Malnutrition and Mortality Patterns among Internally Displaced and Non-Displaced Population Living in a Camp,a Village or a Town in Eastern Chad

Background

Certain population groups have been rendered vulnerable in Chad because of displacement of more than 200,000 people over the last three years as a result of mass violence against civilians in the east of the country. The objective of the study was to assess mortality and nutritional patterns among displaced and non-displaced population living in camps, villages and a town in the Ouddaï and Salamat regions of Chad.

Methodology

Between May and October 2007, two stage, 30-cluster household surveys were conducted among 43,900 internally displaced persons (IDPs) living in camps in Ouaddai region (n = 898 households), among 19,400 non-displaced persons (NDPs) living in 42 villages in Ouaddai region (n = 900 households) and among 17,000 NDPs living in a small town in Salamat region (n = 901 households). Data collection included anthropometric measurements, measles vaccination rates and retrospective mortality. Crude mortality rate (CMR), mortality rate among children younger than 5 years (U5MR), causes of death and the prevalence of wasting (weight-for-height z score <−2) among children aged 6 to 59 months were the main outcome measures.

Conclusions

The CMR among the 4902 IDPs in Gozbeida camps, 4477 NDPs living in a village and 4073 NDPs living in a town surveyed was 1.8 (95% CI, 1.2–2.8), 0.3 (95% CI, 0.2–0.4), 0.3 (95% CI, 0.2–0.5) per 10,000 per day, respectively. The U5MR in a camp (n = 904), a village (n = 956) and a town (n = 901) was 4.1 (95% CI, 2.1–7.7), 0.5 (95% CI, 0.3–0.9) and 0.7 (95% CI, 0.4–1.4) per 10,000 per day, respectively. Diarrhoea was reported to be the main cause of death. Acute malnutrition rates (according to the WHO definition) among 904 IDP children, 956 NDPs children living in a village, 901 NDP children living in a town aged 6 to 59 months were 20.6% (95% CI, 17.9%–23.3%), 16.4% (95% CI, 14.0%–18.8%) and 10.1% (95% CI, 8.1%–12.2%) respectively. The study found a high mortality rate among IDPs and an elevated prevalence of wasting not only in IDP camps but also in villages located in the same region. The town-dweller population remains at risk of malnutrition. Appropriate contingency plans need to be made to ensure acceptable living standards for these populations.     

The Double Burden of Obesity and Malnutrition in a Protracted Emergency Setting: A Cross-Sectional Study of Western Sahara Refugees

Background

Households from vulnerable groups experiencing epidemiological transitions are known to be affected concomitantly by under-nutrition and obesity. Yet, it is unknown to what extent this double burden affects refugee populations dependent on food assistance. We assessed the double burden of malnutrition among Western Sahara refugees living in a protracted emergency.

Methods and Findings

We implemented a stratified nutrition survey in October–November 2010 in the four Western Sahara refugee camps in Algeria. We sampled 2,005 households, collecting anthropometric measurements (weight, height, and waist circumference) in 1,608 children (6–59 mo) and 1,781 women (15–49 y). We estimated the prevalence of global acute malnutrition (GAM), stunting, underweight, and overweight in children; and stunting, underweight, overweight, and central obesity in women. To assess the burden of malnutrition within households, households were first classified according to the presence of each type of malnutrition. Households were then classified as undernourished, overweight, or affected by the double burden if they presented members with under-nutrition, overweight, or both, respectively.The prevalence of GAM in children was 9.1%, 29.1% were stunted, 18.6% were underweight, and 2.4% were overweight; among the women, 14.8% were stunted, 53.7% were overweight or obese, and 71.4% had central obesity. Central obesity (47.2%) and overweight (38.8%) in women affected a higher proportion of households than did GAM (7.0%), stunting (19.5%), or underweight (13.3%) in children. Overall, households classified as overweight (31.5%) were most common, followed by undernourished (25.8%), and then double burden–affected (24.7%).

