Co esponding au ho : Mohammed El. A. Zayed
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Fac o s In luencing Reco e y and Mo ali y in Child en wi h Se e e Acu e
Malnu i ion (SAM): Insigh s om a The apeu ic Feeding P og am
Mohammed El. A. Zayed 1, *, Ome Saeed Magzoub 2, Yasi Abdel ahim Ali Taha ᶾ and Es a Adam Mohamed
Salih ⁴
1 Consul an Pedia ician, Facul y o Medicine and Heal h Science, Ko do an Uni e si y, Ko do an, Sudan.
2 Specialis Gene al Pedia ician a Ain Al-Khaleej Hospi al, Al-Ain, Abu Dhabi, UAE.
3 Specialis Gene al Pedia ician a Mediclinic Baniyas Hospi al, Abu Dhabi, UAE.
4 Facul y o Medicine and Heal h Science, Ko do an Uni e si y, Ko do an, Sudan.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1451-1457
Publica ion his o y: Recei ed on 10 July 2025; e ised on 17 Augus 2025; accep ed on 19 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2962
Abs ac
Backg ound: Se e e acu e malnu i ion (SAM) is a majo heal h issue in low-income coun ies, leading o high a es o
child mo bidi y and mo ali y. E ec i e ea men s, such as eady- o-use he apeu ic oods (RUTF) like Plumpy Nu , a e
essen ial o imp o ing eco e y a es. This s udy examines he sho - e m ou comes o nu i ional he apy o child en
wi h SAM a El-Obeid Specialized Pedia ic Hospi al in Sudan.
Objec i e: The main aim o his s udy was o e alua e he sho - e m esul s o nu i ional he apy o child en wi h
se e e acu e malnu i ion who we e admi ed o he The apeu ic Feeding Uni a El-Obeid Special Pedia ic Hospi al.
Me hod: This s udy was a desc ip i e c oss-sec ional analysis conduc ed om No embe 2022 o Decembe 2022. A
o al o 100 child en diagnosed wi h se e e acu e malnu i ion we e included. Da a we e collec ed using a checklis and
analyzed wi h Google Fo ms o da a managemen and s a is ical analysis.
Resul s: 100 child en unde i e wi h se e e acu e malnu i ion (SAM) we e admi ed o he he apeu ic eeding
p og am a El-Obeid Specialized Pedia ic Hospi al om No embe o Decembe 2022. O hese, 63% we e male, 61.6%
came om u al a eas, and 85.7% we e aged be ween 7 and 24 mon hs. Mos a he s we e a me s (43.4%), and many
mo he s we e illi e a e (63.9%) and housewi es (48%). Be o e admission, 60.6% o he child en had poo ood quali y.
Howe e , his signi ican ly imp o ed a e wa d, wi h 99% ecei ing high-quali y ood. The obse ed co-mo bidi ies
included dia hea (57.6%), omi ing (49.5%), pneumonia (21%), and anemia (14.4%). T ea men ollowed na ional
guidelines, wi h 75% o he child en ecei ing Ce iaxone, 73% ecei ing Zinc, and 44% ecei ing ReSoMal. The
ou comes showed ha 85% o he child en we e cu ed, 6% died, and 5% we e los o ollow-up.
Conclusion: This s udy highligh s he signi ican impac o ea ly in e en ion, nu i ional he apy, and he managemen
o co-mo bidi ies in imp o ing ou comes o child en wi h se e e acu e malnu i ion (SAM). The indings unde sco e
he impo ance o add essing socioeconomic ac o s, such as low ma e nal educa ion and poo ood quali y, as key
con ibu o s o malnu i ion. While he he apeu ic eeding p og am a El-Obeid Specialized Pedia ic Hospi al showed
posi i e esul s, including an 85% cu e a e, he e is s ill oom o imp o emen in educing mo ali y a es, which
exceeded he ecommended h eshold.
