Clinicoepidemiological Profile and Micronutrient Deficiencies in Children with Severe Acute Malnutrition

Abstract

Introduction: Malnutrition is widely prevalent in developing countries and is considered a common denominator
in infant and under-5 mortalities. Most child deaths are associated with inappropriate feeding practices and specific
micronutrient deficiencies during the first year of life. There is a lack of data about severe acute malnutrition (SAM) and
specific micronutrient deficiencies in India; hence, the present study was conducted to study the iron profile, including
folic acid, and vitamin B12 levels and their correlation with the clinicoepidemiological profile of children with SAM.
Materials and methods: This hospital-based cross-sectional study included 95 children with SAM, aged 6 months to 5 years.
A predesigned structured proforma was used to collect information. Data concerning clinical examination and history given
by the mother and a reliable attendant was collected. The quantitative data were expressed as mean and standard deviation
and qualitative data as percentage and proportion. The difference in proportion was analyzed by the Chi-square test and
the difference in means was analyzed by ANOVA. P-value <0.05 was taken as significant. All calculations were done by
Microsoft Excel, Primer. SPSS Software [version 21] was used for doing statistical analysis. Results: In the present study,
a total of 95 SAM patients were included with mean age 19.74 months and an F:M ratio of 1.2:1. Weight-for-height was
found to be the most reliable criterion to identify children with SAM (78.95%). Edema was present in 18 (18.95%) patients.
Around 68.42% of patients had mid-upper arm circumference (MUAC) <11.5 cm; 25.26% of children were found completely
immunized, remaining 74.74% were either partially immunized or unimmunized. According to the Kuppuswamy scale for
the socioeconomic class, more than two-thirds of the parents belonged to the upper-lower class. About 44.21% of children
received exclusive breastfeeding till 6 months of age, while complementary feeding was started in only 25.26% of children
at 6 months of age. Anemia was present in 93 children with a prevalence of 97.89%. Of these, 30 patients had vitamin B12
deficiency anemia, 20 patients had iron deficiency anemia, and 6 patients had folate deficiency anemia. Conclusions: Severe
acute malnutrition is an important preventable and treatable cause of morbidity and mortality in children below 5 years of
age in India. Although malnutrition is highly prevalent in Indian children, there are very limited data that use biochemical
indexes to characterize the epidemiology of micronutrient deficiencies in children with SAM. A detailed understanding of
micronutrient deficiencies and clinical and epidemiological profile of children may help in micronutrient supplementation
and fortification programs and targeting the basic causes of pediatric mortalities.