Childhood growth during recovery from acute illness in Africa and South Asia: a secondary analysis of the childhood acute illness and nutrition (CHAIN) prospective cohort.
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Bourdon Celine, Diallo Abdoulaye Hama, Mohammad Sayeem Bin Shahid Abu Sadat, Khan Md Alfazal, Saleem Ali Faisal, Singa Benson O, Gnoumou Blaise Siézanga, Tigoi Caroline, Otieno Catherine Achieng, Oduol Chrisantus Odhiambo, Lancioni Christina L, Manyasi Christine, McGrath Christine J, Maronga Christopher, Lwanga Christopher, Brals Daniella, Ahmed Dilruba, Mondal Dinesh, Denno Donna M, Mangale Dorothy I, Chimwezi Emmanuel, Mbale Emmie, Mupere Ezekiel, Salauddin Mamun Gazi Md, Ouédraogo Issaka, Berkley James A, Njunge James M, Njirammadzi Jenala, Mukisa John, Thitiri Johnstone, Walson Judd L, Jemutai Julie, Tickell Kirkby D, Shahrin Lubaba, Mallewa Macpherson, Hossain Md Iqbal, Chisti Mohammod Jobayer, Timbwa Molline, Mburu Moses, Ngari Moses M, Ngao Narshion, Aber Peace, Harawa Philliness Prisca, Sukhtankar Priya, Bandsma Robert H J, Bamouni Roseline Maïmouna, Molyneux Sassy, Mwaringa Shalton, Shaima Shamsun Nahar, Ali Syed Asad, Afsana Syeda Momena, Banu Sayera, Ahmed Tahmeed, Voskuijl Wieger P, Kazi Zaubina
Аннотация
METHODS: We evaluated growth following hospitalization among children aged 2-23 months in sub-Saharan Africa and South Asia. Between November 2016 and January 2019, children were recruited at hospital admission and classified as: not-wasted (NW), moderately-wasted (MW), severely-wasted (SW), or having nutritional oedema (NO). We describe earlier (discharge to 45-days) and later (45- to 180-days) changes in length-for-age [LAZ], weight-for-age [WAZ], mid-upper arm circumference [MUACZ], weight-for-length [WLZ] z-scores, and clinical, nutritional, and socioeconomic correlates.
FINDINGS: We included 2472 children who survived to 180-days post-discharge: NW, 960 (39%); MW, 572 (23%); SW, 682 (28%); and NO, 258 (10%). During 180-days, LAZ decreased in NW (-0.27 [-0.36, -0.19]) and MW (-0.23 [-0.34, -0.11]). However, all groups increased WAZ (NW, 0.21 [95% CI: 0.11, 0.32]; MW, 0.57 [0.44, 0.71]; SW, 1.0 [0.88, 1.1] and NO, 1.3 [1.1, 1.5]) with greatest gains in the first 45-days. Of children underweight (<-2 WAZ) at discharge, 66% remained underweight at 180-days. Lower WAZ post-discharge was associated with age-inappropriate nutrition, adverse caregiver characteristics, small size at birth, severe or moderate anaemia, and chronic conditions, while lower LAZ was additionally associated with household-level exposures but not with chronic medical conditions.
INTERPRETATION: Underweight and poor linear growth mostly persisted after an acute illness. Beyond short-term nutritional supplementation, improving linear growth post-discharge may require broader individual and family support.
FUNDING: Bill & Melinda Gates FoundationOPP1131320; National Institute for Health ResearchNIHR201813.