil." Universidade Federal do CearÃ, 2004. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=20.

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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
Polymorphisms in the apolipoprotein E (APOE) have constituted the major rationale to identify potential risk groups for developing late-onset Alzheimer's disease and help to predict recovery of cognitive function after brain injury. However, the APOE impact on cognitive development in children living in poor areas of the developing world, where we have discovered profound significant associations of early childhood diarrhea (at 0-2 yo) with lasting impairments of growth, cognition and school performance, is not known. Therefore, we conducted APOE genotyping in 72 Brazilian shantytown children under active surveillance since birth, using purified DNA extracted from buccal cell samples. We found a high frequency of APOE4 alleles (18% vs 9-11% expected) in children with lower diarrhea burdens. When we examined the children who experienced the heavier diarrhea burdens (+/- median of 7 illnesses in the first 2 years of life), those with APOE4 did significantly better in the coding subtest (39 +/- 9.9; n=7, p=0.01), when compared with APOE4 negative children with similar diarrhea burdens (25 +/- 12.7; n=27). Positive correlations between the APOE4 occurrence and coding scores remained even after adjusting for family income, maternal education and breast-feeding (p<0.05). Moreover, the APOE4 positive group, under heavy burdens of diarrhea, preserved semantic fluency and the mean difference in fluency scores (DIFF), n=73, p=0.025, a standardized coefficient for disproportional verbal fluency impairment. Our findings show that APOE4 is relatively common in children from the GonÃalves Dias Community in the Northeast Brazil and suggest a protective role of APOE4 allele in children with a history of heavy burdens of diarrhea in their first 2 years of life.
Os polimorfismos da apolipoproteÃna E (APOE) tÃm se constituÃdo no principal mÃtodo para identificar grupos de risco para desenvolver a doenÃa de Alzheimer de inÃcio tardio e para servir de prognÃstico da recuperaÃÃo da funÃÃo cognitiva apÃs traumatismo craniano. Entretanto, o impacto da APOE no desenvolvimento cognitivo de crianÃas de Ãreas pobres do Brasil, onde nÃs jÃ temos encontrado associaÃÃes profundas e significativas entre os eventos de diarrÃia infantil precoce (aos 0-2 anos de idade) com o comprometimento duradouro do crescimento, cogniÃÃo e performance escolar, nÃo Ã ainda conhecido. Portanto, nÃs conduzimos um estudo da genotipagem da APOE em 72 crianÃas da Comunidade GonÃalves Dias, em Fortaleza, Nordeste do Brasil, acompanhadas por um projeto coorte desde o nascimento, utilizando DNA extraÃdo de amostras de cÃlulas bucais. Nesse trabalho, encontramos uma elevada freqÃÃncia dos alelos da APOE4 (18% vs 9-11% esperada) em crianÃas com baixa morbidade de diarrÃia. Quando avaliamos as crianÃas que apresentaram elevada morbidade de diarrÃia (+/- mediana de 7 episÃdios nos primeiros 2 anos de vida), Ãquelas portadores do alelo APOE4 mostraram uma melhor performance cognitiva no subteste de coding (39 +/- 9,9; n=7, p=0,01), quando comparadas com crianÃas negativas para o alelo APOE4 com similar morbidade de diarrÃia (25 +/- 12,7; n=27). CorrelaÃÃes positivas entre a ocorrÃncia do alelo APOE4 e os escores de coding permaneceram, mesmo apÃs controlar para renda familiar, educaÃÃo materna e aleitamento materno (p<0,05). AlÃm disso, o grupo positivo para APOE4, com elevada morbidade de diarrÃia, preservou a fluÃncia semÃntica e a diferenÃa mÃdia dos escores de fluÃncia semÃntica (DIFF), n=73, p=0,025, um coeficiente padrÃo para avaliar o impedimento desproporcional da fluÃncia verbal. Nossos achados, portanto, mostram que o alelo APOE4 Ã relativamente comum em crianÃas da Comunidade GonÃalves Dias, no Nordeste do Brasil, e sugerem um papel protetor do alelo APOE4 em crianÃas com histÃria de alta morbidade de diarrÃia nos primeiros dois anos de idade.

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Boltena, Sisay Sinamo. "Factors affecting the rehabilitation outcome (of outpatient therapeutic program) of children with severe acute malnutrition in Durame, Southern Ethiopia." Thesis, UWC, 2008. http://hdl.handle.net/11394/2868.

