Journal of Pediatric Perspectives

Journal of Pediatric Perspectives

Complications and Outcome of Severe Acute Malnutrition in children under Five in Africa: A Systematic Review

Document Type : systematic review

Authors
Mariame Mohamed Ahamada 1
Goudja Gassara 2
Minrong Xiang 1
Jihua Chen 1, 3
1 Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, Changsha 410008, China.
2 Department of Pediatrics, Second Xiangya Hospital, Central South University, Changsha, China.
3 Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha 410078, China.
10.22038/ijp.2024.71861.5273
Abstract
Background: This study aimed to examine the complications associated with Severe Acute Malnutrition (SAM), and the disease outcome in children under five years old in Africa.
Methods: The recommendations of PRISMA 2020 were used for the realization of this systematic review. We searched PubMed, Web of Science, Science Direct, and Google Scholar databases for articles published in English. The search covered all articles conducted in Africa and published between 2010 and 2022. The outcome of SAM was assessed in terms of weight gain, recovery rate, and fatality rate.
Results: Out of 12,553 articles identified, 62 articles met the inclusion criteria for this systematic review. The age range of 6 to 24 months was found to be the most common age group, and marasmus was identified as the most common type of malnutrition. The most frequently encountered complications were diarrhea followed by respiratory tract infections and anemia. The recovery rate was frequently less than 75%, and many studies reported a weight gain of less than 10g/kg/day.
Conclusion: Our work showed that despite the efforts made, SAM is still a major cause of mortality in African children. Such findings highlight the need for implementation of corrective measures that can address this deadly condition.
Keywords
Comorbidity
Mortality
Pediatrics
Recovery
Severe Acute Malnutrition (SAM)
  1. Elia M. Defining, recognizing, and reporting malnutrition. The international journal of lower extremity wounds. 2017 Dec;16(4):230-7.
  2. Sellam EB, Bour A. État nutritionnel des enfants de 6 à 60 mois au Maroc «Préfecture d’Oujda-Angad». BMSAP. 2015;1(27):56-63.
  3. Mambulu-Chikankheni FN, Eyles J, Eboreime EA, Ditlopo P. A critical appraisal of guidelines used for management of severe acute malnutrition in South Africa’s referral system. Health research policy and systems. 2017 Dec;15:1-1.
  4. Ndzo JA, Jackson A. Outcomes of children aged 6–59 months with severe acute malnutrition at the GADO Outpatient Therapeutic Center in Cameroon. BMC research notes. 2018 Dec;11:1-6.
  5. Størdal K, Lie SO. Children who die--is the millennium goal within reach?. Tidsskrift for den Norske Laegeforening: Tidsskrift for Praktisk Medicin, ny Raekke. 2009 Nov 1;129(21):2266-9.
  6. Ghimire U, Aryal BK, Gupta AK, Sapkota S. Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study. BMC pediatrics. 2020 Dec;20:1-9.
  7. Ahmed T, Hossain M, Mahfuz M, Choudhury N, Hossain MM, Bhandari N, et al. Severe acute malnutrition in Asia. Food and nutrition bulletin. 2014 Jun;35(2_suppl1):S14-26.
  8. De Onis M, Onyango AW. WHO child growth standards. The Lancet. 2008 Jan 19;371(9608):204.
  9. Ashworth A, Chopra M, McCoy D, Sanders D, Jackson D, Karaolis N, et al. WHO guidelines for management of severe malnutrition in rural South African hospitals: effect on case fatality and the influence of operational factors. The Lancet. 2004 Apr 3;363(9415):1110-5.
  10. Collins S. Treating severe acute malnutrition seriously. Archives of disease in childhood. 2007 May 1;92(5):453-61.
  11. Bhutta ZA, Berkley JA, Bandsma RH, Kerac M, Trehan I, Briend A. Severe childhood malnutrition. Nature reviews Disease primers. 2017 Sep 21;3(1):1-8.
  12. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews. 2015 Dec;4:1-9.
  13. Onyango AW, Jean-Baptiste J, Samburu B, Mahlangu TL. Regional overview on the double burden of malnutrition and examples of program and policy responses: African region. Annals of Nutrition and Metabolism. 2019 Dec 4;75(2):127-30.
