Menu ENN Search

Kenya and Malawi: Intestinal disturbances and mortality in complex malnutrition cases

View this article as a pdf

Lisez cet article en français ici

This is a summary of the following paper: Wen B, Farooqui A, Bourden C et al. (2023) Intestinal disturbances associated with mortality of children with complicated severe malnutrition. Communications Medicine, 3, 128. https://link.springer.com/article/10.1038/s43856-023-00355-0

 

Children with ‘complicated’1 severe malnutrition have particularly high mortality rates. Some evidence points to a relationship between intestinal dysfunction and these poor outcomes, but this has yet to be tested. This nested case-control study sought to evaluate this relationship by testing faecal samples2 from participants at study admissions (before treatment), then sorting participants by non-survivors (cases) and survivors (matched controls) for analysis.

Subjects were enrolled from an existing randomised controlled trial in Kenya and Malawi (Bandsma et al., 2019) and defined as children (aged 6 months to 13 years), with Mid Upper Arm Circumference (MUAC) <11.5cm, or weight-for-height z-score <-3 (aged 6–59 months) or body mass index-for-age z-score <-3 (age ≥60 months), and/or oedematous malnutrition at any age, and having medical complications or a failed appetite test according to WHO guidelines. Due to the stringent enrolment criteria, the sample size (n=68) was limited by sample availability. The study was randomised at a 1:1 ratio.

Non-survivors had a significantly higher prevalence of nutritional oedema (43%) than survivors (24%, p=0.02), with nutritional oedema increasing the odds of mortality by 140% (OR 2.4, 95% CI 1.2–5.1). The proportion of children with diarrhoea was slightly higher in the non-survivor group (54% vs 40%), but there was no significant difference in the odds ratio for mortality (OR 1.8, 95% CI 0.9–3.6). The median time to death for non-survivors was six days (IQR: 4–10). The median time to discharge for survivors was eight days (IQR: 7–11).

There were specific reductions in certain amino acids, monosaccharides, and microbial fermentation products in the non-survivor group. Although short chain fatty acid production – the main fermentation products of the gut microbiome – did not differ between groups, there was a difference in the overall faecal metabolomic signature between survivors and non-survivors. Overall, enteropathy markers did not differ between groups.

This is a small subgroup of particularly sick children, as evidenced by this sample comprising 54% of the mortality cases in the larger parent study, so these findings cannot be generalised to all cases of child malnutrition. The case-control design prevents us from determining the temporal relationship between a cause and an effect, so further studies are needed to validate these findings. The authors also note that the high variability of faecal data may have introduced confounding, although they did take steps to address this. Nevertheless, these findings indicate that intestinal disturbances may have an indirect association with acute mortality.

References

Bandsma R, Voskuijl W, Chimwezi E et al. (2019) A reduced-carbohydrate and lactose-free formulation for stabilization among hospitalized children with severe acute malnutrition: A double-blind, randomized controlled trial. PLoS Med, 16, 2. https://pubmed.ncbi.nlm.nih.gov/30807589/

Read more...

1 Complicated malnutrition refers to severely malnourished children who require hospital-based management, due to concurrent illnesses or complications.

2 Faecal metabolomic profiling was performed using nuclear magnetic resonance spectroscopy, targeting 68 commonly measured water-soluble faecal metabolites. A separate portion of the sample was used to measure faecal enteropathy markers.

More like this

FEX: Kenya et Malawi : Troubles intestinaux et mortalité en cas de malnutrition complexe

Read the article in English Cet article résume l'étude suivante : B. Wen, A. Farooqui, C. Bourden et al. (2023) Intestinal disturbances associated with mortality...

FEX: Carbohydrate malabsorption in acutely malnourished children and infants: A systematic review

Summary of research* Location: Global What we know: Diarrhoea is commonly associated with SAM; carbohydrate malabsorption may be a contributing factor. What this article...

FEX: Chronic disease outcomes after SAM in Malawian children (ChroSAM): A cohort study

Summary of research* Location: Malawi What we know: Little is known about the long-term health effects of survivors of severe acute malnutrition (SAM), particularly risk of...