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Magister Public Health - MPH
Background: Malnutrition accounted high level of childhood morbidity and mortality in Ethiopia including Durame area. Durame area is one of the food insecure districts in Southern region. As a result of high prevlanece of acute malnutrtion, which is 8.3%, Ministry of Health partnering with World Vision Ethiopia started outpatient therapeutic program (OTP) in seven OTP sites to rehablitate severely malnourished children. Reports indicate that number of factors affect the rehabilitation outcome of children with severe acute malnutrtion in OTP programs. However, there are no studies conducted to assess their contribution in the rehablitaiton outcome. Hence, this study will attempt to investigate these factors and assess their public health significance in Durame area. Aim: To assess the factors affecting the rehabilitation outcome of an OTP for children with severe acute malnutrition in Durame area, Southern Ethiopia Method: the study used a descriptive study with an analytical component. Three-hundred and sixty (360) medical records were calculated during sampling and proportional numbers of medical records were sampled from the seven OTP sites. The medical records were reviewed using semi-structured questionnaires from September 1 to September 10, 2008. The data was entered and analyzed using EPI info version 3.3.2 software. Results: three hundred fifty five (98.6%) of the total sample records were reviewed. Three hundred twenty nine (92.7%) children were cured, 11(3.8%) died, 7 (2%) defaulted and 8 (2.3%) were non-cure. Average weight gain on discharge was 3.4gm/kg/day and the mean length of stay was 55.6 days (SD+14 days). More than 60% of children were admitted in three of the seven OTP sites where Demboya OTP sites taking the larger share. Nearly half of the total children (49.8%) were between 6 to 12 months of age and the median age of admission was 13 months. The male to female ratio in the study population was almost equal. Average family size was 6.3 and 58.3% of children came from households with 6 or more family members. Forty two (11.8%) children in the study had twin. The average walking distance to the OTP sites was 62.9 minutes and two hundred fifty six mothers travelled less than an hour. Most of the children (92.1%) were referred from the community and most of the children were admitted with MUAC followed by pitting edema. One hundred seventy four (49%) of the total children were beneficiaries of GFR. On admission two hundred twenty six (63.7%) children were breastfeeding, 257 (72.4%) had no symptoms of sickness and 327 (92.1%) did not have abnormal physical examination findings. More than half (51.5%) of them did not receive any home visit and the larger share of the home visits (37.3%) were made when children got illnesses. One hundred sixteen (32.7%) children in the study had chronic medical conditions during follow up. Fever or hypothermia (0.6%), dehydration (0.8%), anemia (0.6%), skin infection (1.6%) and Plumpy nut refusal (2.0%) were the main abnormal medical findings during follow up. Assessment of the influence of the socio-demographic and biological characteristics on the rehabilitation outcome indicated that the sites, family size, chronic medical conditions, absenteeism, weight loss, presence of fever or hypothermia, dehydration and anemia had significant association with the treatment outcome (p<0.05). Further analysis for significant variables using regression analysis indicated that absenteeism, chronic medical illness, fever or hypothermia and anemia are predictor variables contributing significant information for the prediction of the treatment outcome (p<0.05). Conclusion: The program has high success rate in terms of increasing cure and decreasing death, default and non-cure rates but it did not meet the minimum international recommendations for average length of stay and average weight gain. The study identified the main socio-demographic and biological characteristics of children with SAM and factors that affect the rehabilitation outcome. Children under the age of 24 months were most affected with SAM and no gender variation. Larger proportions of malnourished children were living in families above the average family size, which had significant association with the outcome. OTP sites were accessible for majority children in the program but higher level of absenteeism which significantly associated with the outcome. The study identified socio-demographic and biological factors that influenced the rehabilitation outcome as well as the predictor variables contributing significant information for the prediction of the treatment outcome. It could assist the program implementers to design appropriate public health measures. The achievement in Durame OTP program indicates effectiveness of community based management of SAM and existing potential to integrate in routine health system in resource scarce setting like Durame. Recommendations: to sustain the achievements and improve the growth areas necessary public health measures are prime importance.

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Khunga, Helen. "Factors affecting detection and referral of malnourished children to Primary Health Care (PHC) level in Kanchele community of Kalomo District, Zambia." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4508.

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Magister Public Health - MPH
Background: Malnutrition in children under the age of 5 years is a global public Health problem. The UNICEF report states that 10.9 million children under five die in developing countries each year due to malnutrition. According to the Zambia Demographic and Health Survey of 2008 malnutrition is one of the main childhood illnesses in Zambia with almost 50% of the under five children being stunted. The referral system in Zambia is organized in a way that starts at the Primary Health Care (PHC) level within the community and managed by the Community Health Workers (CHW). At this level, Community Health Workers screen and identify children that have childhood illnesses which require treatment and they refer them to the Rural Health Centre (RHC). When the problem cannot be handled at the RHC level the child is referred to the district hospital or provincial hospital level within a particular province. However, most children with malnutrition arrive late at the hospital for treatment. Some of them die soon after admission. It was not clear what prevent the mothers from bringing these children early to the hospital for treatment. Methods: The main aim of the study was to explore factors that are associated with detection and referral of malnourished children from Primary Health Care (PHC) at community level to the Health centres in Kalomo district. The study was conducted in Kanchele community of Kalomo in Southern Province of Zambia. Kanchele is a rural community with most basic services such as health facilities not being easily accessed. The study focused on two PHCs which had the highest prevalence of malnutrition. All participants were asked to sign a consent form after the purpose of study had been explained to them. They were informed that all information would be treated with confidentiality and that participation was voluntary and that they had the right to chose not to participate in the study. Furthermore each participant was asked if they agreed to maintain the confidentiality of the information discussed by participants and researchers during the focus group session. The study was qualitative in nature and focus group discussions were conducted with mothers or caregivers of children under five years, community members who have lived in the community for more than one year and community health workers who have also worked in the community for more than one year. Focus group discussions were used to collect data from mothers and community members. While in-depth interviews were used to collect data from CHWs and nutrition group leaders working at the PHC and community leaders. The data collected from the focus group discussions was analysed using thematic approach. Barriers or hindrances to rehabilitating a malnourished child mentioned by the respondents included lack of knowledge on malnutrition, failure to link malnutrition to poor feeding and bad health seeking habits, poor response to referral as a result of a system which is not supported with adequate resource such as transport, a system that does not support parents with food in-case of the child being hospitalised, the current hospital system only provides food to the patient. The failure by health staff to see that malnutrition is a key childhood disease. Data from this study will be used to develop interventions to improve the management of malnourished children. Conclusion: The study shows that mothers and community members are misinformed about the causes and treatment of malnutrition. It also clearly showed that traditional healers and grandparents played an important role in the diagnosis and treatment of malnourished children in this community. Interventions to improve identification and referral of these malnourished children needs to taken into consideration.

