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Hospital-Acquired Malnutrition in Children in a Tertiary Care Hospital

Thesis Info

Author

Quadros, Del-Rossi Sean

Department

Paediatrics and Child Health (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2014

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728053647

Similar


Introduction: Hospital-acquired Malnutrition occurs as a result of reduction in food intake, increased dietary loss and/or increased calorie requirements as a result of disease-induced high catabolic state. A child's nutritional status often deteriorates after admission to the hospital resulting in longer duration of hospital stay and increased risk of complications, which also increases treatment cost. Hospital-acquired Malnutrition is usually assessed using anthropometric measurements and/or serum pre-albumin. Objectives: This study sought to investigate the incidence of Hospital-acquired Malnutrition using anthropometric measurements and to determine diagnostic utility of serum pre-albumin in predicting weight change. A secondary objective was to identify factors associated with Hospital-acquired Malnutrition in children admitted at Aga Khan University Hospital, Nairobi. Methodology: This was a hospital-based, short follow up longitudinal survey carried out on children admitted to Aga Khan University Hospital, Nairobi. One hundred and eighty children were enrolled into the study. Weight and height were taken at admission and discharge. Serum pre-albumin levels were taken at admission and repeated after 48-96 hrs. Data Analysis: The incidence of Hospital-acquired Malnutrition was estimated from the total number of children showing a decrease in weight-for-height/length or BMI Z-scores from the time of admission to discharge. Sensitivity, specificity, positive and negative predictive values of serum pre-albumin were calculated to determine its diagnostic utility in screening for Hospital-acquired Malnutrition. Levels of serum pre-albumin were summarized using a Pre-albumin Risk Stratification model by Bernstein et al. Logistic Regression Analysis, with calculation of odds ratio, was done for selected variables to look for any association with loss of weight during hospitalization. Results: The study showed that 103 (60.6%) children lost weight from admission to discharge, giving a mean weight decrease of 0.5kg (SD±3.37), p=0.055. Of the 170 children studied, 109 who were ≤60 months of age, demonstrated a mean decrease in weight-for-height/length Z-score of 0.145 (SD±0.73), p=0.042, and 61 children aged >60 months demonstrated a mean decrease in BMI Z-score of 0.152 (SD±0.39), p=0.004. Nine percent (10/109) of children ≤60 months and 3.0% (2/61) of children >60 months had worsening of nutritional status as determined by WHO classification. The greatest frequency of weight loss was observed among children diagnosed with gastroenteritis (81.2%), gastritis (64.3%) and pneumonia (55.6%). LOS was demonstrated to be the most significant risk factor for weight loss (OR 1.37, p=0.003, C.I 1.11-1.69). Children who had a hospital stay of 5-7 days had about 4.5 fold risk for weight loss (OR 4.67, 95%
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ظفر اقبال

حیات و تعلیم:
ظفر اقبال27 ستمبر، 1932ء کو بہاولنگر ، پاکستان میں پیدا ہوئے۔ ان کے والد چک نمبر 49/3Rضلع اوکاڑہ کے ایک معزز زمیندار تھے۔ ظفر اقبال نے ابتدائی تعلیم بہاولنگر سے حاصل کی اور میٹرک ایم سی ہائی اسکول اوکاڑہ سے 1950ء میں کیا۔ انٹرمیڈیٹ کا امتحان ایف سی کالج لاہور اور بی اے گورنمنٹ کالج لاہور سے کیا۔ ظفر اقبال نے ایل ایل بی کا امتحان لا کالج جامعہ پنجاب سے پاس کیا۔
وکالت کا امتحان پاس کرنے کے بعد انہوں نے اوکاڑہ کچہری میں پریکٹس شروع کر دی۔ وہ ایک بار اوکاڑہ ایسوسی ایشن اور دو مرتبہ پریس کلب اوکاڑہ کے صدر بھی رہے۔ اس دوران انہوں نے قومی سیاست میں بھرپور طریقے سے حصہ لیا۔ 1977ء کے انتخابات میں ظفر اقبال نے نیشنل عوامی پارٹی کی طرف سے راؤ خورشید علی خاں (پاکستان پیپلز پارٹی کے نامزد امیدوار) کے مقابلے میں الیکشن لڑا لیکن کامیاب نہ ہو سکے۔
ادبی خدمات:
پرائمری کے دوران ان کی طبیعت شاعری کے لیے موزوں ہو چکی تھی، کیونکہ ان کے استاد نور احمد انجم قریشی جو خود بھی شاعر تھے بچوں کو بطور املا اشعار لکھ کر دیتے۔ ظفر اقبال آٹھویں جماعت تک کلیات میر اور دیوانِ غالب کا بھرپور مطالعہ کر چکے تھے۔ شفیق الرحمن کی تحریریں پڑھ کر ان کے اندر لکھنے کی تحریک پیدا ہوئی۔ انہوں نے غزل کے پیرائے میں فنی اور موضوعاتی سطح پر روایت شکنی کے حوالے سے اپنی ایک الگ اور بھرپور پہچان بنائی۔ اْن کے پہلے شعری مجموعے آب رواں کو عوام اور خواص، ہردو حلقوں میں بے حد پزیرائی ملی۔ اس کے بعد انہوں شعری تجربات کا سلسلہ نہ صرف جاری رکھا بلکہ اسے بام عروج تک پہنچایا۔ 1973ء میں انہوں نے پہلا کالم سرور سکھیرا کے پرچے دھنک کے لیے لکھا۔ ان کے مختلف اخبارات میں...

