Study Effect of F-75 Diet on Weight of Severe Acute Malnourished Children in Western Rajasthan

e-ISSN: 0975-5160, p-ISSN: 2820-2651 Available online on www.ijtpr.com International Journal of Toxicological and Pharmacological Research 2024; 14 (12); 190-193 Meena et al. International Journal of Toxicological and Pharmacological Research 190 Original Research Article Study Effect of F-75 Diet on Weight of Severe Acute Malnourished Children in Western Rajasthan Anisha Meena1, Mahendra Jourwal2, Nidhi Kaushal3, Khushboo Singh4, R. K. Bishnoi5 1Assistant Professor, Department of Paediatrics, GMC, Pali 2Assistant Professor, Department of Orthopaedics, GMC, Pali 3Assistant Professor, Department of Paediatrics, GMC, Pali 4Medical Consultant (Community Medicine), WHO, Jodhpur 5HOD & Professor, Department of Paediatrics, GMC, Pali Received: 18-09-2024 / Revised: 21-10-2024 / Accepted: 26-11-2024 Corresponding author: Dr. Anisha Meena Conflict of interest: Nil Abstract: Background: Malnutrition is rampant in paediatric age group globally. Over the last two decades, severe acute malnutrition (SAM) has been increasing in India despite of favourable national – level economic growth. Prevalence of SAM has increased from 6.6% in 2005 – 2006 as per NFHS-3 to 7.5% in 2015 – 2016 as per NFHS-4, and as per NFHS-5 prevalence continues to be 7.7%. Children with SAM are at 9-11 times higher risk of mortality and morbidity than well-nourished children. This is an unprecedented public health emergency requiring policy attention, critical care, nutritional therapy as well as nutritional rehabilitation. Aims and Objective: To study effect of F-75 diet on weight of SAM children admitted in malnutrition treatment centre. Material and Methods: This is Prospective observational study done on SAM Children (without bilateral pedal oedema) aged 6months to 60 months hospitalized in Malnutrition Treatment Center, in Government Medical College Pali and attached Bangur hospital, during study period from April 2022 to April 2024. F-75 diet was given to 387 SAM children that were enrolled in study for initial 3days according to MTC guidelines. Daily weight gain is recorded. Average daily weight gain (gm/kg/day) calculated on day fourth as well as on discharge. Results: Out of 387 children average daily weight gain on day fourth was following: <5gm/kg/day in 35(9%), 5-10 gm/kg/day in 83(21.5%), >10 gm/kg /day in 269(69.5%). This suggests good weight gain on F-75 diet in maximum children due to availability of food in adequate quantity & quality. Conclusion: Although F-75 is not intended for weight gain, still children gained good weight on starter diet. High quality infant and young child feeding counselling is needed to prevent severe acute malnutrition as introduction of complementary feeding at 6 months age can lessen burden of malnutrition. Keywords: Severe Acute Malnutrition, F-75 diet. This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided original work is properly credited. Introduction Malnutrition is one of the major public health problems throughout the developing world and is an underlying factor in over 50% of children's death under 5 years who die each year of preventable causes [6-9]. Severe Acute Malnutrition is defined as severe wasting and/or bilateral oedema. Severe wasting is extreme thinness diagnosed by weight for length/height < - 3SD of WHO Child Growth Standards, or mid upper arm circumference < 115mm (measured by Shakir's tape). Bilateral oedema is diagnosed by grasping both feet, placing a thumb on top of each, and gently pressing for 10 seconds. A pit (dent) remaining under each thumb indicates bilateral oedema [10]. It is estimated that approximately 16% of births worldwide in 2013 were low birth weight (LBW). Rates of LBW are highest (28%) in southern Asia, which are twice those of Sub-Saharan Africa [5]. Approximately 9% of sub-Saharan African and 16% South Asian children suffer from moderate acute malnutrition and approximately 2% of children living in developing countries suffer from severe acute malnutrition [11,12]. International Journal of Toxicological and Pharmacological Research e-ISSN: 0975-5160, p-ISSN: 2820-2651 Meena et al. International Journal of Toxicological and Pharmacological Research 191 Asia carries most of global burden because of combination of large population size and high prevalence [10]. In India approximately 20% of children under five years, are severely wasted [13]. Estimates from most recent nationally representative survey indicate that 6.4% of children below 60 months of age have weight-for-height below third standard deviation. At present, Indian population of 1.2 billion, there are about 132 million children under five years (12% of population), of which 6.4% or roughly 8 million are assumed to be suffering from severe acute malnutrition. To prevent deaths among severely malnourished children, the Government of India have started the Nutrition Rehabilitation Centers (NRCs) with support of UNICEF. The objectives of the programme are to control malnutrition among the children aged 1–5 years in the country and to bring down the percent of severely malnourished children to less than 1% [14]. Materials and Methods This was a prospective observational study done from April 2022 to April 2024 in 10 bedded Malnutrition Treatment Center in Government medical college Pali, Rajasthan, and attached Bangur Hospital. The study participants were 387 children who met criteria of severe acute malnutrition, but without bilateral oedema, between 6 and 60 months of age. WHO criteria for severe acute malnutrition, which included children with weight-for-height (W/H) or length (W/L) with Z score less than 3 standard deviation from mean, and/or mid-upper arm circumference (MUAC) <115 mm, and/or presence of bilateral pitting pedal oedema. These children admitted in MTC were given special therapeutic diet including F 75 and F 100 