Keywo ds: The apeu ic Feeding P og am; Se e e Acu e Malnu i ion; Child en; Reco e y; Mo ali y
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1451-1457
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1. In oduc ion
Se e e acu e malnu i ion (SAM) is a majo global heal h challenge, especially in low- and middle-income coun ies,
whe e i is one o he leading causes o child mo ali y and mo bidi y. SAM is usually ma ked by se e e weigh - o -
heigh de ici s, wi h o wi hou edema, and is equen ly linked o o he heal h issues such as in ec ions, mic onu ien
de iciencies, and inadequa e die a y in ake. Child en wi h SAM a e a high isk o li e- h ea ening condi ions, and
wi hou app op ia e medical ca e and nu i ional ehabili a ion, he isk o dea h inc eases signi ican ly [1].
Globally, 150 million child en unde i e a e unde weigh , wi h o e 20 million su e ing om se e e malnu i ion. In
sub-Saha an A ica, 47 million child en a e s un ed, including 24 million in Eas e n and Sou he n A ica. S un ing
e lec s pas g ow h ailu e due o poo nu i ion, in ec ions, and po e y, while was ing indica es acu e malnu i ion.
In Sudan, 31.0% o child en unde i e a e unde weigh , 32.5% su e om ch onic malnu i ion, and 14.8% expe ience
global acu e malnu i ion. [2].
Rising malnu i ion- ela ed mo ali y calls o s onge go e nmen policies, g ea e in e na ional suppo , and
imp o ed public awa eness o nu i ion and immuniza ion. Wi h o e 60% o Sudan’s popula ion in impo e ished u al
a eas, women and child en a e mos a ec ed. Da a on child en unde i e e eal a c i ical c isis, especially in
ma ginalized egions. U gen heal h educa ion and nu i ional p og ams a e needed, alongside esea ch o highligh he
issue and d i e ac ion [3].
In hospi als, F75 and F100 a e he apeu ic milks o ea ing se e e acu e malnu i ion (SAM). F75 is used in he
s abiliza ion phase, p o iding 80–100 kcal/kg/day o e 8–12 meals o 3–7 days, while F100 is used in ehabili a ion,
o e ing 100–200 kcal/kg/day o 3–4 weeks. Bo h equi e p epa a ion, ha e high mois u e con en , and canno be
s o ed a oom empe a u e o p epa ed a home. Ready- o-use oods (RUFs), such as ba s o pas es, a e nu ien -dense,
equi e no p epa a ion, and a e mic obially esis an due o low mois u e. F75/F100 and RUFs a e used alongside
con inued b eas eeding o op imal eco e y [4]. Despi e es ablished ea men p o ocols, SAM emains a signi ican
conce n in many coun ies, especially in u al a eas whe e access o heal hca e and adequa e nu i ion is o en limi ed
[5].
This s udy assesses ac o s in luencing eco e y and mo ali y in child en wi h SAM a El-Obeid Specialized Pedia ic
Hospi al, ocusing on demog aphics, in e en ions, nu i ion changes, and co-mo bidi ies o imp o e ea men
ou comes.
2. Me hodology
This desc ip i e, c oss-sec ional s udy was conduc ed a El-Obeid Specialized Pedia ic Hospi al, loca ed in El-Obeid, he
capi al o No h Ko do an S a e, Sudan. The hospi al se es as a key heal h acili y o he egion and p o ides specialized
ca e o child en, including he managemen o se e e acu e malnu i ion (SAM). El-Obeid is app oxima ely 588 km
sou hwes o Kha oum, making he hospi al a c i ical esou ce o pedia ic ca e in he a ea.
The s udy ocused on child en unde i e yea s o age diagnosed wi h SAM and admi ed o he hospi al be ween
No embe 2022 and Decembe 2022. A o al o 103 child en’s eco ds we e e iewed, based on he a ailabili y o
comple e medical in o ma ion. Inclusion c i e ia included child en unde i e diagnosed wi h SAM du ing he s udy
pe iod, while child en wi h incomple e eco ds (e.g., missing an h opome ic measu emen s such as weigh , heigh , and
mid-uppe a m ci cum e ence (MUAC), as well as missing da a on age, gende , o discha ge ou comes) we e excluded
om he s udy. Addi ionally, child en wi h seconda y malnu i ion caused by o he heal h condi ions (such as in ec ions
o me abolic diso de s) o hose wi h edema un ela ed o SAM we e excluded o ensu e he s udy ocused exclusi ely
on p ima y se e e acu e malnu i ion cases.