Conclusions

The double burden of obesity and under-nutrition is highly prevalent in households among Western Sahara refugees. The results highlight the need to focus more attention on non-communicable diseases in this population and balance obesity prevention and management with interventions to tackle under-nutrition. Please see later in the article for the Editors'' Summary     

Mortality Rates above Emergency Threshold in Population Affected by Conflict in North Kivu,Democratic Republic of Congo,July 2012–April 2013

The area of Walikale in North Kivu, Democratic Republic of Congo, is intensely affected by conflict and population displacement. Médecins-Sans-Frontières (MSF) returned to provide primary healthcare in July 2012. To better understand the impact of the ongoing conflict and displacement on the population, a retrospective mortality survey was conducted in April 2013. A two-stage randomized cluster survey using 31 clusters of 21 households was conducted. Heads of households provided information on their household make-up, ownership of non-food items (NFIs), access to healthcare and information on deaths and occurrence of self-reported disease in the household during the recall period. The recall period was of 325 days (July 2012–April 2013). In total, 173 deaths were reported during the recall period. The crude mortality rate (CMR) was of 1.4/10,000 persons/day (CI95%: 1.2–1.7) and the under-five- mortality rate (U5MR) of 1.9/10,000 persons per day (CI95%: 1.3–2.5). The most frequently reported cause of death was fever/malaria 34.1% (CI95%: 25.4–42.9). Thirteen deaths were due to intentional violence. Over 70% of all households had been displaced at some time during the recall period. Out of households with someone sick in the last two weeks, 63.8% sought health care; the main reason not to seek health care was the lack of money (n = 134, 63.8%, CI95%: 52.2–75.4). Non Food Items (NFI) ownership was low: 69.0% (CI95%: 53.1–79.7) at least one 10 liter jerry can, 30.1% (CI95%: 24.3–36.5) of households with visible soap available and 1.6 bednets per household. The results from this survey in Walikale clearly illustrate the impact that ongoing conflict and displacement are having on the population in this part of DRC. The gravity of their health status was highlighted by a CMR that was well above the emergency threshold of 1 person/10,000/day and an U5MR that approaches the 2 children/10,000/day threshold for the recall period.     

Famine in southern Ethiopia 1985-6: population structure,nutritional state,and incidence of death among children.

OBJECTIVE--To assess the effects of drought on mortality in children. DESIGN--Prospective epidemiological study forming part of nutritional monitoring during famine relief work. SETTING--24 Food distribution sites in Arero and Borana provinces in southern Ethiopia. PATIENTS--A monthly average of 14,173 and 5,334 children under 5 were examined in 1985 and 1986, respectively. Altogether 148,966 child months (105,872 for 1985 and 43,094 for 1986) were available for analysis. INTERVENTION--The families of all children were supplied with food each month. Basic medical care was also provided. MAIN OUTCOME MEASURE--Mortality in children under 5. RESULTS--A 40% increase in crude mortality was observed among children living in traditional and stable societies. The severe consequences were observed mainly among children living in relief shelters, where a threefold to fourfold increase in crude mortality was recorded among children. Increased childhood mortality was also associated with high prevalence of malnutrition, living in the most arid areas, and the dry season. A long period of food aid was needed to normalise the nutritional state, especially for children living in relief shelters. CONCLUSIONS--The most severe consequences of the widespread famine that occurred in the Arero and Borana provinces of southern Ethiopia during 1985-6 were seen among children living in relief shelters. Early food intervention may decrease the scale of migration and thus also reduce the severe consequences of a famine.     

Insecticide-treated plastic tarpaulins for control of malaria vectors in refugee camps

Spraying of canvas tents with residual pyrethroid insecticide is an established method of malaria vector control in tented refugee camps. In recent years, plastic sheeting (polythene tarpaulins) has replaced canvas as the utilitarian shelter material for displaced populations in complex emergencies. Advances in technology enable polythene sheeting to be impregnated with pyrethroid during manufacture. The efficacy of such material against mosquitoes when erected as shelters under typical refugee camp conditions is unknown. Tests were undertaken with free-flying mosquitoes on entomological study platforms in an Afghan refugee camp to compare the insecticidal efficacy of plastic tarpaulin sprayed with deltamethrin on its inner surface (target dose 30 mg/m2), tarpaulin impregnated with deltamethrin (initially > or = 30 mg/m2) during manufacture, and a tent made from the factory impregnated tarpaulin material. Preliminary tests done in the laboratory with Anopheles stephensi Liston (Diptera: Culicidae) showed that 1-min exposure to factory-impregnated tarpaulins would give 100% mortality even after outdoor weathering in a temperate climate for 12 weeks. Outdoor platform tests with the erected materials (baited with human subjects) produced mosquito mortality rates between 86-100% for sprayed or factory-impregnated tarpaulins and tents (average approximately 40 anophelines and approximately 200 culicines/per platform/night), whereas control mortality (with untreated tarpaulin) was no more than 5%. Fewer than 20% of mosquitoes blood-fed on human subjects under either insecticide-treated or non-treated shelters. The tarpaulin shelter was a poor barrier to host-seeking mosquitoes and treatment with insecticide did not reduce the proportion blood-feeding. Even so, the deployment of insecticide-impregnated tarpaulins in refugee camps, if used by the majority of refugees, has the potential to control malaria by killing high proportions of mosquitoes and so reducing the average life expectancy of vectors (greatly reducing vectorial capacity), rather than by directly protecting refugees from mosquito bites. Mass coverage with deltamethrin-sprayed or impregnated tarpaulins or tents has strong potential for preventing malaria in displaced populations affected by conflict.     