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Akech, Samuel Owuor. "Haemodynamic status and management of shock in children with severe febrile illness." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:93ce62fd-2137-4063-bb27-5443a5c7e8bc.

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Most in-hospital deaths secondary to infections in under-five deaths within sub-Saharan Africa (SSA) occur in the initial 24 hours of admission and shock has been identified as a major risk factor for the early deaths. However, controversies exist on the appropriate clinical diagnosis of shock, choice of ideal fluid for resuscitation (crystalloid or colloid), and safety of fluid resuscitation in severe malnutrition or severe malaria. This thesis investigates these aspects and also reviews the evidence base of current paediatric fluid resuscitation guidelines for children (aged >60 days and ≤12 years) with severe febrile illnesses. Capillary refill time >2 seconds, weak pulse volume, or bradycardia, in the presence of abnormal temperature and severe disease are predictive of impaired perfusion (defined by lactic acidosis) and death. Tachycardia and temperature gradient are neither associated with increased risk of death nor predictive of hypoperfusion. Existing international definitions of shock have low sensitivities (FEAST=44%, WHO=2%, and ACCM=59%) and high specificities (FEAST=82%, WHO=100%, and ACCM=66%) for diagnosis of impaired perfusion. Clinical criteria derived (called derived shock) had a sensitivity of 30% and specificity of 93%. Shock in children with severe febrile illnesses in Kilifi has a complex presentation but mainly presents with hyperdynamic circulation (high cardiac index) and vasodilatation. Cases with low cardiac index (myocardial dysfunction) are relatively rare but increase the risk of mortality when present. Synthetic colloids (gelofusine, hydroxyethyl starch 130/0.4 (HES), and dextran 70) are safe for use in fluid resuscitation in children with severe malaria. However, HES is the most promising compared to other synthetic colloids concerns still remain about its renal safety. However, further evaluation of synthetic colloids for treatment of shock is not warranted due to the findings of FEAST trial. A Pilot trial shows that bolus isotonic fluids are safe, have better efficacy, and produce faster resolution of shock compared to low-sodium solutions at volumes and rates recommended by WHO in children with severe malnutrition. Evidence available from all ten the trials in children with sepsis show that fluid resuscitation using crystalloids and colloids result in similar survival. However, fluid bolus resuscitation results in increased mortality compared to no bolus (control) in children in SSA. This finding excludes children with gastroenteritis, trauma, burns, and malnutrition. Colloids are better than crystalloids for severe dengue shock but both have similar efficacy in moderate dengue shock.

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Loots, Reginald. "Factors associated with malnutrition amongst children six months to five years of age in a semi-rural area of the Western Cape." Thesis, Cape Peninsula University of Technology, 2019. http://hdl.handle.net/20.500.11838/3079.

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Thesis (MTech (Health and Science))--Cape Peninsula University of Technology, 2019
Malnutrition is a global concern and particularly in children. It impacts negatively on mortality, morbidity, educability and productivity, and it affects millions of children in South Africa. As part of our Millennium Development Goals set by the Department of Health and WHO, it is vital to combat malnutrition by eradicating extreme poverty and hunger. Malnutrition is regarded as a change in nutritional status that carries the penalty of illness, dysfunction or death. Child malnutrition poses one of the biggest challenges in South Africa according to the WHO and has been well documented over the past 20 years. A lack of knowledge from parents or caregivers on the nutritional needs of children and the levels of poverty contribute to childhood malnutrition; the extent of hunger has also been associated with low energy intake, low micronutrient intake and poor income levels. This affects growth patterns negatively. Thus, this study aims to examine the key factors that are causing malnutrition in children in a semi-rural community in the Western Cape. A combination of both qualitative and quantitative research approaches were used. Qualitative data were collected through group interviews and quantitative data were collected through a self-administered questionnaire from 105 parents and caregivers. Thematic content analysis was used for qualitative data analysis and SPSS was used to analyse the quantitative data. The results revealed that the associated factors to malnutrition amongst children six months to five years of age included obesity, underweight, stunting, severe acute malnutrition and moderate acute malnutrition. The results further indicated that the majority of households were single mothers with low income and a poor educational background. This study recommended that health education and health promotion should be done at all heath facilities with regular intervals as well as within the community. Authorities should provide a platform for all clinicians to go for regular updates and to participate in continuous development programmes to combat malnutrition. The findings of this study could contribute to the existing body of knowledge with regard to the factors that contribute to malnutrition. The results could improve health care practices in the communities of the Western Cape and the South African context at large.

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Olsson, Maja, and Nilsson Julia Söndergaard. "How to work with parents of malnourished children : The experience of six Kenyan nurses." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-16991.