2.1. Da a Collec ion and Analysis
Da a we e ga he ed om he child en's medical eco ds using a s uc u ed checklis ha cap u ed c i ical in o ma ion
on an h opome ic measu emen s (weigh , heigh , MUAC), age, gende , SAM diagnosis, and discha ge ou comes. This
checklis ensu ed ha all ele an a iables we e cap u ed o each child admi ed o SAM ea men . A e collec ion,
he da a we e manually cleaned, coded, and en e ed in o Google Fo ms, whe e u he analysis was conduc ed.
S a is ical analysis was pe o med o iden i y ends and co ela ions be ween demog aphic ac o s (age, gende ) and
he se e i y o SAM, as well as he ou comes o ea men . Desc ip i e s a is ics we e used o summa ize he da a,
including equencies and pe cen ages o ca ego ical a iables and mean ± s anda d de ia ion o con inuous a iables.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1451-1457
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The esul s we e analyzed o de e mine common ac o s associa ed wi h SAM in he egion and o assess ea men
ou comes.
2.2. E hical Conside a ions
E hical app o al was ob ained om he Uni e si y o Ko do an's Facul y o Medicine and he No h Ko do an S a e
Minis y o Heal h E hics Commi ees. Ca egi e s we e ully in o med abou he s udy's objec i es and me hods, and
w i en in o med consen was ob ained. The s udy adhe ed o s ic e hical s anda ds, ensu ing anonymized and
con iden ial da a, wi h all in o ma ion s o ed secu ely in compliance wi h da a p o ec ion p o ocols.
3. Resul s
A o al o 100 child en unde i e yea s old diagnosed wi h se e e acu e malnu i ion (SAM) we e admi ed o he
The apeu ic Feeding Uni a El-Obeid Specialized Pedia ic Hospi al be ween No embe and Decembe 2022. Among
hese child en, 63% we e male, and 61.6% came om u al a eas. Mos o he child en we e in he 7-24 mon hs age
ange (85.7%), while 14.3% we e in he 25–59-mon h age g oup. No ably, no child en unde six mon hs we e admi ed.
In e ms o amily s uc u e, 39.2% o he child en came om amilies wi h 3-4 child en, and 21.6% had mo e han ou
siblings (Table 1).
The a he s o he child en we e p ima ily a me s (43.4%), ollowed by unskilled wo ke s (34%) and eache s (22.7%).
In e ms o educa ion, 48.5% o a he s we e illi e a e, and 63.9% o mo he s had no o mal educa ion. A signi ican
po ion o mo he s (48%) we e housewi es, wi h 39% wo king as a me s (Table 2).
Be o e admission, 60.6% o child en we e consuming poo -quali y ood. Howe e , a e admission, he quali y o ood
imp o ed d as ically, wi h 99% o he child en ecei ing high-quali y nu i ion (Table 3). Edema was p esen in 41% o
he child en, and common como bidi ies included dia hea (57.6%), omi ing (49.5%), pneumonia (21%), anemia
(14.4%), ube culosis (12.5%), and a small p opo ion (0.5%) wi h hea ailu e (Table 4).
Table 1 Demog aphic Cha ac e is ics o Child en wi h Se e e Acu e Malnu i ion
Cha ac e is ic
F equency (%)
Gende
Male
63%
Female
37%
Geog aphic Loca ion
Ru al
61.6%
U ban
38.4%
Age G oup
7-24 mon hs
85.7%
25-59 mon hs
14.3%
Numbe o Child en in Family
1-2 Child en
12.4%
3-4 Child en
39.2%
>4 child en
21.6%
The he apeu ic managemen in ol ed Ce iaxone (75%), Zinc supplemen s (73%), and ReSoMal (44%). A smalle
p opo ion o child en ecei ed Benzyl Penicillin (14%) and Me onidazole (14%). No ably, no child en ecei ed i on
o olic acid supplemen s (Table 5). Rega ding ou comes, 85% o he child en we e success ully cu ed, 6% died, and 5%
we e los o ollow-up.