Maternal smoking in pregnancy and sex differences in perinatal death between boys and girls

The sex difference in perinatal mortality in developed countries is largely unexplained. The current study evaluated the differences in the impact of maternal smoking during pregnancy on the risk of perinatal death between males and females. The analysis involved 11,469 and 9,404 newborns derived from two population-based birth cohorts in Northern Finland, for 1966 and 1985-86, respectively. The perinatal mortality rate was 23 per thousand in the 1966 cohort and 9 per thousand in the 1985-86 cohort. The rate ratio (RR) for mortality for males over females is 1.15 and 1.60 in the two cohorts, respectively. Among children whose mothers smoked during pregnancy, the RR was 2.2 (95% CI 1.0, 4.7) for the former cohort and 4.8 (95% CI 1.5, 15.2) for the later cohort; and among the children whose mothers did not smoke the corresponding RR was 1.2 (95% CI 0.9, 1.6) and 1.1 (95% CI 0.6, 1.9). Maternal smoking during pregnancy could be an important determinant accounting for the excess perinatal death for males over females. Our results encourage evaluation of the findings among other populations.     

Maternal smoking in pregnancy and sex differences in perinatal death between boys and girls

Abstract

The sex difference in perinatal mortality in developed countries is largely unexplained. The current study evaluated the differences in the impact of maternal smoking during pregnancy on the risk of perinatal death between males and females. The analysis involved 11,469 and 9,404 newborns derived from two population‐based birth cohorts in Northern Finland, for 1966 and 1985–86, respectively. The perinatal mortality rate was 23 per thousand in the 1966 cohort and 9 per thousand in the 1985–86 cohort. The rate ratio (RR) for mortality for males over females is 1.15 and 1.60 in the two cohorts, respectively. Among children whose mothers smoked during pregnancy, the RR was 2.2 (95% CI 1.0, 4.7) for the former cohort and 4.8 (95% CI 1.5, 15.2) for the later cohort; and among the children whose mothers did not smoke the corresponding RR was 1.2 (95% CI 0.9, 1.6) and 1.1 (95% CI 0.6, 1.9). Maternal smoking during pregnancy could be an important determinant accounting for the excess perinatal death for males over females. Our results encourage evaluation of the findings among other populations.     

Prevention of mumps in preschool institutions using a live mumps vaccine made from strain L-3

The effectiveness of the emergency vaccinal prophylaxis of epidemic parotitis was studied in 19 children's day-care centers. As revealed in this study, the immunological effectiveness of vaccination did not depend on the age of vaccinees, but sharply decreased if live parotitis vaccine contained less than 10,000 HADU50 per immunization dose. After a single administration of the vaccine 91.1 +/- 0.98% of children were found to produce mumps antibodies. The immunization of children with live parotitis vaccine prepared from strain l-3 immediately after the first case of parotitis had been registered proved to be a highly effective measure. The coefficient of epidemiological effectiveness was 96.4%.     

Trends in paediatric medical admissions.

In the Oxford region from 1975 to 1985 the rate of discharge from paediatric departments, when standardised for age, rose by 88%. This increase was studied by using routinely collected data. It occurred in all age groups and was due mainly to an increase in emergency admissions for acute common childhood illnesses, particularly respiratory and gastro-intestinal diseases. There was no evidence that increasing morbidity accounted for this rise; the change was due to factors in medical care. Over the 11 years the median length of stay fell from 2.4 to 1.5 days and by 1985 40% of children were discharged within a day after admission. The increase in admissions was due to lower thresholds for admission resulting in part from the increased availability of beds because of the diminishing lengths of stay.     