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Background In Nyanza in western Kenya are 30,5% of children estimated as malnourished. It is a family situation that nurses often come in contact with. Therefore it is of interest to know how nurses work with parents of malnourished children when they have a significant role in developing the family's knowledge and child health. Aim. The aim is to investigate how nurses experience that they are working with parents of malnourished children. Method. Semi-structured qualitative interviews with a life-world approach were conducted. All respondents work at St. Joseph Mission Hospital. Results. The study shows the nurses long-term goal was to change parents thought patterns regarding their situation and the role nutrition play in it. To identify each family's uniqueness is crucial to this change, the identification determines the content of the relationship and nurses' attitudes. Providing security, knowledge about nutrition, participation in the caring of the child and a personal relationship with the parents of malnourished children, are important elements in the relationship. The reflection of the nurses also constitute a significant part of the work. Discussion. The nurses work to guide parents to a change in thought patterns and can be viewed as individually foundation stones for how nurses work with parents of malnourished children. The essence is changing the parents thought patterns about their behavior, perception and knowledge regarding nutrition. To achieve optimal results, it requires that the nurse works self-reflectively, with openness and attention and that nurses design education individually. Clinical implications. How the Kenyan nurses works to distinguish empathy and sympathy in practice, can be a useful reflection in health care in Sweden. In the nurses attitudes and actions, they use their emotions to create a personal and professional relationship. The Kenyan nurses' ways of dealing with their emotions, can create new alternative approach among Swedish nurses.
Program: Sjuksköterskeutbildning

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John, Valescia Xenobia. "Factors Affecting Inadequate Growth During Early Childhood in Guyana, South America." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4456.

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Children under 5 years of age in Guyana are at an increased risk for inadequate growth. According to the United Nations Development Programme, 1 out of 3 children of preschool age are undernourished globally. This is a major public health concern as undernourishment in children under 5 years can lead to lifelong health complications. The study assessed the relationship between inadequate growth and urban classification in children under 5 years in Guyana, South America, after controlling for the following variables: mother's level of education, mother's age at birth of the child, household size, wealth, and marital status. The study framework combined the social ecological theory/model with concepts of malnutrition. The study used data from the 2009 Guyana Demographic and Health Survey, a quantitative, cross-sectional study. Logistic regression was used to test for a statistically significant association between inadequate growth and urban classification. There was a statistically significant bivariate relationship between inadequate growth and urban classification, which was no longer significant after controlling for sociodemographic covariates. Age, OR = 0.98; 95% CI = 0.96, 1.00; p =.033 was marginally significant and wealth, OR = 0.54; 95% CI = 0.37, 0.80; p = .005 were statistically significant, after controlling for sociodemographic covariates. There was a significant relationship between urban classification and mother's age at birth of child, mother's level of education, wealth quintile, and marital status. This study, which identified the need for targeted interventions, such as education, job placement, adequate housing, and appropriate nutrition, based on mother's age and wealth, will lead to positive social change in Guyana.

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Monárrez-Espino, Joel. "Health and nutrition in the Tarahumara of Northern Mexico : studies among women and children /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3987.

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Ross-Suits, Hannah Murphy. "Maternal Autonomy as a Protective Factor in Child Nutritional Outcome in Tanzania." Digital Archive @ GSU, 2010. http://digitalarchive.gsu.edu/iph_theses/99.

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Child malnutrition is a problem in all countries and centers in poorer communities. Biological and socioeconomic factors alike contribute to malnutrition with recent studies focusing on aspects of maternal autonomy as an influencing factor. In this study, maternal autonomy is defined as the independence in her actions and control over resources a mother has within her household and is made up of several factors, including decision-making power, opinion of domestic abuse, and financial independence. Child nutritional outcomes were operationalized using the anthropometric measures height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ). For this study, the 2004-2005 Tanzanian Demographic and Health Survey (DHS) dataset was examined using weighted logistic regression in SPSS version 17. After controlling for sociodemographic covariates, the only maternal autonomy variable which was statistically associated with child nutritional outcome (associated with height-for-age) was if the mother had final say in decisions regarding her own healthcare (OR=0.857, 95% CI=0.749-0.980). Sociodemographic variables which were statistically associated with child nutritional outcome were child age (older children had higher odds ratios for stunting and lower odds ratios for wasting), child gender (being female was a protective factor against stunting and underweight), duration of breastfeeding (intervals longer than 24 months had higher odds ratios for stunting, wasting, and underweight), and family’s position in the wealth index (being in the richer and richest quintiles were protective factors against stunting and underweight). While further research is needed to examine other influencing factors such as sanitation, diet, and disease prevalence, decision-making power regarding a mother’s own healthcare is an important factor that may influence her ability to meet the nutritional needs of her children. This implies that public health professionals may want to look into avenues by which maternal autonomy may be enhanced for possible interventions to improve child nutritional status in Tanzania.

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Chuproski, Paula. "Práticas alimentares de crianças menores de dois anos de idade em Guarapuava-PR: experiências do cotidiano." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-01042009-111140/.