  14. Picot J, Hartwell D, Harris P, Mendes D, Clegg AJ, Takeda A. The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review. Health Technology Assessment (Winchester, England). 2012;16(19):1.
  15. Ashworth A. Guidelines for the inpatient treatment of severely malnourished children. World Health Organization; 2003.
  16. Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health information & libraries journal. 2009 Jun;26(2):91-108.
  17. Barouaca H, Squali FZ, Hida M. Effect of short-term of nutrition rehabilitation on catch-up growth in marasmus and kwashiorkor children. J Food Nutr Disord. 2013;2:1-5.
  18. Sinanduku JS, Mishika PL, Mukunda FM, Mudisu L, Mukuku O, Luboya ON. Severe Acute Malnutrition in Children Admitted to Sendwe Hospital in Lubumbashi, Democratic Republic of Congo. Ann Pediatr Res. 2020; 4 (2).;1037.
  19. Madec Y, Germanaud D, Moya-Alvarez V, Alkassoum W, Issa A, Amadou M, et al. HIV prevalence and impact on renutrition in children hospitalised for severe malnutrition in Niger: an argument for more systematic screening. PloS one. 2011 Jul 28;6(7):e22787.
  20. Page AL, de Rekeneire N, Sayadi S, Aberrane S, Janssens AC, Rieux C, et al. Infections in children admitted with complicated severe acute malnutrition in Niger. PloS one. 2013 Jul 17;8(7):e68699.
  21. Akparibo R, Harris J, Blank L, Campbell MJ, Holdsworth M. Severe acute malnutrition in children aged under 5 years can be successfully managed in a non‐emergency routine community healthcare setting in Ghana. Maternal & child nutrition. 2017 Oct;13(4):e12417.
  22. Alvarez Morán JL, Alé GF, Charle P, Sessions N, Doumbia S, Guerrero S. The effectiveness of treatment for Severe Acute Malnutrition (SAM) delivered by community health workers compared to a traditional facility based model. BMC Health Services Research. 2018 Dec;18:1-0.
  23. Obani KO. Prevalence and Outcome of Severe Acute Malnutrition among Children 6-59 Months, in Magumeri Local Government Area, Borno State, Attending General Hospital Magumeri, Borno State, Nigeria. Prevalence.;7(4).
  24. Chamla D, Oladeji O, Maduanusi I, Mele S, Mshelia H, Safi N. High burden of co-morbidity and mortality among severely malnourished children admitted to outpatient therapeutic programme facilities in the conflict setting of Borno, Nigeria: a retrospective review. Public health nutrition. 2019 Jul;22(10):1786-93.
  25. Aliyu I, Ibrahim HU, Idris U, Michael GC, Ibrahim UA, Mohammed A, et al. The clinical profile and outcome of children with acute malnutrition in a tertiary health center in North-West Nigeria: A 1-year retrospective review. Journal of Clinical Sciences. 2020 Oct 1;17(4):120-6.
  26. Compaoré EW, Kiemdé ME, Souho T, Ouedraogo O, Pietra V, Agbokou K, et al. Discontinuation of healthcare and factors associated to mortality among severe acute malnourished children under five years in healthcare and nutritional care settings. Clinical Nutrition ESPEN. 2021 Jun 1;43:501-5.
  27. Seck N, Basse I, Boiro D, Keïta Y, Thiam L, Ndongo AA, et al. Management of Severe Acute Malnutrition in a Senegalese Paediatric Hospital. Open Journal of Pediatrics. 2021 Apr 28;11(2):198-207.
  28. Irena AH, Mwambazi M, Mulenga V. Diarrhea is a major killer of children with severe acute malnutrition admitted to inpatient set-up in Lusaka, Zambia. Nutrition journal. 2011 Dec;10:1-6.
  29. Benyera O, Hyera FL. Outcomes in malnourished children at a tertiary hospital in Swaziland after implementation of the World Health Organization treatment guidelines. South African Journal of Child Health. 2013 Dec 10;7(4):135-8.
  30. Munthali T, Jacobs C, Sitali L, Dambe R, Michelo C. Mortality and morbidity patterns in under-five children with severe acute malnutrition (SAM) in Zambia: a five-year retrospective review of hospital-based records (2009–2013). Archives of public health. 2015 Dec;73:1-9.