FEX: Duodenal microbiota in stunted undernourished children with enteropathy

View this article as a pdf Research snapshot1 The link between environmental enteric dysfunction (EED), a disorder of the small intestine, and childhood undernutrition has...

en-net: MUAC and Mortality relationship

I have found a nutritional survey report conducted in Sudan with GAM of 27.0% and SAM of 7.5%, while the U5MR IS 1.19/10 000/day using ENA for SMART software. Does this result...

FEX: Thiamine content of F-75 for complicated severe acute malnutrition: time for a change?

Summary of research1 Location: Global What we know: Complicated cases of severe acute malnutrition (SAM) are usually severely ill with comorbidities. What this article adds:...

FEX: Postscript on measuring mortality rates in cross-sectional surveys: a commentary

Bradley A.Woodruff, MD MPH, Medical Epidemiologist International Emergency and Refugee Health Branch U.S. Centres for Disease Control and Prevention Congratulations to Mark...

FEX: Infant infection and nutrient deficiency predict impaired growth at five years: Pakistan

View this article as a pdf This is a summary of the following paper: González-Fernández D, Cousens S, Rizvi A et al. (2023) Infections and nutrient deficiencies...

FEX: Routine antibiotics for infant growth failure: A systematic review

View this article as a pdf This is a summary of the following paper: Imdad A, Chen F, François M et al. (2023) Routine antibiotics for infants less than 6 months of age...

FEX: Anthropometric predictors of mortality in undernourished adults in southern Sudan

Summary of published research1 Location: South Sudan What we know: Acute adult undernutrition tends to occur in prolonged severe famines. There is a lack of evidence on which...

FEX: Promoting linear growth when treating child wasting

View this article as a pdf This article discusses the state of evidence surrounding the treatment of wasted and stunted children considering current challenges and possible...

FEX: Relationship of maternal short stature with coexisting forms of malnutrition in Pakistan

This is a summary of the following paper: Khaliq A, Nambiar S, Miller D et al (2024) Assessing the relationship of maternal short stature with coexisting forms of malnutrition...

FEX: Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali

Summary of research1 Location: Mali What we know: Community-led total sanitation (CLTS) is being scaled up, but there is limited evidence on child health impacts. What this...

FEX: Probiotics and prebiotics for SAM in Malawi

A mother receives her child's supply of RUTF Summary of research1 A recent study set out to assess the clinical and nutritional efficacy of a probiotic and prebiotic...

FEX: Risk factors associated with severe acute malnutrition in infants under six months in India: a cross sectional analysis

By Susan Thurstans Susan is a registered nurse and midwife with over 12 years' experience in maternal and child health and nutrition programmes in both development and...

FEX: Role of intestinal dysfunction in the nutritional compromise seen in human immunodeficiency virus-infected adults in rural India

Research snapshot1 Human immunodeficiency virus (HIV) disease progression is often marked by enteropathy, which contributes to malabsorption of macro- and micro-nutrients and...

FEX: Generalised Oedema in COVID-19 Positive Children - A Case Series

View this article as a pdf Experiences on COVID-19 and nutrition captured to date in Field Exchange have been at a programme level rather than at individual case management...

FEX: Stunting and wasting in children under two years old in a semi-nomadic pastoralist population in Kenya

By Amelia Reese-Masterson, Masumi Maehara and Mark Murage Gathii Amelia Reese-Masterson is Research Advisor in the Nutrition, Food Security and Livelihoods Unit at...

FEX: Antenatal malaria prophylaxis plus iron and folic acid for child nutrition outcomes

View this article as a pdf Lisez cet article en français ici This is a summary of the following paper: Godha D, Tharaney M, Nanama S et al. (2022) The association...

en-net: Relationship between Mortality and Acute Malnutrition

In most surveys I have seen, there is a positive linear relationship between CMR/U5MR and acute malnutrition. Also, the report...

Close

Reference this page

Kenya and Malawi: Intestinal disturbances and mortality in complex malnutrition cases. Field Exchange 71, December 2023. p28. www.ennonline.net/fex/71/kenya-and-malawi-intestinal-disturbances-and-mortality-in-complex-malnutrition-cases

(ENN_7767)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.