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As práticas alimentares maternas constituem um dos fatores primordiais para o adequado estado nutricional das crianças e para o seu pleno crescimento e desenvolvimento. Entretanto, elas são influenciadas pela questão socioeconômica, escolaridade materna, acesso a serviços de saúde e pelos valores e crenças do entorno cultural das famílias. Os objetivos deste estudo foram descrever as práticas alimentares de crianças menores de dois anos de idade com baixo peso e baixa estatura para a idade em seguimento em unidades de saúde e analisar relatos maternos acerca da alimentação e desnutrição infantil. Foi realizado um estudo exploratório descritivo com abordagem qualitativa, buscando uma aproximação com os sujeitos pesquisados e um olhar para as experiências maternas no cotidiano. O estudo foi desenvolvido na cidade de Guarapuava-PR e os participantes foram oito crianças, na faixa etária dos 6 aos 24 meses de idade, e suas mães. As técnicas de investigação foram a observação participante e a entrevista semi-estruturada e, a partir da análise temática, buscou-se apreender as estruturas de relevância das práticas alimentares observadas e dos relatos maternos, agrupando em quatro temas: As crianças e mães estudadas, A alimentação da criança no cotidiano dos domicílios, A alimentação na infância: âmbito familiar e social, A alimentação e o cuidado à saúde da criança. Foi possível apreender as características maternas e das crianças, do ambiente e da família; aspectos sobre a história da amamentação, introdução de alimentos complementares, a alimentação da criança, destacando quem prepara, o que prepara, como prepara, os horários, rotinas e local; a alimentação da família, mostrando como ela é diferenciada da alimentação da criança, a situação social das famílias, particularmente com relação à disponibilidade de alimentos nos domicílios, e os programas e equipamentos sociais aos quais as crianças estão vinculadas; além de aspectos ligados à interação entre mães e crianças nos momentos da alimentação, cuidados e percepção das mães com relação à saúde e ao estado nutricional das crianças. Observou-se que a alimentação das crianças era monótona, predominantemente láctea no café da manhã e lanches, e no almoço com alimentos considerados básicos, como arroz, feijão, macarrão, batata e algumas vezes carnes; as hortaliças e frutas eram escassas. Neste estudo, houve um entendimento de que o estado nutricional da criança está ligado a vários aspectos, relativos à amamentação, introdução de alimentos complementares em idade oportuna, alimentação adequada em quantidade e qualidade, higiene, situação social da família, programas sociais e políticas públicas abrangentes, cuidados cotidianos e com a saúde. As famílias trazem valores de sua cultura, que nem sempre estão em consonância com as recomendações dos organismos internacionais e nacionais sobre a saúde e alimentação das crianças. Conhecer o ambiente onde as famílias vivem, a situação de vida e os seus valores e crenças pode ajudar os profissionais de saúde na promoção de práticas alimentares saudáveis e no direcionamento do tratamento de distúrbios nutricionais. Essa aproximação a uma realidade contextualizada e compartilhada pode trazer elementos ricos para a integralidade da atenção à saúde da criança e sua família.
The maternal feeding practices are one of the essential factors for the children\'s right nutritional state as well as for enhancing their physical development. However, they are influenced by the socioeconomical background, the maternal schooling, the access to health public services and by the values and beliefs of the home environment. This work aims to depict the feeding practices of children under 2 years and who have low weight and height for their age. The survey was carried out through observation in Health Units as well as through the analysis of accounts about undernourished children and their feeding. An investigative and descriptive study with a qualitative research was undertaken in order to obtain more detailed and more accurate information about the people who were being investigated and also to have a look at the maternal experience in daily life. This approach was carried out in the City of Guarapuava-PR and the people who joined in it were eight children whose age group was from 6 to 24 months of age and their mothers. The investigation techniques used were the participant observation and semi-structured interviews and, from the thematic analysis, the research intends to seize the significant structures connected with the feeding practices observed and with the maternal reports, ranking them in four subjects: The children and mothers studied, The children\'s feeding in their home\'s daily life, The feeding during the childhood in the family and social circle, The child\'s health care. It was possible to understand the home environment and the surroundings features; to have information on the breastfeeding story, on the introduction of complementary food, as well as on the baby\'s feeding highlighting who prepares it, what is prepared, how it is prepared, the time when it is prepared, the routines and places. The study also enabled to know about the family\'s feeding pointing out how it is different from the child\'s feeding and about the social situation of the families, especially when it is related to the availability of food in the residences, about the social benefit plans people got; furthermore it was possible to check aspects linked with the interaction among the mothers and the children during the feeding, the mother\'s care and awareness of the children\'s health and nutritional condition. It was noted that the children\'s diet was fairly routine with a prevailing consumption of milk for breakfast; snacks and basic food like rice, beans, pasta, potato and sometimes meat for lunch; vegetable and fruit were hardly ever consumed. From this study one is able to realize that the child\'s nutritional condition is connected with many aspects related to the breast-feeding, the introduction of complementary food in the appropriate age, the correct quantity and quality in feeding, the hygiene, the family\'s social situation, the social benefit plans and comprehensive government\'s policies, ordinary cares for the health. Families bring values from their background that not always follow practices recommended by National and International Organizations on children\'s daily cares for the health. It may be useful to health care professionals to know the surroundings where these families live, their life situation, values and beliefs so that it will be easier to establish healthy diet habits and to treat nutritional disorders. This approach is a reality inside a context and if it is shared it can help to have a broader look at the family\'s and at the kids\' health.

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Jesson, Julie. "Malnutrition et infection pédiatrique par le VIH en Afrique de l'Ouest." Thesis, Bordeaux, 2016. http://www.theses.fr/2016BORD0308/document.

