A prospective cohort study followed a group of Malawian children for 15 years after treatment in hospital for severe disease malnutrition childish. The study compares the health outcomes of this group (now adolescents and young adults) with those of similarly aged siblings and peers from their communities who did not suffer severe undernutrition as children. Researchers are calling for action to save lives in the short term and ensure the long-term health, development and well-being of surviving children.
THE new results of one of the few studies reporting long-term health outcomes for children with severe malnutrition were published on February 15, 2024 in The Lancet Child and Adolescent Health. The article is titled “Long-term outcomes after severe childhood malnutrition in Malawian adolescents (LOSCM): a prospective observational cohort study.”
Severe malnutrition: the effects on health
Very few other studies have been able to monitor a vulnerable group like this for such a long period of time. With malnutrition currently in the news in numerous countries, and the topic receiving significant attention following the July 2023 release of new World Health Organization (WHO) guidelines on malnutrition, the project is particularly timely and important.
The researchers, led by the University of Liverpool and working in collaboration with a number of collaborators including the London School of Hygiene & Tropical Medicine, the Malawi-Liverpool Wellcome Trust Clinical Research Program and Kamuzu University of Health Sciences, Malawi, followed and studied the health outcomes of 168 adolescents with prior severe childhood malnutrition, along with 123 siblings and 89 community adolescents without prior severe malnutrition.
Overall, the researchers summarized that a very large number of subjects with severe childhood malnutrition died in the years following discharge from care, and that survivors had persistent adverse effects of shorter height and possibly less strength than those without prior severe malnutrition. However, survivors showed catch-up growth throughout childhood and beyond, which provides optimism for continued recovery of height deficits after treatment.
The researchers suggest that these findings highlight the importance of supporting the nutrition, health and wellbeing of those suffering from severe childhood malnutrition after discharge from care and the need to address adverse life circumstances during early childhood and childhood. adolescence.
Dr Marko Kerac of the London School of Hygiene & Tropical Medicine said: “While we are happy to see that the health and growth of our survivors of child malnutrition in 2006/7 appears to be in line with that of their siblings and peers in the community, it is critical to see these findings in context.
“Over 1,000 children were initially admitted to our treatment program for severe malnutrition. Many died during the program and in the months and years that followed. It is therefore particularly tragic that the world has not made much progress since that food crisis 15 years ago. With climate crises and conflicts, there are millions of children who still suffer from hunger and malnutrition today.
“Urgent action is needed, not just to save lives in the short term, but to ensure the long-term health, development and well-being of all survivors. The prevention and treatment of child malnutrition must never be seen as a cost but as an investment in the future of individuals, societies and entire countries.”
Lead researcher Dr Amir Kirolos from the University of Liverpool and the Malawi-Liverpool-Wellcome Trust said: “Prevention, early identification and treatment of severe childhood malnutrition saves lives. Our study shows the importance of addressing other adverse factors alongside the treatment of severe malnutrition.” Poverty, hunger and living with HIV were common in our study and affect too many children and adolescents in Malawi and around the world.
“We need further research and investment to address these adverse factors and all forms of child malnutrition. This will allow affected children to not only survive, but thrive, reaching their full potential in the long term.”
While this cohort found no clear evidence of cognitive impairment or a higher risk of cardiometabolic disease, the group is still young, and researchers recommend that further research is needed in Malawi and other settings to better understand long-term health risks term as they develop. adulthood.
Further studies and investments are needed to improve the home and living conditions of people in need to improve the long-term health outcomes of millions of children around the world who currently suffer from malnutrition.
Three reports from Queen Mary University of London have provided valuable insights into the management of severe acute malnutrition (SAM), the most life-threatening form of malnutrition for children.
Researchers have found that the home environment influences how children recover from severe acute malnutrition because they are usually sent back to the same home environments that contribute to poor health in the first place.
The study builds on previous research conducted in Zimbabwe and has broadened the focus to include areas of Lusaka, Zambia, and Migori and Homa Bay counties, Kenya, to see if researchers can draw parallels between these settings. Indeed, similar themes emerged from the qualitative analysis at all levels.
Research supported by the National Institute for Health and Care Research (NIHR) has found that supportive home and care environments are vital for children to survive and thrive, as children often leave hospital before multiple body systems fully recover and they are usually discharged back to hospital. the same domestic environment.
The study also highlighted how complex cases of malnutrition are as it is a condition that can be attributed to broader socioeconomic factors, significantly entrenched poverty, as well as the individual behaviors of health workers. Alongside acute medical care, interventions for entire communities through education and training, the creation of support networks and opportunities for income-generating activities should also be considered.
Isabella Cordani, project coordinator at the Center for Genomics and Child Health and project coordinator at the Blizard Institute at Queen Mary, said: “Although there are comprehensive WHO guidelines on the management of SAM in children, the focus is to antibiotics, nutrition therapies and fluid management.
This medical fo
cus fails to appreciate the multiple social and environmental factors of ill health. Significantly, healthcare professionals may not be able to follow the medical advice they have been given while grappling with significant challenges in other areas of life.
Professor Tim Brown, professor of global health geography at Queen Mary, said: “What was surprising about the findings were the similarities between the three countries studied. For example, in all three countries mothers tended to delay seeking health care at clinics for their malnourished children.” Most of the time they sought advice from traditional healers or religious leaders before going to the clinic, and sometimes this led to life-threatening delays.
“Another example of the similarities between countries is the experience of social stigma and shame. Many mothers reported experiencing various forms of stigmatization – being laughed at and the subject of gossip – because their child was malnourished. Furthermore, there was some shared experience of being blamed for their children's malnutrition during hospital admission.
Social stigma and shame have led some mothers or other caregivers to attempt to hide their children's conditions, refuse treatments associated with malnutrition, or delay taking their children to a clinic. This happened especially for the youngest mothers.”
Some patients seen at an inflammatory bowel disease (IBD) clinic test positive for malnutrition, according to a research letter published online in Gastro Hep Advances.
Aaron C. Viser, MD, of the University of North Carolina at Chapel Hill, and colleagues used data from a multidisciplinary inflammatory bowel disease clinic (June 7 to July 19, 2022) of 237 adult patients with confirmed or confirmed Crohn's disease. ulcerative colitis (UC) presenting for a routine visit, clinical care of person being screened for malnutrition using the Malnutrition Screening Tool (MST).
The researchers found that administering the screening took two to three minutes per patient, with 14% screening positive for malnutrition (Crohn's disease: 15%; UC: 12%).
Among patients with inflammatory bowel diseases tested positive for malnutrition, being a new consultation; have a normal body mass index, active disease, and a history of smoking; and taking corticosteroid or aminosalicylate drugs was more common. The prevalence of a positive screen was higher (28%) among patients with active disease and lower (8%) among patients in remission.
After adjusting for age and sex, IBD patients with active disease were more likely to screen positive for malnutrition than those in remission (odds ratio [OR], 4.6; 95% confidence interval [CI], from 2.1 to 10.2). A positive screen was also more likely among former smokers (OR, 2.4; 95% CI, 1.0 to 5.7) and current smokers (OR, 2.3; 95% CI, 1.0 to 5.7). 0.4 to 12.3) compared to non-smokers.
“The validated three-question MST could be easily implemented into routine clinical care in an inflammatory bowel disease clinic with the goal of providing same-day dietitian support to patients at risk of malnutrition,” the authors write.
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