  31. Muzigaba, M., et al., Independent and interactive effects of HIV infection, clinical stage and other comorbidities on survival of children treated for severe malnutrition in rural South Africa: A retrospective multicohort study. South African Journal of Child Health, 2017. 11(1): p. 46-53.
  32. Tripoli FM, Accomando S, La Placa S, Pietravalle A, Putoto G, Corsello G, et al. Analysis of risk and prognostic factors in a population of pediatric patients hospitalized for acute malnutrition at the Chiulo hospital, Angola. Italian Journal of Pediatrics. 2021 Dec;47:1-4.
  33. Wen B, Brals D, Bourdon C, Erdman L, Ngari M, Chimwezi E, et al. Predicting the risk of mortality during hospitalization in sick severely malnourished children using daily evaluation of key clinical warning signs. BMC medicine. 2021 Dec;19:1-4.
  34. Mandla N, Mackay C, Mda S. Prevalence of severe acute malnutrition and its effect on under-five mortality at a regional hospital in South Africa. South African Journal of Clinical Nutrition. 2022;35(4):149-54.
  35. Bwakura‐Dangarembizi M, Dumbura C, Amadi B, Chasekwa B, Ngosa D, Majo FD, et al. Recovery of children following hospitalisation for complicated severe acute malnutrition. Maternal & child nutrition. 2022 Apr;18(2):e13302.
  36. Gebremichael DY. Predictors of nutritional recovery time and survival status among children with severe acute malnutrition who have been managed in therapeutic feeding centers, Southern Ethiopia: retrospective cohort study. BMC public health. 2015 Dec;15:1-1.
  37. Habtemu Jarso HJ, Abdulhalik Workicho AW, Fessahaye Alemseged FA. Survival status and predictors of mortality in severely malnourished children admitted to Jimma University Specialized Hospital from 2010 to 2012, Jimma, Ethiopia: a retrospective longitudinal study.
  38. Shanka NA, Lemma S, Abyu DM. Recovery rate and determinants in treatment of children with severe acute malnutrition using outpatient therapeutic feeding program in Kamba District, South West Ethiopia. J Nutr Disord Ther. 2015;5(2):155.
  39. Massa D, Woldemichael K, Tsehayneh B, Tesfay A. Treatment outcome of severe acute malnutrition and determinants of survival in Northern Ethiopia: A prospective cohort study. International journal of nutrition and metabolism. 2016 Apr 30;8(3):12-23.
  40. Kanan SO, Swar MO. Prevalence and outcome of severe malnutrition in children less than five-year-old in Omdurman Paediatric Hospital, Sudan. Sudanese Journal of Paediatrics. 2016;16(1):23.
  41. Nyeko R, Calbi V, Ssegujja BO, Ayot GF. Treatment outcome among children under-five years hospitalized with severe acute malnutrition in St. Mary’s hospital Lacor, Northern Uganda. BMC Nutrition. 2016 Dec;2:1-7.
  42. Kabeta A, Bekele G. Factors associated with treatment outcomes of under-five children with severe acute malnutrition admitted to therapeutic feeding unit of Yirgalem hospital. Clinics Mother Child Health. 2017;14(261):2.
  43. Yohannes T, Laelago T, Ayele M, Tamrat T. Mortality and morbidity trends and predictors of mortality in under-five children with severe acute malnutrition in Hadiya zone, South Ethiopia: a four-year retrospective review of hospital-based records (2012–2015). BMC nutrition. 2017 Dec;3:1-8.
  44. Mulugeta Yohannis Kabalo MY, Canaan Negash Seifu CN. Treatment outcomes of severe acute malnutrition in children treated within Outpatient Therapeutic Program (OTP) at Wolaita Zone, Southern Ethiopia: retrospective cross-sectional study.
  45. Mekuria G, Derese T, Hailu G. Treatment outcome and associated factors of severe acute malnutrition among 6–59 months old children in Debre Markos and Finote Selam hospitals, Northwest Ethiopia: a retrospective cohort study. BMC nutrition. 2017 Dec;3:1-8.
  46. Girum T, Kote M, Tariku B, Bekele H. Survival status and predictors of mortality among severely acute malnourished children< 5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study. Therapeutics and clinical risk management. 2017 Jan 23:101-10.
