Socio-economic and environmental factors affecting the rehabilitation of children with severe malnutrition

  • Felliyani Felliyani
  • Sri S Nasar
  • Taralan Tambunan
Keywords: severe malnutrition, infectious disease, socio-economic status, environment

Abstract

Background Poor diet and high infection rates inflicted by low
socio-economic status and poor environments among infants and
young children appear to be major causes of severe malnutrition.
Objective To determine the practical and likely effectiveness in
rehabilitation of severe malnutrition.
Methods A descriptive observational study was conducted on 27
children at three different sites: (1) Five inpatients at the Inpatient
Ward, Cipto Mangunkusumo Hospital, Jakarta (IP-CM); (2) 8 out-
patients at the Metabolic and Nutrition Clinic, Cipto Mangunkusumo
Hospital (OP-CM); (3) 14 outpatients at the Nutrition Clinic, Bogor
(NC). All the patients followed were aged <60 months and suf-
fered from severe malnutrition (weight for length index <-3 NCHS
Z-score). Subjects were followed for 12 weeks. The IP-CM group
received standard treatment following the WHO recommendation,
while the OP-CM and NC group received proper medical treat-
ment and nutrition education for mothers. The OP-CM group un-
derwent more extensive laboratory investigations.
Results All children generally had low socio-economic status. Most
children experienced poor feeding, child care, and other health
practices. A tendency of increased prevalence, number of episodes,
and duration of infectious diseases was noted in the majority of
subjects. However, an improvement of nutritional status was ob-
served during treatment in all groups, particularly in the IP-CM
group.
Conclusion Socio-economic status and environmental factors
must be considered in the management of severe malnutrition.
Educating parents concerning proper feeding and child care prac-
tices appears to be of permanent nutritional benefit for the chil-
dren.

Author Biographies

Felliyani Felliyani
Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.
Sri S Nasar
Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.
Taralan Tambunan
Department of Child Health, Medical School, University of
Indonesia, Jakarta, Indonesia.

References

1. Biro Pusat Statistik. Statistik kesejahteraan rakyat
2002. Jakarta: CV Dua Putra Sarko; 2002. p. 31-32.
2. Tomkins A, Watson F. Malnutrition and infection: a
review. London: Clinical Nutrition Unit, London School
of Hygiene and Tropical Medicine; 1989. p. 1-42.
3. UNICEF. The state of the world’s children. New York:
Oxford University Press; 1998. p. 11-12.
4. Ehiri JE, Prowse JM. Child health promotion in devel-
oping countries: the case for integration of environ-
ment and social intervention? In: Ehiri JE, editor. New
York: Oxford University Press; 1999. p. 1-10.
5. World Health Organization. Management of severe
malnutrition: manual for physician and other senior
health workers. Geneva: WHO; 1999. p. 4-34.
6. Hubbard VS, Hubbart LR. Clinical assessment of nu-
tritional status. In: Walker WA, Watkins JB, editors.
Nutrition in pediatrics. London: BC Decker Inc. Pub-
lisher; 1997. p. 17-9.
7. WHO expert committee. Physical status: the use and
interpretation of anthropometrics. Geneva: WHO;
1995. p. 6-8.
8. Dirjen P2M PLP. Pedoman program pemberantasan
infeksi saluran pernafasan akut. Jakarta: Departemen
Kesehatan Republik Indonesia; 1996. p. 3-10.
9. Departemen Kesehatan Republik Indonesia. Buku ajar
diare. Jakarta: Departemen Kesehatan RI; 1999. p. 1-15.
10. Godis L. Measuring the occurrence of disease. In:
Gordis L, editor. Epidemiology. Philadelphia: WB
Saunders Company; 1996. p. 30-57.
11. Corrales KM, Utter SL. Failure to thrive. In: Samour
PQ, Helm KK, Lang CE, editors. Handbook of pediat-
ric nutrition. 2nd ed. Maryland: An Aspen Publica-
tion Inc; 1999. p. 395-409.
12. Waterlow JC. Protein-energi malnutrition: general in-
troduction. In: Waterlow JC, editor. Protein-energy
malnutrition. 1st ed. London: Hodder and Stoughton
Limited; 1992. p. 1-11.
13. Kikafunda JK, Walker AF, Collett D. Risk Factors for early
childhood Malnutrition. Pediatrics 1998; 102: e45-59.
14. Umeta M, West CE, Verhoef H, Haidar J, Hautvast.
Factors associated with stunting in infants aged 5-11
months in the Dodota-Sire district, rural Ethiopia. J
Nutr 2003;133:1064-9.
15. Mortajemi Y, Kaferstein F, Moy G, Queveodo F. Con-
tamination weaning food: a major risk factor for diar-
rhea and associated malnutrition. Bull WHO
1993;72:79-92.
16. Molbak K, Jensen H, Ingholt L, Aaby P. Risk factors
for diarrheal disease incidence in early childhood: a
community study from Guinea-Bissau. Am J Epidemil
1997;146:273-82.
17. Victora CG, Kirkwood BR, Ashworth A, Black RE,
Rogers S, Sazawal S, et al. Potential interventions for
the prevention of childhood pneumonia in developing
countries: improving nutrition. AJCN 1999;70:309-20.
18. De Onis, Frongillo EA, Blossner M. Is malnutrition
declining? an analyisis of changes in levels of child
malnutrition since 1980. Bull WHO 2000;78:1222-
33.
19. Victora CG, Smith PG, Vaughan JP, Nobre LC,
Lombardi C. Evidence for protection by breast feeding
against infant deaths from infectious diseases in Brazil.
Lancet 1987;21:319-22.
20. Molbak K, Gottschau A, Aaby P, Hojllyng N, Ingholt
N, da Silva AP. Prolonged breast feeding, diarrheal dis-
ease and survival of children in Guinea-Bissau. BMJ
1994;308:1403-6.
21. Dibley MJ, Sadjimin T, Kjolhede CL, Moulton LH.
Vitamin A supplementation fails to reduce inci-
dence of acute respiratory illness and diarrhea in
preschool age Indonesian children. J Nutr 1996;
126:434-42.
22. Selwyn BJ. The epidemiology of acute respiratory tract in-
fection in young children: comparison of findings from sev-
eral developing countries. Rev Infect Dis 1990;12:870-88.
23. Khanum S, Ashworth A, Huttly SRA. Controlled trial
of three approaches to the treatment of severe malnu-
trition. Lancet 1994;334:1728-32.
24. Brewster DR, Manary MJ, Graham SM. Case man-
agement of kwashiorkor: an intervention project at
seven nutrition rehabilitation centers in Malawi. Eur J
Clin Nutr 1997;51:139-47.
25. Collins S, Sadler K. Outpatient care for severely mal-
nourished children in emergency relief programmes: a
retrospective cohort study. Lancet 2002;360: 824-30.
Published
2016-10-10
How to Cite
1.
Felliyani F, Nasar S, Tambunan T. Socio-economic and environmental factors affecting the rehabilitation of children with severe malnutrition. PI [Internet]. 10Oct.2016 [cited 17Apr.2024];45(3):99-06. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/808
Section
Articles
Received 2016-10-05
Accepted 2016-10-05
Published 2016-10-10