Objective: To study the various clinical manifestations, co-morbidities and causative organisms of infections in SAM (severe acute malnutrition) in children aged 6 months to 59 months in a tertiary care hospital of odisha.

Methods: It is a hospital based prospective observational study done in a tertiary care hospital, Cuttack, Odisha during the period of November 2015 to October 2017.All children from 6 months to 59 months of age diagnosed with SAM were included and the clinical manifestations and spectrum of infections in them were evaluated.

Results: In our study population the prevalence of SAM was found to be 2.8%.Fever was the most common symptom (71%), next was vomiting (51%), loose stools (46.8%), cough 46.3 % and poor appetite and/ or weight loss (31%).Most common comorbidities found were diarrhea(46.8%),acute respiratory tract infection (46.3%), septicemia(27.4%) and urinary tract infection(26.3%). The commonest organisms encountered in blood culture in the study were Staphylococcus aureus (48.1%) followed by CONS (28.9%), Group D Streptococcus (11.5%), E.Coli (7.7%), and Klebsiella (3.8%).

Conclusion: Severe acute malnutrition is prevalent in odisha (2.8%) and leads to increased Mortality (6.8%) in children between 6 months to 59 months of age. The commonest presentation to hospital is fever(71%) with comorbid condition acute gastroenteritis(46.8%) followed by respiratory tract infections and septicemia. The most common infective organism affecting children with SAM is staphylococcus aureus(48.1%) followed by CONS (28.9%).

Keywords: SAM (severe acute malnutrition), infections, clinical manifestations, comorbidities, Odisha

1. Guideline: Updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization; 2013.
2. World Health Organization, Country Office For India; National Rural Health Mission (IN). Facility Based Care of Severe Acute Malnutrition: Participant Manual.(New Delhi): World Health Organization, Country Office for India; 2011 Mar. 119p
3. International Institute for Population Sciences (IIPS) and ICF. 2017. National Family Health Survey (NFHS-4), 2015-16: India. Mumbai: IIPS.
4. Bagga A, Tripathi P, Jatana V, Hari P, Kapil A, Srivastava RN, et al. Bacteriuria and urinary tract infection in malnourished children. Pediatr Nephrol 2003; 18:366-370.
5. Bernal C, Velásquez C, Alcaraz G, Botero, J. Treatment of severe malnutrition in children: Experience in implementing the World Health Organization guidelines in Turbo, Colombia. J Pediatr Gastroenterol Nutr 2008;46:322-328.
6. Kelsey D J Jones,JamesA Berkley,”Severe acute malnutrition and infection”, Paediatr Int Child Health.2014;34(Suppl 1):1-29
7. Umma Abdullahi Idris, Wammanda D. Robinson, Jamilu A Faruk, Garba Dayyabu Gwarzo.”Prevalence of Bacteremia among Febrile Children with Severe Malnutrition in North Western Nigeria”. Nigerian Journal of General Practice ¦ Volume 16 ¦ Issue 1 ¦ January-June 2018
8. Mahgoub HM,Adam I.Morbidity and mortality in severe malnutrition among Sudanese children in New Halfa Hospital, Eastern Sudan.Trans R Soc Trop Med Hyg.2012;106:66-8.
9. Ashraf S, Javed MT, Abbas N, Aysha H, Hameed S (2001) Malnutrition in diseased children with reference to age, sex, socioeconomic status and area of living. Int J Agri Biol 3(4): 419-422
10. Berkley JA, Lowe BS, Mwangi I, et al. Bacteremia among children admitted to a rural hospital in Kenya. N Engl J Med 2005; 352(1).pp.39–47
11. Wiedermann U, Tarkowski A, Bremell T, Hanson L, Kahu H, Dahlgren U: Vitamin A deficiency predisposes to Staphylococcus aureus infection. Infect Immun. 1996, 64 (1): 209-214.
12. D. C. Christie, G. T. Heikens, and M. H. N. Golden, “Coagulase-negative staphylococcal bacteremia in severely malnourished Jamaican children,” Pediatric Infectious Disease Journal, vol. 11, no. 12, pp. 1030–1036, 1992.
13. Piette, A. & Verschraegen, G. (2009). Role of coagulase-negative staphylococci in human disease. Vet Microbiol 134, 45–54.
14. Uduak A. Okomo, Danlami Garba, AugustinE. Fombah, Ousman Secka." Bacterial Isolates and Antibiotic Sensitivity among Gambian Children with Severe Acute Malnutrition" International Journal of Pediatrics, Volume 2011, Article ID 825123
15. Alem A, Alemseged A, Getenet B, Genet G: "Bacteremia among severely malnourished children in Jimma university hospital, Ethiopia" Ethiop J Health Sci. Vol. 21, No. 3 November 2011
16. R.Prasanth, M.R. Savitha, H.N. Yashwanth Raju, M. Shanthi,” Clinical Spectrum of severe acute malnutrition admitted to nutritional rehabilitation centre of a tertiary care hospital with special reference to incidence of bilateral pitting pedal oedema in children with severe acute malnutrition,” International Journal Of Contemporary Pediatrics,2018 Sep; 5(5):1928-1932
17. Sharma, M. Lata “P1190 A study of malnutrition and associated infection in children in urban private Hospital in India”. Journal of Pediatric Gastroenterology & Nutrition  June 2004-Volume 39-Issue p-S509

Dr Soumini Rath

Department of Pediatrics, Kalinga Institute of Medical Sciences, KIIT Deemed to be University, Bhubaneswar, 751024 Odisha, India

Mobile no 9337799393, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.