  47. Tirore MG, Atey TM, Mezgebe HB. Survival status and factors associated with treatment outcome of severely malnourished children admitted to Ayder referral hospital: a cross-sectional study. BMC nutrition. 2017 Dec;3:1-9.
  48. Rytter MJ, Babirekere-Iriso E, Namusoke H, Christensen VB, Michaelsen KF, Ritz C, et al. Risk factors for death in children during inpatient treatment of severe acute malnutrition: a prospective cohort study. The American journal of clinical nutrition. 2017 Feb 1;105(2):494-502.
  49. Asres DT, Prasad RP, Ayele TA. Recovery time and associated factors of severe acute malnutrition among children in Bahir Dar city, Northwest Ethiopia: an institution based retrospective cohort study. BMC nutrition. 2018 Dec;4:1-8.
  50. Derseh B, Mruts K, Demie T, Gebremariam T. Co-morbidity, treatment outcomes and factors affecting the recovery rate of under-five children with severe acute malnutrition admitted in selected hospitals from Ethiopia: retrospective follow up study. Nutrition journal. 2018 Dec;17:1-8.
  51. Guesh G, Degu G, Abay M, Beyene B, Brhane E, Brhane K. Survival status and predictors of mortality among children with severe acute malnutrition admitted to general hospitals of Tigray, North Ethiopia: a retrospective cohort study. BMC research notes. 2018 Dec;11:1-7.
  52. Wagnew F, Tesgera D, Mekonnen M, Abajobir AA. Predictors of mortality among under-five children with severe acute malnutrition, Northwest Ethiopia: an institution based retrospective cohort study. Archives of Public Health. 2018 Dec;76:1-0.
  53. Nabukeera-Barungi N, Grenov B, Lanyero B, Namusoke H, Mupere E, Christensen VB, et al. Predictors of mortality among hospitalized children with severe acute malnutrition: a prospective study from Uganda. Pediatric research. 2018 Jul;84(1):92-8.
  54. Abate HK, Kidane SZ, Feyessa YM, Gebrehawariat EG. Mortality in children with severe acute malnutrition. Clinical nutrition ESPEN. 2019 Oct 1;33:98-104.
  55. Hassen SL, Astatkie A, Mekonnen TC, Bogale GG. Survival Status and Its Determinants among Under‐Five Children with Severe Acute Malnutrition Admitted to Inpatient Therapeutic Feeding Centers in South Wollo Zone, Amhara Region, Ethiopia. Journal of nutrition and metabolism. 2019;2019(1):2643531.
  56. Atnafe B, Roba KT, Dingeta T. Time of recovery and associated factors of children with severe acute malnutrition treated at outpatient therapeutic feeding program in Dire Dawa, Eastern Ethiopia. PloS one. 2019 Jun 13;14(6):e0217344.
  57. Wagnew F, Dejenu G, Eshetie S, Alebel A, Worku W, Abajobir AA. Treatment cure rate and its predictors among children with severe acute malnutrition in northwest Ethiopia: a retrospective record review. PloS one. 2019 Feb 20;14(2):e0211628.
  58. Desyibelew HD, Baraki AG, Dadi AF. Mortality rate and predictors of time to death in children with severe acute malnutrition treated in Felege-Hiwot Referral Hospital Bahir Dar, Northwest Ethiopia. BMC research notes. 2019 Dec;12:1-5.
  59. Fikrie A, Alemayehu A, Gebremedhin S. Treatment outcomes and factors affecting time-to-recovery from severe acute malnutrition in 6–59 months old children admitted to a stabilization center in Southern Ethiopia: A retrospective cohort study. Italian journal of pediatrics. 2019 Dec;45:1-9.
  60. Bilal JA, Eltahir HG, Al-Nafeesah A, Al-Wutayd O, Adam I. Acute severe malnutrition treatment outcomes in children ages 6–59 months admitted to Singa Hospital, Sudan. Transactions of The Royal Society of Tropical Medicine and Hygiene. 2020 Aug 1;114(8):612-7.
  61. Gebremedhin K, Ayele G, Boti N, Andarge E, Fikadu T. Predictors of time-to-recovery from severe acute malnutrition treated in an outpatient treatment program in health posts of Arba Minch Zuria Woreda, Gamo zone, Southern Ethiopia: A retrospective cohort study. PloS one. 2020 Jun 30;15(6):e0234793.
