Scaling Up Improved Inpatient Treatment of Severe Malnutrition: Key Factors and Experiences From South Africa, Bolivia, Malawi, and Ghana.

Severe acute malnutrition (SAM) can have high mortality, especially in very ill children treated in the hospital. Many medical and nursing schools do not adequately, if at all, teach how to manage children with SAM. There is a dearth of experienced practitioners and trainers to serve as exemplars of good practice or participate in capacity development.

Sarcopenia and malnutrition: commonly occurring conditions in the older population.

This article reviews the prevalence of loss of muscle mass and function, (sarcopenia) alongside malnutrition in the older population (>65 years). It outlines what is meant by both sarcopenia and malnutrition and looks at how these conditions can interact to cause detrimental outcomes in both underweight and overweight older adults. It also details some of the potential consequences of loss of muscle mass on the effective functioning of the human body and clinical outcomes and includes tips for nurses on how they can incorporate simple strategies into everyday care to both identify and treat patients at risk of sarcopenia and malnutrition.

Effects of chlorhexidine mouthwash on the oral microbiome.

Introduction/objectives: Chlorhexidine (CHX) is a commonly used mouthwash with potent anti-microbial effects useful for the management of oral disease. However, we are moving away from the view of simply 'killing' bacteria, towards managing oral microbial ecosystems (oral microbiome), as an integrated system, to promote oral and systemic health. Here, we aimed to review the effects of CHX mouthwash on the balance of microbial communities in the mouth in vivo in oral health and disease.

Effects of Chlorhexidine mouthwash on the oral microbiome.

Following a single blind, cross-over and non-randomized design we investigated the effect of 7-day use of chlorhexidine (CHX) mouthwash on the salivary microbiome as well as several saliva and plasma biomarkers in 36 healthy individuals. They rinsed their mouth (for 1 min) twice a day for seven days with a placebo mouthwash and then repeated this protocol with CHX mouthwash for a further seven days. Saliva and blood samples were taken at the end of each treatment to analyse the abundance and diversity of oral bacteria, and pH, lactate, glucose, nitrate and nitrite concentrations.

Efficacy of F-100, diluted F-100, and infant formula as rehabilitation diet for infants aged < 6 months with severe acute malnutrition: a randomized clinical trial.

Purpose: To assess the efficacy and safety of F-100, diluted F-100 (F100D), and infant formula (IF) for dietary management in the rehabilitation phase of severe acute malnutrition (SAM) of infants aged under 6 months (u6m).

Methods: Double-blind randomized clinical trial was conducted to assess the efficacy and safety of F-100, F-100D, and IF at the Nutrition Rehabilitation Unit, icddr,b. Infants (n = 153) u6m with SAM were enrolled and randomly assigned to any of the three diets after stabilization.

Improved care and survival in severe malnutrition through eLearning.

Background: Scaling up improved management of severe acute malnutrition (SAM) has been identified as the nutrition intervention with the greatest potential to reduce child mortality but it requires improved operational capacity.

Objective: To investigate whether an eLearning course, which can be used at scale in resource-poor countries, leads to improved diagnosis, clinical management and survival of children with SAM.

Design: A 2-year preintervention and postintervention study between January 2015 and February 2017.

Dietary intake of inorganic nitrate in vegetarians and omnivores and its impact on blood pressure, resting metabolic rate and the oral microbiome.

Vegetarian diets are commonly associated with lower blood pressure levels. This has been related to greater consumption of inorganic nitrate, since vegetables are the main source of this anion. Dietary nitrate is reduced to nitrite by commensal bacteria in the mouth, which in turn leads to increased circulatory nitrite availability.

Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: Cross-Country Interrupted Time-Series Study.

Background: Scaling up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality, but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to the guidelines of the World Health Organization.

Objective: The aim of this study was to test whether the malnutrition eLearning course improves knowledge and skills of in-service and preservice health professionals in managing children with severe acute malnutrition and enables them to apply the gained knowledge and skills in patient care.

Dietary nitrate and blood pressure: evolution of a new nutrient?

Dietary nitrate is mainly obtained from vegetables, especially green leafy vegetables and beetroot. As a result of early research, dietary nitrate is currently viewed as a contaminant linked to increased risks of stomach cancer and methaemoglobinaemia. Consequently, nitrate levels are restricted in certain vegetables and in water supplies to ensure exposure levels remain below an acceptable daily intake of 3·7 mg/kg per d.

Capacity-building in the management of moderate acute malnutrition.

Evidence from low- and middle-income countries indicates that although there is a willingness to prevent and treat malnutrition at scale, there is very limited capacity to achieve this. Three broad areas of concern are human resources and the quality of services; management systems and supplies; and demand side factors. This paper focuses on building human resources in the context of preventing and managing malnutrition.

High-nitrate vegetable diet increases plasma nitrate and nitrite concentrations and reduces blood pressure in healthy women.

Objective: Epidemiological studies suggest that green leafy vegetables, which are high in dietary nitrate, are protective against CVD such as stroke. High blood pressure (BP) is a major risk factor for stroke and inorganic nitrate has been shown to reduce BP. The objective of the present study was to test the hypothesis that diets containing high-nitrate (HN) vegetables would increase plasma nitrate and nitrite concentrations and reduce BP in healthy women.

Promotion of exclusive breast-feeding at scale within routine health services: impact of breast-feeding counselling training for community health workers in Recife, Brazil.