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Table 2 Pa en al Occupa ion and Educa ion Le el
Cha ac e is ic
F equency (%)
Fa he 's Occupa ion:
Fa me
43.4%
Non-skilled wo ke
34%
Teache
22.7%
Fa he 's Educa ion Le el
Illi e a e
48.5%
P ima y school
20.6%
Seconda y school
22.7%
Uni e si y
8.2%
Mo he 's Occupa ion
Housewi e
48%
Fa me
39%
Teache
11.2%
Mo he 's Educa ion Le el
Illi e a e
63.9%
P ima y school
23%
Uni e si y
9.8%
Table 3 Quali y o Food Be o e and A e Admission
Food Quali y
F equency (%)
Be o e Admission
Poo
60.6%
Good
19.4%
A e Admission
Good
99%
Poo
1%
Table 4 P e alence o Co-mo bidi ies Among SAM Child en
Co-mo bidi y
F equency (%)
Dia hea
57.6%
Vomi ing
49.5%
Pneumonia
21%
Anemia
14.4%
Tube culosis (TB)
12.5%
Hea ailu e
0.5%
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Table 5 Medica ions used in he ea men o SAM child en
Medica ion/The apy
F equency (%)
Ce iaxone
75%
Benzyl Penicillin
14%
Me onidazole
14%
Zinc
73%
ReSoMal (ORS)
44%
4. Discussion
This s udy assessed he sho - e m ou comes o nu i ional he apy in child en wi h se e e acu e malnu i ion (SAM)
admi ed o he The apeu ic Feeding Uni (TFU) a El-Obeid Specialized Pedia ic Hospi al. The indings highligh key
ac o s in luencing eco e y and mo ali y a es in child en wi h SAM and p o ide insigh s in o he managemen
p ac ices ha could imp o e he ou comes o hese ulne able child en.
The indings indica ed ha he majo i y o child en admi ed o he TFU we e males (63%), wi h mos being be ween 7
and 24 mon hs old (85.7%). This aligns wi h p io esea ch demons a ing ha se e e malnu i ion disp opo iona ely
impac s child en unde wo yea s o age, especially males [6]. Howe e , a s udy by Ta esse e al. in E hiopia epo ed an
equal dis ibu ion be ween he sexes [7]. Malnu i ion in ea ly childhood is pa icula ly conce ning due o he c i ical
pe iod o g ow h and de elopmen , wi h long- e m consequences on cogni i e and physical de elopmen [8]. The
p edominance o u al child en (61.6%) is also in line wi h global pa e ns, whe e child en om u al and emo e a eas
a e a g ea e isk o malnu i ion due o limi ed access o nu i ious ood and heal hca e se ices [9].
The socioeconomic s a us o he child en’s amilies also seems o play a ole in he nu i ional s a us o he child en. A
signi ican p opo ion o a he s we e a me s (43.4%), and mos mo he s we e illi e a e o had only p ima y educa ion
(63.9%), sugges ing ha lowe le els o educa ion and occupa ion ela ed o lowe income may con ibu e o highe
a es o SAM. This aligns wi h e idence ha pa en educa ion and socioeconomic s a us a e key de e minan s o
childhood nu i ion and heal h. Addi ionally, poo ood quali y be o e admission (60.6%) indica es inadequa e ood
in ake, which could be a signi ican con ibu ing ac o o he child en’s malnu i ion. S udies ha e shown ha he
quali y and di e si y o ood a ailable o child en, pa icula ly in households wi h lowe income, s ongly co ela e wi h
he isk o SAM [10].