Assessing the Relevance of Indus Waters Treaty to the International Law on NonNavigational Uses of the International Watercourses

Indus Waters Treaty is the most comprehensive and complex document which divides Indus Rivers System between India and Pakistan. It has continued to function through three wars and various political tensions between both neighboring states. It was signed in 1960 when no international law was available to deal the non-navigational uses of the international watercourses. Since the Helsinki rules were adopted by the International Association of Law in 1966 and the United Nations Convention on International Water Courses was approved by the United Nations General Assembly in 1997, both documents have little effect on the terms and conditions of the Indus Waters Treaty. This paper is an attempt to explore the relevance of the provisions of the Treaty to the contemporary international law on non-navigational uses of the international rivers

Salinity and Extreme Temperature Effects on Sprouting Buds of Sugarcane Saccharum Officinarum L. : Some Histological and Biochemical Studies

Sugarcane shows reduced crop stand under relatively suboptimal conditions, the main reason for this is sensitivity of bud tissue to temperature fluctuations and salinity at sowing time. The aim of these studies was to explore the physiological, developmental and molecular changes occurring in the immature sugarcane buds under heat, cold and salt stresses, and possible role of proline and glycinebetaine in mitigating the changes in a time course manner during sprouting of nodal buds. All the stresses reduced bud fresh and dry weight, led to the generation of H 2 O 2 , reduced the tissue levels of K + and Ca 2+ , but enhanced the synthesis of osmolytes in a time course manner. Heat stress mainly produced oxidative damage and acted as a dehydrative force, whereas cold stress caused oxidative stress and slowed down the physiological activities. Salinity was the most damaging of all the stresses. The main effects of salinity were the accumulation of Na + and Cl - , reduced tissue contents of Ca 2+ and K + and enhanced synthesis of H 2 O 2 in the developing sugarcane bud. As for histological changes, all the stresses delayed and reduced the formation of new bud leaves and their expansion, which was mainly because of reduction in the number and area of mesophyll cells and poor development of vascular bundles. The pretreatment of bud chips with proline and GB effectively reduced stress effects being more effective under heat stress followed by cold stress and the least under salinity stress. As revealed from the correlation studies, although pretreatment with proline and GB appeared to have no direct role in stress tolerance, main effects were the reduced generation of H 2 O 2 , improvement in the K + and Ca 2+ nutrition and further enhancement in the levels of free proline, GB and soluble sugars under heat and cold stress. Under salt stress, the pretreatment reduced Na + and Cl - , in addition to the observed effects under heat and cold stresses. Histological changes revealed that the pretreatment with osmoprotectants increased the mesophyll cell area leading to expansion in the bud leaves and led the development of elaborated vascular tissues. Of the two, GB was more effective than proline for all stress treatments but for different measured variables. Detailed studies on the molecular and metabolic responses indicated the enhanced expression of Asn, dehydrins, LEA and GAPDH genes, stronger accumulation of proline and alanine followed by glycine, glutamic viiiacid and 5-oxo-proline. Among the sugars, sucrose followed by diethylene glycol, fructose, glucose and glycerol, and nucleic acids, adenosine and uracil, as well as organic acids, aconitate, chlorogenate, ribonate_put, quinate, pipecolate, erythronate, GABA, glucoronate, gluconate, glucarate, glucoranate and octadecanoate showed accumulation at all temperature treatments and time periods. HCA and LVL revealed that out of 108 metabolites, chlorogenate, putrescine, octadecanoate, fructose, proline, glycine, sucrose, quinate, trans-aconitate, guanine, GABA and ethanolamine showed greater accumulation under high temperature. In crux, albeit all stresses deterred the transition of bud from immature to mature state, the salinity was the most damaging. In most cases, improvement produced by proline was greater than GB. Heat stress revealed distinct patterns of gene expression and metabolites synthesis. The correlation data showed that pretreatment with the osmoprotectants improved bud growth under stress regimes; the roles are indirect in improved Ca 2+ and K + nutrition and reduced production of H 2 O 2 . Nevertheless, these findings suggest that in low to moderately hot, cool and saline areas sugarcane bud sprouting can be improved by pretreatment of bud chips with the 20 mM levels of proline and GB and requisite crop stand can be achieved