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Marasmic patients stayed significantly longer in the hospital than kwashiorkor and marasmic kwashiorkor patients (p=0.032 and p=0.001, respectively).
Characterisation of SAM patients by baseline clinical profile (N=346) Variable n (%) * Age (months) 6-12 112 (33.6) 13-24 175 (52.5) 25-36 28 (8.4) 37-60 18 (5.5) SAM syndromic classification Marasmus 111 (33.2) Kwashiorkor 141 (42.2) Marasmic kwashiorkor 82 (24.6) Oedema grade None 99 (29.6) Mild 23 (6.9) Moderate 96 (28.7) Severe 116 (34.7) Dermatosis grade None 102 (30.5) Mild 79 (23.7) Moderate 120 (35.9) Severe 33 (9.9) LRTIs Yes 67 (20.1) No 267 (79.9) Other comorbidities Yes 96 (28.7) No 238 (71.3) Critically ill on admission Yes 50 (14.9) No 284 (85.1) HIV status Positive 113 (33.8) Negative 221 (66.2) HIV/AIDS disease stage 1 31 (27.4) 2 41 (36.3) 3 32 (28.3) 4 9 (8.0) SAM = severe acute malnutrition; LRTIs = lower respiratory tract infections.
Although controls had highest detection of aflatoxins (90.9%), followed by kwashiorkor (84.6%), marasmus (81.8%) and marasmic kwashiorkor (60%) in descending order, the observed differences in rates of detection in urine were not significant (p>0.05).
The median concentration of total aflatoxins in urine was highest in kwashiorkor patients, followed by marasmic kwashiorkor, controls and marasmus in descending order (table 2).
To determine possible differences in excretion of aflatoxins in urine, the ratio of simultaneous samples of serum and urinary aflatoxin concentrations were determined in 24 patients (kwashiorkor n=6, marasmic kwashiorkor n=10, marasmus n=6) and controls (n=6).
Fifteen (88.2%) marasmus patients and 9(81.8%) marasmic kwashiorkor patients showed a history of malaria.
The mean concentrations of TNFa, IL6 and IL1 were higher in children suffering from kwashiorkor than marasmus or marasmic kwashiorkor.
Qualified medical staff including clinical officers and nurses at each of the health centres assessed the clinical nutritional status of the children, classifying them as Marasmic, Kwashiorkor or Marasmic/ Kwashiorkor.
The results showed Meteitei to have the highest prevalence of 18% for Kwashiorkor, Marasmus and Marasmic Kwashiorkor while Makunga showed the least prevalence of 4%.
According to the Wellcome Trust classification of protein energy malnutrition, 77 patients (60.1%) were of normal weight for age, 40 (31.2%) were underweight for age, 4 (3.1%) had kwashiorkor, 5 (3.9%) were marasmic and 2 (1.6%) had marasmic kwashiorkor.
The prevalence of protein energy malnutrition (kwashiorkor, marasmus and marasmic kwashiorkor) was 8.5%.