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Les enfants infectés par le VIH en Afrique subsaharienne sont exposés à un risque de malnutrition élevé au cours de leur vie. Or, les données sur la nutrition chez ces enfants sont encore limitées en Afrique de l’Ouest. L’objectif global de cette thèse est d’étudier la relation entre nutrition et infection par le VIH, chez les enfants infectés vivant en Afrique de l’Ouest. Plus spécifiquement, il s’agit d’estimer la prévalence de la malnutrition, de décrire l’évolution de la croissance après l’initiation du traitement antirétroviral, et d’évaluer des interventions nutritionnelles à intégrer au sein de la prise en charge pédiatrique du VIH. Les principaux résultats montrent une prévalence élevée de la malnutrition chez ces enfants, proche de 50 % avant la mise sous traitement antirétroviral. L’initiation du traitement a des effets positifs sur la croissance, d’autant plus important que l’initiation se fait de façon précoce. Un déficit pondéral est plus facilement corrigeable qu’un déficit statural, mais une part non négligeable d’enfants continue d’être malnutrie même après deux ans de traitement. En complément du traitement antirétroviral, des interventions de soutien nutritionnel sont donc nécessaires pour lutter contre la malnutrition chez ces enfants. Celles évaluées sont efficaces pour ceux malnutris aigues, mais pas pour ceux avec une malnutrition chronique. De plus, la croissance peut être un marqueur utile de la progression du VIH pédiatrique.L’intégration de la prise en charge nutritionnelle au sein de la prise en charge globale du VIH pédiatrique est possible en Afrique de l’Ouest, mais d’autres études et des actions de plaidoyer sont à développer pour l’adapter au mieux
HIV-infected children in sub-Saharan Africa are exposed to high risk of malnutrition duringtheir life. However, data on the nutrition of HIV-infected children are still limited in West Africa.Thus, the main objective of this thesis is to better investigate the link between nutrition and HIVinfection among HIV-infected children in West Africa. More specifically, it is aimed to estimate theprevalence of malnutrition, to describe growth evolution after antiretroviral treatment initiation, andto assess proposed nutritional interventions to integrate to pediatric HIV care. The main results showa high prevalence of malnutrition among these children, around 50% before antiretroviral treatmentinitiation. This initiation had positive effects on growth evolution; all the more important whenantiretroviral treatment is early initiated. Weight deficiency is easier to recover than heightdeficiency, but a substantial part of children stay malnourished even after two years of treatment. Inaddition to antiretroviral treatment, nutritional support interventions are needed to fight againstmalnutrition among these children. Those assessed were efficient for acute malnourished children,but not for those with chronic malnutrition. Furthermore, growth could be a useful marker of HIVprogression. Integration of nutritional care into global pediatric HIV care is possible in West Africa,but further studies and advocacy work have to be developed to better adapt it

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47

Doudou, Halidou Maïmouna. "Impact d'une supplémentation en spiruline chez les enfants malnutris sévères dans le cadre de la réhabilitation nutritionnelle: esai clinique randomisé en double aveugle." Doctoral thesis, Universite Libre de Bruxelles, 2008. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/210410.

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Introduction

Près de 842 millions de personnes dans le monde sont toujours sous- alimentées ou exposées à une insécurité alimentaire chronique. Or une consommation insuffisante en protéines et en calories, ainsi que les carences en micronutriments ont un impact majeur sur la morbidité et la mortalité, en particulier chez les enfants. On estime qu’entre 2000 et 2005 le nombre d’enfants présentant une insuffisance pondérale a augmenté dans la plupart des régions d’Afrique sub saharienne, alors qu’il diminuait dans toutes les autres régions en développement. Il est plus que nécessaire de chercher des solutions efficaces et économiquement adaptées pour la prise en charge de la malnutrition.

De nos jours, plusieurs ONG et associations humanitaires proposent la spiruline, comme «une solution efficace et durable aux problèmes de la malnutrition» et encouragent les projets de culture artisanale de spiruline dans le monde et particulièrement les pays en développement comme le Niger. Les effets bénéfiques attribués à la spiruline comme complément alimentaire dans la récupération nutritionnelle sont multiples: elle est considérée comme une cyanobactérie, riche en protéines, en acide gras, en minéraux, en vitamines et contient de la chlorophylle, des fibres et un pigment bleu (la phycocyanine).

L'objectif général de notre travail est d’étudier l’impact de la supplémentation en spiruline chez des enfants en malnutrition sévère lors de la récupération nutritionnelle.

Méthodologie

Ce travail a regroupé quatre types d’études:

• Une revue secondaire sur les données nutritionnelles issues des enquêtes démographiques et de santé au Niger et certaines enquêtes et rapports ponctuels sur la nutrition afin de déterminer l'évolution de la prévalence de la malnutrition des enfants de moins de 5 ans et d'identifier les facteurs déterminants de cette malnutrition;

• Une revue systématique/meta analyse des études sur la supplementation en spiruline en milieu hospitalier pour évaluer dans quelle mesure la spiruline utilisée comment supplément alimentaire a un effet bénéfique sur la réhabilitation nutritionnelle;

• Une étude d’observation à visée descriptive et analytique dans deux centres de récupération nutritionnelle intensive (CRENI) en milieu hospitalier au Niger ;

• Un essai clinique randomisé en double aveugle dans trois centres de récupération nutritionnelle afin d’étudier l'impact de la supplémentation en spiruline sur la mortalité, la morbidité, les mesures anthropométriques et les mesures biologiques d'enfants en malnutrition sévère hospitalisés dans des CRENI au Niger.