Admissions for protein-calorie malnutrition at the National Children's Hospital, Costa Rica, 1975]

The hospital records of 478 children with protein-calorie malnutrition (PCM) were reviewed. These represented all children diagnosed as malnourished during 1975 (3.6 per cent of all hospital admittances in the National Children's Hospital); 52% of the cases were infants less than 6 months of age; 28% had low birth weight, a rate much in excess of the prevalence of low birth weight in the general population of Costa Rica (7%). In general, malnourished children had been weaned early, 75% during the first month of life. A considerable number of children belonged to "malnourishing families" which have particular characteristics favorable to establishment of malnutrition in the family. Thus, 36% of their siblings had also been admitted with malnutrition at a previous date to that of this study.     

Epidemiological survey of rhinosporidiosis in Kanyakumari district of Tamil Nadu

One hundred and twelve nasal polyps received along with full history from three different hospitals of Kanyakumari district of Tamil Nadu during the period 1983–1987 were found positive for rhinosporidiosis on histopathological examination. Among the four taluks (countries) the majority of the cases (41.1 per cent) came from Agastheeswaram, followed by Kalkulam (28.6 per cent), Thovalai (17.0 per cent) and Vilavancode (13.3 per cent). The 11–20 years age group found to be highly susceptible (60 per cent). There was no sex prepondence in contracting the disease as the cases were evenly distributed between both sexes. These findings exhibited the endemic nature of the disease in Kanyakumari district.Unreported cases to an extent of 9 to 40 per cent were encountered during the ENT disease diagnostic camps conducted in nine high incidence villages. Further 8 more cases were detected in addition to cases attended in the hospitals and ENT camps when a complete enumeration of cases was undertaken in Pallam village. Thus the actual number of cases found in the district need a stratified random sampling.     

Birth weight and other determinants of infant and child mortality in three provinces of China

Information on levels, trends and determinants of infant and child mortality was available from the 1985 In-depth Fertility Survey which was conducted in three provinces of China. Mortality of children below age 5 varied from 49 per 1000 live births in Shaanxi to 20 in Shanghai in 1980-85 and has declined substantially since 1960, from 206 in Shaanxi and 66 in Shanghai. Male mortality was considerably higher than female mortality in the neonatal and post-neonatal period, and at ages 1-5 years. Birth weight, place of residence and mother's education were found to be important determinants of mortality; age of mother and parity were less important.     

The incidence of stroke in Baranya county (east Croatia)

The aim of this retrospective study was to provide a survey of the incidence of stroke in Baranya, Croatia, on patients examined at Beli Manastir Health Center Department of Emergency from November 1, 1997 (the time of Baranya reintegration into the legal system of the Republic of Croatia after the war) till December 31, 2001. A total of 513 patients with symptoms of cerebrovascular diseases, or one patient every third day on an average, were examined. Total incidence of stroke was 16.09 per 10,000 population. The majority of patients were in the 61-80 age group with an incidence of 46.94/10,000 after the age of 60, 15-fold that was recorded in younger age groups. The most common risk factors recorded in examined group included hypertension, heart diseases, hyperlipidemia and diabetes mellitus. Total stroke mortality was 38.38%, whereas mortality in patients with hemorrhagic and ischemic stroke was 62.85% and 33.52%, respectively. The ratio of ischemic and hemorrhagic stroke in study subjects was 5:1, and in the causes of death 2.5:1. Out of 81 deceased stroke patients, 96.3% died within first 28 of admission. All of the patients with hemorrhagic stroke died within first 28 days, most within first 7 days (81.8%), whereas 94.9% of patients with ischemic stroke died within first 28 days.     

Post-Discharge Mortality in Children with Severe Malnutrition and Pneumonia in Bangladesh

Background

Post-discharge mortality among children with severe illness in resource-limited settings is under-recognized and there are limited data. We evaluated post-discharge mortality in a recently reported cohort of children with severe malnutrition and pneumonia, and identified characteristics associated with an increased risk of death.

Methods

Young children (<5 years of age) with severe malnutrition (WHO criteria) and radiographic pneumonia on admission to Dhaka Hospital of icddr,b over a 15-month period were managed according to standard protocols. Those discharged were followed-up and survival status at 12 weeks post-discharge was determined. Verbal autopsy was requested from families of those that died.

Results

Of 405 children hospitalized with severe malnutrition and pneumonia, 369 (median age, 10 months) were discharged alive with a follow-up plan. Of these, 32 (8.7%) died in the community within 3 months of discharge: median 22 (IQR 9–35) days from discharge to death. Most deaths were reportedly associated with acute onset of new respiratory or gastrointestinal symptoms. Those that died following discharge were significantly younger (median 6 [IQR 3,12] months) and more severely malnourished, on admission and on discharge, than those that survived. Bivariate analysis found that severe wasting on admission (OR 3.64, 95% CI 1.66–7.97) and age <12 months (OR 2.54, 95% CI 1.1–8.8) were significantly associated with post-discharge death. Of those that died in the community, none had attended a scheduled follow-up and care-seeking from a traditional healer was more common (p<0.001) compared to those who survived.

