Micronutrient Status and the Predictors of Recovery Time in Children with Severe Acute Malnutrition: A Prospective Observational Study

Introduction: Severe Acute Malnutrition (SAM) remains a major cause of child mortality worldwide. Understanding the determinants of recovery time in children with SAM is pivotal for reducing associated mortality and morbidity. The significance of this study stems from investigating whether recovery duration in this population could be shortened by elucidating the roles of micronutrients and other multifactorial influences, including clinical and demographic characteristics before hospitalisation and during inpatient care.

Aim: To determine the median time to recovery and the factors associated with time to recovery, and to assess the prevalence of micronutrient deficiency and the complications experienced by children under five with SAM during hospitalisation.

Materials and Methods: A prospective observational study was conducted from September 2021 to September 2022, involving 130 children at the Nutritional Rehabilitation Centre (NRC), Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India, with SAM, aged from the post neonatal period up to 59 months, of both sexes. The clinical status, anthropometry, co-morbidities, treatment, feed increments, duration of hospital stay, and complications during the stay were assessed and recorded. Laboratory assessment of serum micronutrient levels at admission was performed. The children were followed for 15 days to determine time to recovery as per World Health Organisation (WHO) guidelines. Multivariate logistic regression analysis was performed to identify factors associated with faster recovery (defined as a recovery time shorter than the median). International Business Machines Statistical Package for the Social Sciences (IBM SPSS) version 21 was used for statistical analysis.

Results: The median recovery time was 19.5 days. Factors strongly associated with faster recovery in SAM children included a hospital stay of less than two weeks, oedema at presentation, a caloric intake of ≥120 kcal/kg/day at discharge, and normal serum copper levels. The overall prevalence of micronutrient deficiency in the study group was 84.6%, with deficiencies in magnesium (n=99, 76.2%), zinc (n=70, 53.8%), iron (n=54, 41.5%), and copper (n=33, 25.4%).

Conclusion: Low serum micronutrient values were associated with longer hospital stays, highlighting the importance of micronutrient supplementation during stabilisation and rehabilitation of children with SAM. Special emphasis should be placed on preventing co-morbidities to achieve faster recovery. Policy efforts should focus on community-based treatment, which is essential for achieving faster recovery in the inpatient management of SAM in children.