A Comparative Study To Know The Haematological Profile And Biochemical Profile Among Children With Severe Acute Malnutrition And Healthy Children

Abstract

BACKGROUND: Malnutrition is India’s silent crisis as the maximum number of malnourished children less than five years of age and related deaths twice to that of sub-Saharan Africa are reported here.1 In India, more than five millions children are estimated to die every year as a result of undernutrition directly or indirectly due to which succumbs in the loss of one child every ten seconds.2SAM is the main public health problem, which affects around 7.5% of under-five children in India according to NFHS-4 (2015-16).3 Severely malnourished children are more prone to long term developmental delay and have weakened immunity making them susceptible to infections. Children with SAM can suffer consequences for their future health, learning and economic performance. SAM results in numerous pathophysiological changes in the body systems including alterations in hematological parameters. OBJECTIVES: PRIMARY OBJECTIVE: 1. To compare the haematological profile among children with severe acute malnutrition and healthy or well nourished children. 2. To compare the biochemical profile among children with severe acute malnutrition and healthy or well nourished children. SECONDARY OBJECTIVE: Comparison of anthropometric parameters in children with severe acute malnutrition and healthy or well nourished children. METHODOLOGY: A total of 60 subjects in the age group of 6 months to 5 years, with 30 cases diagnosed as severely acute malnourished and 30 controls at Nutrition Rehabilitation Center, KLES Dr.Prabhakar Kore Charitable Hospital and Medical research centre, Belagavi from January 2018- December 2018. Under aseptic conditions, 5 ml of venous blood was collected in vacutainers, 2.5 ml in EDTA vacutainers for haematological investigations and 2.5 ml in plain vacutainers for biochemical investigations. All the samples were then analyzed using an automated analyser. RESULTS: In the present study, for identification of SAM cases, all the 30 cases (100%) have <-3SD weight for height and 10 cases (33.33%) have MUAC <11.5 cm. The most common age group of the children that were enrolled in the study was between 13-36 months with females (53.33%) outnumbering males (46.67). The male : female ratio was 1:1.42.Most of the SAM children had marasmus (90%) followed by marasmic-kwashiorkar (6.66%) and kwashiorkor (3.33%).Majority of the SAM cases had anaemia (90%), out of which majority had moderate anaemia (50%) followed by severe anaemia (26.67%), mild anaemia (13.33%) and normal blood picture (10%).The most common type of anaemia observed was microcytic hypochromic anaemia (63.33%) followed by dimorphic anaemia (23.33%), normocytic hypochromic anaemia (3.3%) and normal blood picture (10%) .Most of the cases which had microcytic hypochromic anaemia (63.33%) majority of them had decreased serum ferritin levels (84.21%) and rest had normal ferritin levels. In our study the mean serum sodium, mean serum albumin and mean serum total proteins were significantly lowered in severely malnourished subjects as compared to controls. CONCLUSION: The findings of this study highlights the significant haematological and biochemical changes occurring in cases of severe acute malnutrition in children aged between 6- 60 months as compared to healthy children. This study also highlights “weight for age” as more sensitive marker than MUAC for identification of SAM children in children aged between 6 – 60 months of age.