Conclusion and Significance

Post-discharge mortality was common in Bangladeshi children following inpatient care for severe malnutrition and pneumonia. The underlying contributing factors require a better understanding to inform the potential of interventions that could improve survival.     

Weather-based prediction of Plasmodium falciparum malaria in epidemic-prone regions of Ethiopia I. Patterns of lagged weather effects reflect biological mechanisms

Background

Introducing sustainability and self-reliance is essential in chronic humanitarian emergencies before financial assistance is phased out. In Pakistan-based Afghan refugee camps, this was attempted through shifting from indoor residual spraying (IRS) to the subsidized sale of insecticide-treated nets (ITNs) for prevention of malaria and anthroponotic cutaneous leishmaniasis (ACL). Here we outline the strategy and document the progress to provide guidance for replication of similar approaches in other chronic refugee situations.

Methods

The operational monitoring data presented were collected through: (i) two surveys of knowledge, attitude and practice (KAP); (ii) routine sales reporting of health-care providers; (iii) records completed during field visits; and (iv) registers used during annual re-treatment campaigns.

Results

From 2000 until 2003, subsidized ITN sales expanded from 17 to 44 camps. Based on 2003 sales records, maximum coverage from subsidized sales exceeded 50% in 13 camps and 20% in an additional 14 camps. Free annual treatment campaigns showed that many refugees were in possession of non-programme nets, which were either locally-made or had leaked from an ITN programme in Afghanistan. Estimated re-treatment coverage of sold and existing nets through annual campaigns exceeded 43% in all camps and was above 70% in the majority.

Conclusion

Subsidized sales of ITNs have effectively introduced the components of sustainability and self-reliance to the prevention of malaria and ACL in Afghan refugee camps. Similar approaches should be investigated in other chronic refugee situations to discourage expectations of continuing humanitarian donations that cannot be fulfilled.     

Childhood cancer mortality in Australia

Aim: To determine current rates of childhood cancer mortality at a national level for Australia and to evaluate recent trends. Methods: Using population-based data from the Australian Paediatric Cancer Registry, we calculated cancer-related mortality counts and rates for the 3-year period 2006-2008 and trends between 1998 and 2008 by sex, age group, and cause of death (defined according to the International Classification of Childhood Cancers, third edition). Rates were directly age-standardised to the 2000 World Standard Population, and linear regression was used to determine the magnitude and significance of trends. The standardised mortality ratio for non-cancer deaths among children with cancer was also estimated. Results: A total of 282 children (23 per million per year) died from cancer in Australia between 2006 and 2008. Large decreases were observed in cancer mortality rates over the study period, particularly for boys (-5.5% per year; p<0.001), children aged 10-14 years old (-5.5% per year; p=0.001), and leukaemia patients (-9.4% per year; p<0.001). However, there was no significant change in mortality due to tumours of the central nervous system. Children with cancer were twice as likely to die from non-cancer causes compared to other children (SMR=2.06; p=0.001). Conclusions: While ongoing improvements in childhood cancer mortality in Australia are generally encouraging, of concern is the lack of a corresponding decrease in mortality among children with certain types of tumours of the central nervous system during the past decade. The results also highlight the need for intensive monitoring of childhood cancer patients for other serious diseases that may subsequently arise.     