Rega ding he clinical aspec s, edema was p esen in 41% o cases, which is a signi ican indica o o se e e malnu i ion
and luid imbalance. Child en wi h edema a e a highe isk o complica ions, including in ec ions and elec oly e
imbalances, which can complica e ea men and eco e y [11]. The p esence o como bidi ies, such as dia hea
(57.6%), omi ing (49.5%), pneumonia (21%), and anemia (14.4%), u he exace ba es he challenges in managing
SAM. These como bidi ies a e o en seen in child en wi h malnu i ion and con ibu e o delayed eco e y and highe
mo ali y a es. Dia hea is a leading cause o malnu i ion- ela ed mo bidi y and mo ali y, especially in se ings wi h
inadequa e sani a ion and limi ed access o heal hca e [12,13].
The he apeu ic in e en ions used in his s udy, which included SAM-speci ic medica ions and nu i ional supplemen s
such as Plumpy' Nu , appea ed o align wi h s anda d ea men guidelines. The use o specialized he apeu ic oods o
child en wi h SAM, including eady- o-use he apeu ic oods (RUTF), has e ec i ely imp o ed hei nu i ional s a us
[14]. The adminis a ion o an ibio ics (75% ecei ed Ce iaxone) and zinc (73%) also aligns wi h ecommended
p ac ices o managing in ec ions and enhancing nu i ional ehabili a ion [15,16]. Howe e , he lack o i on and olic
acid supplemen a ion in his coho is a limi a ion, as hese mic onu ien s a e essen ial o imp o ing eco e y in
child en wi h SAM, especially hose wi h anemia [13].
In e ms o ou comes, 85% o child en we e cu ed, 6% died, and 5% we e los o ollow-up. The mo ali y a e obse ed
in his s udy (6%) is wi hin he ange epo ed in o he he apeu ic eeding uni s in low- esou ce se ings [17]. Howe e ,
i s ill alls abo e he Sphe e S anda ds minimum accep able cu -o o SAM ea men p og ams, which ecommend a
mo ali y a e below 5% [18]. This sugges s ha while he he apeu ic eeding p og am is e ec i e, he e is s ill oom
o imp o emen in educing mo ali y and ensu ing be e eco e y a es.
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The p edic o s o a highe cu e a e iden i ied in his s udy include he p esence o edema, HIV posi i i y, and he use
o Plumpy' Nu . These indings a e consis en wi h o he s udies showing ha child en wi h edema o co-mo bidi ies,
such as HIV, equi e mo e in ensi e managemen and moni o ing o ensu e eco e y. Mo eo e , Plumpy' Nu , a eady-
o-use he apeu ic ood, has imp o ed ou comes in child en wi h SAM, pa icula ly in educing eco e y ime and
p e en ing complica ions [15,17,19].
5. Conclusion
In conclusion, his s udy emphasizes he c i ical ole o ea ly in e en ion, nu i ional he apy, and e ec i e
managemen o co-mo bidi ies in imp o ing ou comes o child en wi h se e e acu e malnu i ion (SAM). The esul s
highligh he impo ance o add essing socioeconomic ac o s, such as low ma e nal educa ion and poo ood quali y,
which con ibu e signi ican ly o malnu i ion. Al hough he he apeu ic eeding p og am showed posi i e ou comes,
wi h an 85% cu e a e, he e is s ill po en ial o imp o emen , pa icula ly in educing mo ali y a es, which su passed
he ecommended h eshold
Recommenda ions
To imp o e SAM managemen , heal hca e s a should ecei e p ope aining, and he apeu ic eeding wi h
mic onu ien s mus be ensu ed. S eng hening he moni o ing o SAM p og ess and p omo ing communi y-based
p e en ion is essen ial. Addi ionally, imp o ing access o ood, heal hca e, and educa ion, suppo ing mic onu ien
supplemen a ion o a ec ed child en, and enhancing da a collec ion will help in o m be e u u e in e en ions.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
The au ho s decla e no con lic o in e es .
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
Funding
Sel - unded esea ch.
Re e ences
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