  62. Tesfay W, Abay M, Hintsa S, Zafu T. Length of stay to recover from severe acute malnutrition and associated factors among under-five years children admitted to public hospitals in Aksum, Ethiopia. PloS one. 2020 Sep 29;15(9):e0238311.
  63. Abate BB, Tilahun BD, Kassie AM, Kassaw MW. Treatment outcome of Severe Acute Malnutrition and associated factors among under-five children in outpatient therapeutics unit in Gubalafto Wereda, North Wollo Zone, Ethiopia, 2019. PLoS One. 2020 Sep 3;15(9):e0238231.
  64. Adem F, Edessa D, Bayissa B, Mohammed Hassen M, Mohammed MA. Treatment outcomes and associated factors in hospitalised children with severe acute malnutrition: a prospective cohort study. Pediatric Health, Medicine and Therapeutics. 2020 Jul 21:235-43.
  65. Negussie AS, Tadesse AW. Predictors of undesirable treatment outcomes of severe acute malnutrition among inpatient children in Addis Ababa, Ethiopia: a retrospective cohort study. BMC Public Health. 2020 Oct 9;20(1):1532.
  66. Hussen Kabthymer R, Gizaw G, Belachew T. Time to cure and predictors of recovery among children aged 6–59 months with severe acute malnutrition admitted in Jimma University medical center, Southwest Ethiopia: A retrospective cohort study. Clinical Epidemiology. 2020 Oct 22:1149-59.
  67. Wondim A, Tigabu B, Kelkay MM. Time to Recovery from Severe Acute Malnutrition and Its Predictors among Admitted Children Aged 6‐59 Months at the Therapeutic Feeding Center of Pawi General Hospital, Northwest Ethiopia: A Retrospective Follow‐Up Study. International journal of pediatrics. 2020;2020(1):8406597.
  68. Tefera TK, Abebe SM, Hunegnaw MT, Mekasha FG. Time to recovery and its predictors among children 6–59 months admitted with severe acute malnutrition to East Amhara hospitals, Northeast Ethiopia: a multicenter prospective cohort study. Journal of Nutrition and Metabolism. 2020;2020(1):5096201.
  69. Budul AB, Farah AM, Nour TY. Treatment outcome of severe acute malnutrition among children (6-59 months) in outpatient therapeutic feeding program in Gursum District, Somali region, Ethiopia. Science. 2020 Mar;8(2):36-42.
  70. Nduhukire T, Atwine D, Rachel L, Byonanebye JE. Predictors of in-hospital mortality among under-five children with severe acute malnutrition in South-Western Uganda. Plos one. 2020 Jun 26;15(6):e0234343.
  71. Banga D, Baren M, Ssonko NV, Sikakulya FK, Tibamwenda Y, Banga C, et al. Comorbidities and factors associated with mortality among children under five years admitted with severe acute malnutrition in the nutritional unit of Jinja Regional Referral Hospital, Eastern Uganda. International journal of pediatrics. 2020;2020(1):7809412.
  72. Bitew ZW, Ayele EG, Worku T, Alebel A, Alemu A, Worku F, et al. Determinants of mortality among under-five children admitted with severe acute malnutrition in Addis Ababa, Ethiopia. Nutrition Journal. 2021 Dec;20:1-5.
  73. Oumer A, Mesfin L, Tesfahun E, Ale A. Predictors of death from complicated severe acute malnutrition in East Ethiopia: survival analysis. International Journal of General Medicine. 2021 Nov 24:8763-73.
  74. Kassaw A, Amare D, Birhanu M, Tesfaw A, Zeleke S, Arage G, et al. Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study. BMC pediatrics. 2021 Dec;21:1-0.
  75. Tegegne AS, Belay DB. Predictors for time to recovery from sever acute malnutrition among under-five children admitted to therapeutic feeding unit at Dubti referral hospital, Afar region, Ethiopia. BMC pediatrics. 2021 Dec 10;21(1):562..
  76. Odikro M, Ediau M, Kisakye A, Muneza F, Kiwanuka G, Wamani H. Predictors of recovery from complicated severe acute malnutrition among children 6–59 months admitted at Mbale Hospital. Uganda. J Interv Epidemiol Public Health. 2021 Mar 31;4.