Résultats

La revue des données existantes sur la nutrition au Niger a montré que la prévalence de l’émaciation (Z-score poids/taille <-2)) des enfants a dépassé depuis 1992 le seuil critique de 10% défini par l'OMS, avec stagnation entre 1998 et 2000 et légère augmentation entre 2004 et 2005. La prévalence du retard de croissance staturale (Z-score taille/âge <-2) était en augmentation depuis 1992. Les facteurs identifiés, favorisant la malnutrition des enfants sont multiples: le niveau socio-économique bas des parents, les caractéristiques des enfants (sexe masculin, âge plus élevé), les pratiques alimentaires (non allaitement), les morbidités et les aléas climatiques.

Dans les centres de récupération nutritionnelle intensive (CRENI), Le marasme était le type de malnutrition le plus fréquent (68,7%). La mortalité était de 14,5% et le modèle de régression logistique montrait que le risque de décès était plus élevé chez les enfants de moins d’un an [(OR ajusté (IC 95%): 2,8 (1,9 – 5,8)] et chez ceux de périmètre brachial < 11,5 cm [1,5 (1,7 – 4,0)]. Les résultats ont montré que quand l’âge de l’enfant augmentait, le Z-score taille/âge diminuait en moyenne alors que le Z-score poids/taille augmentait. L’augmentation du nombre d’hospitalisations antérieures était associée à une diminution des Z-scores taille/âge et poids/âge. On observait également que le Z-score poids/taille était significativement plus bas chez les garçons et chez les mères avec BMI de < 18,5 kg/m². La prise en charge médicale et diététique dans ces CRENI avait permis un gain de poids moyen de 12,9g/kg/j.

En se référant aux normes OMS, les apports énergétiques apportés par les aliments utilisés ne permettaient pas de couvrir les besoins des enfants en récupération. Les types d’aliments utilisés étaient le lait thérapeutique F100 et une farine de mil fabriqué localement « vitamil ».

La supplémentation en spiruline chez des sujets malnutris a été étudiée par certains auteurs.

La revue de 7 études (3 essais contrôlés randomisés et 4 essais non contrôlés) a permis de constater que la supplémentation en spiruline avait un effet positif sur un certain nombre de paramètres comme le poids, le périmètre brachial, la taille, l’albumine, le pré albumine, les protides et l’hémoglobine. Cependant, il faut noter que ces études n’avaient pas le même protocole et n’étaient pas homogènes, Une méta analyse ne permettait pas alors d’avoir des résultats fiables.

L’essai clinique randomisé en double aveugle de supplémentation en spiruline chez des enfants en malnutrition sévère a donné les résultats suivants :

La proportion de décès était de 8,5% dans le groupe spiruline et 13,5% dans le groupe placebo, mais la différence n'était pas significative (P = 0,12). Néanmoins la survie étaitµ meilleure dans le groupe spiruline et la durée de la diarrhée était significativement réduite par la supplémentation en spiruline.

La durée médiane d'hospitalisation était significativement inférieure dans le groupe spiruline: Med (min - max): 16 (8 - 51) par rapport au groupe placebo: Med (min - max): 23 (7 - 60) (P Log Rank < 0,001). La fonte des oedèmes était significativement plus rapide dans le groupe spiruline: Med (min - max): 5 (3 - 12) versus Med (min - max): 6 (1 - 21) dans le groupe placebo (P Log Rank = 0,05). Les effets de la suppléméntation en spiruline sont plus importants sur le gain pondéral moyen (p<0,001) et le gain en périmètre brachial (p<0,001) que sur le gain statural (NS).

L’effet de la spiruline semble être minime sur l’évolution du taux d’albumine (proportion d’enfants dont le taux s’était normalisé :15,7% groupe spiruline versus 11,2% groupe placebo (NS), mais plus efficace sur le taux des enfants ayant présenté des oedèmes à l’admission. L’évolution du taux d’hémoglobine était statistiquement meilleure dans le groupe spiruline (proportion d’enfants dont le taux s’était normalisé :44,9% versus 33,3% groupe placebo, P = 0,010) particulièrement chez les enfants de moins de 24 mois. Les gains d’albumine et d’hémoglobine n’étaient pas corrélés au gain du poids.

Cet essai a montré que les densités parasitaires (plasmoduim falciparum) sanguines à l’admission à J3 et à J7, ne différaient pas de façon significative entre le groupe spiruline et le groupe placebo. Les enfants admis avec toux et diarrhée guérissaient plus rapidement dans le groupe spiruline que dans le groupe placebo. Le gain de poids à la sortie d’hospitalisation était meilleur dans le groupe spiruline chez les enfants VIH positif. Le passage du taux de CD4 à une valeur &61619;500/mm³ à J56 était dans 43% des cas attribuable à la supplémentation en spiruline chez les enfants VIH positif (NS). Tous les enfants qui avaient un taux de CRP >20 mg/l à l’admission, avaient diminué leur taux (CRP &61603;&
Doctorat en Sciences médicales
info:eu-repo/semantics/nonPublished

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Hjalmarsson, Julia, and Karin Kjernald. "Indian nurses’ experiences of supporting parents of children with cleft lip and palate : A minor field study." Thesis, Högskolan i Borås, Institutionen för Vårdvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-17902.

