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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.

ABSTRACT:

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 FoundationOPP1131320; National Institute for Health ResearchNIHR201813.

SUBMITTER: Bourdon C 

PROVIDER: S-EPMC10950691 | biostudies-literature | 2024 Apr

REPOSITORIES: biostudies-literature

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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.

Bourdon Celine C   Diallo Abdoulaye Hama AH   Mohammad Sayeem Bin Shahid Abu Sadat AS   Khan Md Alfazal MA   Saleem Ali Faisal AF   Singa Benson O BO   Gnoumou Blaise Siézanga BS   Tigoi Caroline C   Otieno Catherine Achieng CA   Oduol Chrisantus Odhiambo CO   Lancioni Christina L CL   Manyasi Christine C   McGrath Christine J CJ   Maronga Christopher C   Lwanga Christopher C   Brals Daniella D   Ahmed Dilruba D   Mondal Dinesh D   Denno Donna M DM   Mangale Dorothy I DI   Chimwezi Emmanuel E   Mbale Emmie E   Mupere Ezekiel E   Salauddin Mamun Gazi Md GM   Ouédraogo Issaka I   Berkley James A JA   Njunge James M JM   Njirammadzi Jenala J   Mukisa John J   Thitiri Johnstone J   Walson Judd L JL   Jemutai Julie J   Tickell Kirkby D KD   Shahrin Lubaba L   Mallewa Macpherson M   Hossain Md Iqbal MI   Chisti Mohammod Jobayer MJ   Timbwa Molline M   Mburu Moses M   Ngari Moses M MM   Ngao Narshion N   Aber Peace P   Harawa Philliness Prisca PP   Sukhtankar Priya P   Bandsma Robert H J RHJ   Bamouni Roseline Maïmouna RM   Molyneux Sassy S   Mwaringa Shalton S   Shaima Shamsun Nahar SN   Ali Syed Asad SA   Afsana Syeda Momena SM   Banu Sayera S   Ahmed Tahmeed T   Voskuijl Wieger P WP   Kazi Zaubina Z  

EClinicalMedicine 20240312

<h4>Background</h4>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.<h4>Methods</h4>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 admis  ...[more]