  77. Muwanguzi E, Oboi JE, Nabbamba A, Wanyama R. Treatment outcome and associated factors for severely malnourished children (1–5 years) admitted to Lacor Hospital and Gulu Regional Referral Hospital in Uganda. Journal of Nutritional Science. 2021 Jan;10:e33.
  78. Panda PC, Soren G, Rout S, Behera R. Outcome of severe acute malnutrition management at a tertiary care nutrition rehabilitation centre. JMSCR. 2019;7:112-4.
  79. Bharathi S, Anuradha K, Rao JV. An experience at a tertiary level hospital NRC in management of severe acute malnutrition in children aged between 6-59 months adopting World Health Organization recommendations. Res Health Sci. 2016 May 25;1(1):41-50.
  80. Das K, Das S, Mohapatra S, Swain A, Mohakud NK. Risk and adverse outcome factors of severe acute malnutrition in children: a Hospital-Based Study in Odisha. Cureus. 2021 Sep;13(9).
  81. Al Amad M, Al‐Eryani L, Al Serouri A, Khader YS. Evaluation of outpatient therapeutic programme (OTP) for treatment of severe acute malnutrition in Yemen: a focus on treatment default and its risk factors. Journal of evaluation in clinical practice. 2017 Dec;23(6):1361-6.
  82. Rogers E, Ali M, Fazal S, Kumar D, Guerrero S, Hussain I, et al. Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan. Public health nutrition. 2018 Feb;21(2):385-90.
  83. Panigrahi BK, Agarwalla SK, Ali N. Clinical Profile and outcome of Severe Acute Malnutrition (SAM) Children admitted in Nutrition Rehabilitation Centre, City Hospital, Berhampur, Odisha.
  84. Harding KL, Aguayo VM, Namirembe G, Webb P. Determinants of anemia among women and children in Nepal and Pakistan: An analysis of recent national survey data. Maternal & child nutrition. 2018 Nov;14:e12478.
  85. Das S, Paul DK, Bhattacharya M, Basu S, Chatterjee A, Sen S, et al. Clinicoepidemiological Profile, Risk Factors and Outcome of Severe Acute Malnutrition Children at the Nutritional Rehabilitation Centre of a Tertiary Care Centre in Eastern India-A 4 Years Experience. Adv Res Gastroentero Hepatol. 2017;5(2):55-9.
  86. Ahmed AU, Ahmed TU, Uddin MS, Chowdhury MH, Rahman MH, Hossain MI. Outcome of standardized case management of under-5 children with severe acute malnutrition in three hospitals of Dhaka city in Bangladesh. Bangladesh Journal of Child Health. 2013 Jun 18;37(1):5-13.
  87. Prada DR, Delgado G, Patiño CH, Pérez-Navero J, Campos MG. Using of WHO guidelines for the management of severe malnutrition to cases of marasmus and kwashiorkor in a Colombia children's hospital. Nutricion hospitalaria. 2011;26(5):977-83.
  88. Kumar R, Singh J, Joshi K, Singh HP, Bijesh S. Co-morbidities in hospitalized children with severe acute malnutrition. Indian Pediatrics. 2014 Feb;51:125-7.
  89. Shalini H, Vidya GS. A Study on the Clinicosocial Profile of Severe Acute Malnutrition Cases Admitted to Nutritional Rehabilitation Centre, Davanagere, Karnataka. Annals of Community Health APR-JUN. 2021;9(02).
  90. Wagnew F. A meta-analysis of Inpatient Treatment Outcomes of Severe Acute Malnutrition and predictors of mortality among Ethiopian under-five Children. In30th EPHA Annual Conference 2019 Jan 31.
  91. Dhanalakshmi K, Devi CG. The outcome of severe acute malnutrition children admitted to nutrition rehabilitation centre of a tertiary level care hospital. Int J Contemp Pediatr. 2017 Apr 25;4(3):801-3.
  92. Shah RH, Javdekar BB, Rh S, May P. Management of children with severe acute malnutrition: experience of nutrition rehabilitation centre at Baroda, Gujarat. Int J Contemp Pediatr. 2014 May;1(1):3-6.
Journal of Pediatric Perspectives
Volume 12, Issue 9
September 2024
Pages 19040-19069