血液肿瘤住院患儿营养风险筛查及高度营养风险的危险因素分析

摘要 目的：筛查血液肿瘤住院患儿营养风险,并对其营养不良风险的危险因素进行分析。方法：选取2019年1月-2019年12月我院收治的的血液肿瘤住院患儿290例,采用自制问卷调查表,调查患儿的一般资料情况,采用欧洲肠外肠内营养协会推荐使用的儿科营养风险筛查工具（STAMP）评价患儿营养风险状况,采用单因素及多因素Logistic回归分析高度营养风险的危险因素。结果：依据STAMP评分标准,对研究对象290例患儿进行评价,高度营养风险的患儿247例,占比85.17%。中度营养风险的患儿43例,占比14.83%。低度营养风险患儿0例,占比0.00%。单因素分析结果显示,血液肿瘤住院患儿营养不良风险与年龄、化疗次数、肿瘤分期、总蛋白缺乏、血红蛋白缺乏有关（P<0.05）,而与居住地、性别、肿瘤类型、家庭人均月收入、患儿监护人文化程度无关（P>0.05）。Logistic回归分析发现,年龄为1~3岁、化疗次数＞5次、肿瘤分期为晚期、存在血红蛋白缺乏是血液肿瘤住院患儿高度营养风险的危险因素（P＜0.05）。结论：血液肿瘤住院患儿存在较高比例的营养不良风险,且受年龄、化疗次数、肿瘤分期、血红蛋白缺乏等多种因素影响,临床可考虑针对此类群体进行营养筛查,并给予及时的干预,以改善血液肿瘤住院患儿的营养状况。     

Nutritional status and mortality of refugee and resident children in a non-camp setting during conflict: follow up study in Guinea-Bissau

ObjectiveTo study the effects on children of humanitarian aid agencies restricting help to refugee families (internally displaced people).DesignFollow up study of 3 months.SettingPrabis peninsular outside Bissau, the capital of Guinea-Bissau, which has functioned as a refugee area for internally displaced people in the ongoing war, and the study area of the Bandim health project in Bissau.Participants422 children aged 9-23 months in 30 clusters.ResultsDuring the refugee situation all children deteriorated nutritionally, and mortality was high (3.0% in a 6 week period). Rice consumption was higher in families resident in Prabis than in refugees from Bissau but there was no difference in food expenditure. Nutritional status, measured by mid- upper arm circumference, was not associated with rice consumption levels in the family, and the decline in circumference was significantly worse for resident than for refugee children; the mid-upper arm circumference of refugee children increased faster than that of resident children. For resident children, mortality was 4.5 times higher (95% confidence interval 1.1 to 30.0) than for refugee children. Mortality for both resident and refugee children was 7.2 times higher (1.3 to 133.9) during the refugee’s stay in Prabis compared with the period after the departure of the refugees.ConclusionIn a non-camp setting, residents may be more malnourished and have higher mortality than refugees. Major improvements in nutritional status and a reduction in mortality occurred in resident and refugee children as soon as refugees returned home despite the fact that there was no improvement in food availability.

Key messages

• During the war in Guinea-Bissau, most of the population fled from the capital and moved in with relatives, friends, or strangers
• International agencies insisted on only providing help to refugees (internally displaced people)
• During the first month of conflict, there were already profound effects on the nutritional status and mortality of young children
• Food consumption was higher in resident families, but resident children were more malnourished and had higher mortality than refugee children
• Nutritional status and survival improved for both refugee and resident children once the refugees returned to Bissau

     

Effects of HIV Infection on the Metabolic and Hormonal Status of Children with Severe Acute Malnutrition

Background

HIV infection occurs in 30% of children with severe acute malnutrition in sub-Saharan Africa. Effects of HIV on the pathophysiology and recovery from malnutrition are poorly understood.

Methods

We conducted a prospective cohort study of 75 severely malnourished Ugandan children. HIV status/CD4 counts were assessed at baseline; auxologic data and blood samples were obtained at admission and after 14 days of inpatient treatment. We utilized metabolomic profiling to characterize effects of HIV infection on metabolic status and subsequent responses to nutritional therapy.

Findings

At admission, patients (mean age 16.3 mo) had growth failure (mean W/H z-score −4.27 in non-edematous patients) that improved with formula feeding (mean increase 1.00). 24% (18/75) were HIV-infected. Nine children died within the first 14 days of hospitalization; mortality was higher for HIV-infected patients (33% v. 5%, OR = 8.83). HIV-infected and HIV-negative children presented with elevated NEFA, ketones, and even-numbered acylcarnitines and reductions in albumin and amino acids. Leptin, adiponectin, insulin, and IGF-1 levels were low while growth hormone, cortisol, and ghrelin levels were high. At baseline, HIV-infected patients had higher triglycerides, ketones, and even-chain acylcarnitines and lower leptin and adiponectin levels than HIV-negative patients. Leptin levels rose in all patients following nutritional intervention, but adiponectin levels remained depressed in HIV-infected children. Baseline hypoleptinemia and hypoadiponectinemia were associated with increased mortality.

Conclusions

Our findings suggest a critical interplay between HIV infection and adipose tissue storage and function in the adaptation to malnutrition. Hypoleptinemia and hypoadiponectinemia may contribute to high mortality rates among malnourished, HIV-infected children.