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The aim of this study was to describe the nurses’ experiences of supporting parents whose children are subjects of the Nutrition Program at Guwahati Comprehensive Cleft Care Center. Cleft lip and palate are congenital malformations of the face, where nose, lip and/or upper jaw fail to coalesce adequately in utero, creating a gap. The organization Operation Smile provides free reconstructive surgery to children with facial malformations. The Guwahati Comprehensive Cleft Care Center in Assam was founded with the knowledge that the population in this area is largely underserved in relation to the care of these patients. Children with clefts are commonly malnourished; children who suffer from moderate or severe malnutrition are prone to infectious complications associated with surgical procedures. To enhance patient safety and improve the chances of successful interventions, the Operation Smile India Nutrition Program was started in 2011. The parents of children who are enrolled in the Nutrition Program get education by trained nurses. The education contains thorough information on how children can best assimilate nutrition and how their diet should be designed at different ages. There is a lack of studies about the nurse’s experiences of supporting the parents on this matter. It is of great interest to examine nurses’ experiences of supporting the parents of children with cleft lip or palate. The study was based on a qualitative approach, and semi-structured interviews were conducted with six nurses. The interviews were transcribed and the material was analyzed with qualitative content analysis. Three categories were discerned in the transcribed material: Caring actions, Education and Creating trust. Each category is followed by a number of subcategories. The findings show that the relationship to the parents was crucial for the nurses’ supporting actions to succeed. In the discussion, certain aspects of the findings are highlighted, such as the nurses’ emotional involvement and their way of admonishing the parents. Some aspects of the nurses’ work with supporting the parents are applicable to nurses’ work with next of kin anywhere in the world.
Program: Sjuksköterskeutbildning

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Hecht, Christina Barbara [Verfasser], and Berthold [Akademischer Betreuer] Koletzko. "Malnutrition prevalence, screening and outcome in hospitalised children in Europe: a prospective multicentre cohort study / Christina Barbara Hecht ; Betreuer: Berthold Koletzko." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2019. http://d-nb.info/1202011829/34.

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Serrem, C. A. (Charlotte Atsango). "Development of soy fortified sorghum and bread wheat biscuits as a supplementary food to combat protein energy malnutrition in young children." Thesis, University of Pretoria, 2010. http://hdl.handle.net/2263/25565.

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Protein Energy Malnutrition (PEM) due to under nutrition is a major public health problem among children in Africa and other developing countries. Sorghum and bread wheat, which are important dietary staples in the semi-arid tropics of Africa, are suitable vehicles for delivering proteins to alleviate PEM. Formulation of foods from these low-lysine staples fortified with legumes is a sustainable approach to improve the protein nutritional quality of foods for young children. Biscuits offer a valuable vehicle for fortification as they are nutrient dense, ready-to-eat, have a long shelf-life and are popular. Therefore, this study investigated the effect of complementing sorghum and bread wheat with defatted soy flour on the nutritional and sensory quality and consumer acceptability of biscuits. Biscuits were formulated and developed by compositing sorghum and bread wheat flours with defatted soy flour at different ratios. To establish the nutritional characteristics of biscuits, proximate composition, lysine and reactive lysine contents and in vitro protein digestibility were determined. Protein Efficiency Ratio (PER), Food Efficiency Ratio (FER) True Digestibility and Biological Value (BV) of sorghum biscuits were determined using Sprague Dowley weanling male rats. The sensory characteristics of biscuits were evaluated using a descriptive panel and instrumental texture analysis. Acceptability was evaluated using eight to nine year old school children. Compared to the 100% cereal biscuits, sorghum-soy and bread wheat-soy composite biscuits in a 1:1 ratio had at least double the protein, mineral and crude fibre contents. The lysine contents of biscuits increased by 500-700%. For the sorghum-soy biscuits, in vitro protein digestibility increased by 170% and Protein Digestibility Corrected Amino Acid Score (PDCAAS) was 8 times higher. Two such biscuits of 28 g each could provide 50% of the recommended daily protein intake for 3 to 10 year olds. In the animal study, PER and FER for sorghum-soy biscuits were equivalent to the reference casein. True Digestibility was high for all diets, 85 to 95% and BV of sorghum biscuits was higher than sorghum-soy diet by 20%. Principal Component Analysis (PCA) revealed that 61% and a further 33% of the variation in sensory properties was due to the type of cereal and concentration of soy in biscuits, respectively. Maximum stress increased by 39% and 34% in sorghum-soy and bread wheat-soy biscuits, respectively at 1:1 ratio. Spread factor of biscuits increased by 7 to 32%. Biscuits were darker in colour (reduced L* value) by 14 to 56% and hardness increased by 84% in sorghum biscuits. Positive hedonic scores by 8 to 9 year old school children for fortified biscuits were sustained above 80% through 8 consumption occasions. This data shows that fortifying with defatted soy flour imparts positive sensory characteristics associated with biscuits to sorghum and bread wheat biscuits and the acceptance of such biscuits may be sustained over an extended period of time. This study indicates that soy fortified sorghum and bread wheat biscuits have high nutrient density, protein quality, positive sensory properties and high acceptability if consumed over an extended period. Hence, the biscuits have great potential as protein-rich supplementary foods to alleviate PEM among children and to provide an income to small holder farmers in rural African communities through purchase of grain for the Home Grown School Feeding Programme.
Thesis (PhD)--University of Pretoria, 2011.
Food Science
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