as per WHO/UNICEF protocol for management of severe acute malnutrition (WHO 1999). F 75 diet were given for initial 3 days and then shifted to F 100 diet. These children were observed for daily weight gain. After ruling out the acute complications and their initial stabilization, these children were subjected to the actual MTC protocol. Children were given diet as per WHO/UNICEF protocol daily along with other supplements. WHO weight for height reference charts were used for their assessment. Daily weight measurements were done at fixed time using a single standardized weighing scale. Average daily weight gain was calculated on day fourth and on discharge. Results Among 387 children, 205 (52.9%) were males while 182 (47.1%) children were females. This pie chart suggests that female children are less affected as compared to male children, probably due to more awareness of Female education & health by government of India. Figure 1: According to age distribution, most of the children 251 (64.85%) belonged to 6-18 months of age, 89 (22.99%) children were of 19 -36 months of age and 47 (12.16%) children were of 37-60 months of age. This bar chart suggests maximum children being affected at 6 – 18 months, which is the time for introduction of complementary feeds. Hence, awareness and education regarding complementary feeding are required to tackle this. 205 182 Male Female International Journal of Toxicological and Pharmacological Research e-ISSN: 0975-5160, p-ISSN: 2820-2651 Meena et al. International Journal of Toxicological and Pharmacological Research 192 Figure 2: Among 387 children, 22 (5.7%) belong to General category, 175 (45.2%) belong to OBC category, 92 (23.7%) belong to Scheduled Caste category and 98(25.4%) belong to Scheduled Tribe category. This doughnut pie chart suggests children belonging to Scheduled caste & Scheduled tribe category are less affected, probably due to intensive government policies for educating backward classes. Figure 3: On day fourth average daily weight gain was <5gm/kg/day in 35 (9%) children, 5-10 gm/kg/day in 83 (21.5%), >10 gm/kg /day in 269 (69.5%). Table 1: Weight gain on 4th day of admission No. of children Percentage < 5 g/kg/day 35 9% 5 – 10 g/kg/day 83 21.5% > 10 g/kg/day 269 69.5% Total 387 On discharge average daily weight gain rate was <5gm/kg/day in 95 (26.61%), 5-10 gm/kg/day in 81(22.68%), >10gm/kg/day in 181 (50.70%) children. Table 2: Weight gain on Discharge No. of children Percentage < 5 g/kg/day 41 10.6% 5 – 10 g/kg/day 109 28.2% > 10 g/kg/day 237 61.2% Total 387 0 50 100 150 200 250 300 6 - 18 months 19 - 36 months 37 - 60 months General OBC SC ST International Journal of Toxicological and Pharmacological Research e-ISSN: 0975-5160, p-ISSN: 2820-2651 Meena et al. International Journal of Toxicological and Pharmacological Research 193 Discussion As it is well known fact that F-75 is used only for biochemical and metabolic, we do not expect any weight gain in child. In fact, due to loss of oedema, weight loss can be seen in such children. But in present study we clearly saw that children gained good weight on starter diet. So, this gives an inference that children who are malnourished, can recover very well in initial days of treatment also if they are eating the right foods in right quantity & right quality and are not suffering from diseases or infections. To prevent severe acute malnutrition there is need of Ø Promoting Exclusive Breastfeeding till 6 months Ø Successful introduction of Complementary feeding Ø High quality infant and young child feeding counselling Ø Awareness regarding various diseases Ø Adequate health care facilities for disease management As in present study, most affected age group was 6months to 18 months, there is need for counselling regarding Complementary feeding so as to decrease magnitude of malnutrition. References 1. NFHS-3. National Family Health Survey. Government of India, Ministry of Health and Family Welfare 2005. 2. NFHS-4. National Family Health Survey. Government of India, Ministry of Health and Family Welfare 2015. 3. NFHS-5. National Family Health Survey. Government of India, Ministry of Health and Family Welfare 2020. 4. “Maternal and Child undernutrition and overweight in low-income and middle-income countries” Black RE, Victoria CG, Walker SP, et al. Lancet Aug2013; volume 382, issue 9890; pages 427-451. 5. Treatment of severe and moderate acute malnutrition in low and middle-income settings” Lenters LM, Wany K, Webb P, et al: Systematic review, Meta-analysis and Delphi process. BMC Public Health, September2013 - Springer; Volume 13; article number S23,1 – 15. 6. Where and why are 10 million children dying every year?” Robert E Black et al. The Lancet 2003. 7. “Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles,” Laura E Caulfield et al. The American Journal of Clinical Nutrition, vol. 80, issue 1, July 2004, pages 193– 198. 8. Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries, Amy L. Rice et al. Bulletin of the World Health Organization 2000, vol. 78, issue 10, pages 1207–1221. 9. Changes in child survival are strongly associated with changes in malnutrition in developing countries, David L Pelletier et al. Journal of Nutrition Jan 2003, vol. 133, issue 1, pages 107–119. 10. NELSON 22nd Edition Part V chapter 62 11. Unicef, “Nutritional Status,” http://www. Chil dinfo.org/malnutrition nutritional status. php. 12. World Health Organization, Global Database on Child Growth and Malnutrition, http://www.who.int/nutgrowthdb/estimates201 2/en/. 13. International Institute for Population Sciences (IIPS) and Macro International, National Family Health Survey (NFHS-3), 2005-06: India, vol. I, IIPS, Mumbai, India, 2007. 14. World Health Organization, Management of Severe Malnutrition: A Manual for Physicians 11 and Other Senior Health Workers, World Health Organization, Geneva, Switzerland, 1999, http://whqlibdoc.who.int/hq/1999/a5736.pdf.