Objective: Breast-feeding counselling has been identified as the intervention with the greatest potential for reducing child deaths, but there is little experience in delivering breast-feeding counselling at scale within routine health systems. The study aim was to compare rates of exclusive breast-feeding associated with a breast-feeding counselling intervention in which community health agents (CHA) received 20 h of training directed at counselling and practical skills with rates pre-intervention when CHA received 4 h of didactic teaching.

Design: Cross-sectional surveys of breast-feeding practices were conducted pre- and post-intervention in random samples of 1266 and 1245 infants aged 0-5.

Malnutrition treatment to become a core competency.

The International Pediatric Association has resolved that the identification and treatment of severe malnutrition should be a core competency for paediatricians and related health professionals worldwide. The Resolution is in response to the urgent need to reduce deaths and disability among young children. The Resolution has implications for the training of doctors, nurses and other health workers as current curricula are often insufficient to confer competency.

Dietary counseling in the management of moderate malnourishment in children.

Background: Dietary counseling is an integral part of treating malnutrition. A first step toward improving the management of moderate malnutrition is to evaluate dietary messages in current programs and assess their adequacy and effectiveness.

Objectives: To ascertain current recommendations regarding family foods for the treatment of moderate malnutrition and assess whether these are likely to meet nutritional requirements for rehabilitation; to review the effectiveness of dietary counseling in the management of moderate malnutrition.

Early head growth: relation with IQ at 8 years and determinants in term infants of low and appropriate birthweight.

Aim: To investigate the relation between head growth at different periods and IQ at 8 years, and to identify factors associated with more rapid head growth.

Method: Two parallel cohorts of term low birthweight (LBW) and appropriate birthweight (ABW) infants were enrolled at birth in northeast Brazil. Anthropometric measurements were made at birth, 2 months, 6 months, 12 months, 24 months, and 8 years.

Why do some hospitals achieve better care of severely malnourished children than others? Five-year follow-up of rural hospitals in Eastern Cape, South Africa.

Staff at 11 rural hospitals in an under-resourced region of Eastern Cape Province, South Africa, participated in an intervention to improve the quality of care of severely malnourished children through training and support aimed at implementing the WHO case-management guidelines. Despite similar intervention inputs, some hospitals reduced their case-fatality rates by at least half, whereas others did not. The aim of this study was to investigate reasons for this disparity.

Growth monitoring and promotion: review of evidence of impact.

Unlabelled: [Table: see text]

Summary: The rationale for growth monitoring and promotion is persuasive but even in the 1980s the appropriateness of growth monitoring programmes was being questioned. The concerns centred largely around low participation rates, poor health worker performance and inadequacies in health system infrastructure that constrained effective growth‐promoting action. More recently there has been a call for a general review of the impact of large‐scale growth monitoring and promotion programmes to determine if the investments are justified.

Breast feeding and mental and motor development at 12 months in a low-income population in northeast Brazil.

The aim of this prospective study was to investigate the association between breast feeding and mental and motor development at age 12 months, controlling for comprehensive measures of the child's socio-economic, maternal and environmental background, and nutritional status. A cohort of 205 infants born during May-August 2001 in a poor area in the interior of the State of Pernambuco was enrolled, of whom 191 were tested at age 12 months with the Bayley Scales of Infant Development II, and in whom breast-feeding status was measured at days 1, 10, 30, 60, 90, 120, 150, 180, 270 and 360. After adjusting for potential confounders, full breast feeding (i.

Efficacy and effectiveness of community-based treatment of severe malnutrition.

Background: There is a long tradition of community-based rehabilitation for treatment of severe malnutrition: the question is whether it is effective and whether it should be advised for routine health systems.

Objective: To examine the effectiveness of rehabilitating severely malnourished children in the community in nonemergency situations.

Methods: A literature search was conducted of community-based rehabilitation programs delivered by day-care nutrition centers, residential nutrition centers, primary health clinics, and domiciliary care with or without provision of food, for the period 1980-2005.

Development and behaviour of low-birthweight term infants at 8 years in northeast Brazil: a longitudinal study.

Aim: To investigate the development and behaviour of low-birthweight (LBW) term infants compared with matched term infants of appropriate birthweight (ABW).

Methods: Two parallel cohorts of LBW infants (1500-2499 g) and ABW controls (3000-3499 g) were enrolled at birth in northeast Brazil. At 8 y, 164 children were assessed using clinical and psychological tests.

WHO guidelines for severe malnutrition: are they feasible in rural African hospitals?

Aims: To assess the feasibility of implementing and sustaining the WHO guidelines for inpatient management of severe malnutrition in under-resourced rural South African hospitals, and to identify any constraints.

Intervention: Three 2-day training workshops were held in 1998, followed by monthly 1-day visits for 5 months, ending in March 1999, in two rural district hospitals with limited resources in Eastern Cape Province, South Africa.

Methods: A 12-month observational study was conducted from April 2000 to April 2001 in Mary Theresa and Sipetu hospitals (Eastern Cape Province, South Africa), including 1011 child-hours of observation on the wards, medical record reviews, interviews with carers and staff, and inventories of essential supplies.

[The impact of training based on the Baby-Friendly Hospital Initiative on breastfeeding practices in the Northeast of Brazil].

Objective: To evaluate the impact of training based on the Baby Friendly Hospital Initiative on breastfeeding practices in maternity wards and during the first 6 months of life.

Methods: Ninety percent of nursing auxiliaries and midwives were trained at two institutions (A and B) in Palmares, Pernambuco state. Three hundred and thirty-four mothers were interviewed within the first 48 hours and 10 days after childbirth to evaluate breastfeeding practices at the maternities and fulfillment of steps 4 through 10 of the Baby Friendly Hospital Initiative.