TY - JOUR
T1 - Childhood growth during recovery from acute illness in Africa and South Asia
T2 - a secondary analysis of the childhood acute illness and nutrition (CHAIN) prospective cohort
AU - Bourdon, Celine
AU - Diallo, Abdoulaye Hama
AU - Mohammad Sayeem Bin Shahid, Abu Sadat
AU - Khan, Md Alfazal
AU - Saleem, Ali Faisal
AU - Singa, Benson O.
AU - Gnoumou, Blaise Siézanga
AU - Tigoi, Caroline
AU - Otieno, Catherine Achieng
AU - Oduol, Chrisantus Odhiambo
AU - Lancioni, Christina L.
AU - Manyasi, Christine
AU - McGrath, Christine J.
AU - Maronga, Christopher
AU - Lwanga, Christopher
AU - Brals, Daniella
AU - Ahmed, Dilruba
AU - Mondal, Dinesh
AU - Denno, Donna M.
AU - Mangale, Dorothy I.
AU - Chimwezi, Emmanuel
AU - Mbale, Emmie
AU - Mupere, Ezekiel
AU - Salauddin Mamun, Gazi Md
AU - Ouédraogo, Issaka
AU - Berkley, James A.
AU - Njunge, James M.
AU - Njirammadzi, Jenala
AU - Mukisa, John
AU - Thitiri, Johnstone
AU - Walson, Judd L.
AU - Jemutai, Julie
AU - Tickell, Kirkby D.
AU - Shahrin, Lubaba
AU - Mallewa, Macpherson
AU - Hossain, Md Iqbal
AU - Chisti, Mohammod Jobayer
AU - Timbwa, Molline
AU - Mburu, Moses
AU - Ngari, Moses M.
AU - Ngao, Narshion
AU - Aber, Peace
AU - Harawa, Philliness Prisca
AU - Sukhtankar, Priya
AU - Bandsma, Robert H. J.
AU - Bamouni, Roseline Maïmouna
AU - Molyneux, Sassy
AU - Mwaringa, Shalton
AU - Shaima, Shamsun Nahar
AU - Ali, Syed Asad
AU - Afsana, Syeda Momena
AU - Banu, Sayera
AU - Ahmed, Tahmeed
AU - Voskuijl, Wieger P.
AU - Kazi, Zaubina
N1 - Publisher Copyright: © 2024 The Authors
PY - 2024/4/1
Y1 - 2024/4/1
N2 - Background: Growth faltering is well-recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle-income countries. 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 Foundation OPP1131320; National Institute for Health Research NIHR201813.
AB - Background: Growth faltering is well-recognized during acute childhood illness and growth acceleration during convalescence, with or without nutritional therapy, may occur. However, there are limited recent data on growth after hospitalization in low- and middle-income countries. 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 Foundation OPP1131320; National Institute for Health Research NIHR201813.
KW - Africa
KW - Children
KW - Growth
KW - Hospital
KW - Kwashiorkor
KW - Length
KW - Malnutrition
KW - Post-discharge
KW - Stunting
KW - Vulnerability
KW - Wasting
KW - Weight
KW - “Acute illness”
KW - “South asia”
UR - http://www.scopus.com/inward/record.url?scp=85187363897&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2024.102530
DO - 10.1016/j.eclinm.2024.102530
M3 - Article
C2 - 38510373
SN - 2589-5370
VL - 70
JO - EClinicalMedicine
JF - EClinicalMedicine
M1 - 102530
ER -