Nutritional Assessment of Japanese Encephalitis and Acute Encephalitis Syndrome confirmed patients of Gorakhpur Uttar Pradesh - Open Journal Systems
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 395
Nutritional Assessment of Japanese Encephalitis and Acute
Encephalitis Syndrome confirmed patients of Gorakhpur Uttar
Pradesh
Khushnoor Ansari
Research Scholar, Department of Home Science, NKBMG PG College Chandausi Sambhal, UP
Abstract
Malnutrition and infectious diseases are closely interlinked, Japanese Encephalitis and Acute Encephalitis
Syndrome has also been associated with malnourishment and or poor immune system of children. The
present study investigates the nutritional and growth status of children of Gorakhpur, Uttar Pradesh, infected
with JE/AES. For this study 100 patients were selected (58 boys and 42 girls) purposively. The subjects were
divided into 3 age groups viz, 1-3, 4-7 and 8-10. Their anthropometric characters viz, height and weight
were measured. The results were compared with WHO standard. From the study, it is clear that a large
number of JE/AES patients from Gorakhpur UP suffer are severely malnourished. The nutritional status of
both boys and girls is lower than the WHO standard both in terms of overall bodily development and BMI.
Key Words: Malnutrition, JE/AES, Gorakhpur, Anthropometry, WHO
Introduction There are many factors associated with malnutrition
or under-nutrition but poverty has been recognized as one
The relationship between malnutrition and infection
which is both cause and consequence of malnutrition8.
is the leading cause of morbidity and mortality in many
The impact of poverty upon health is largely mediated
poor regions of the developing countries1. Every year
by nutrition and is expressed throughout the whole life
about 10 million children are killed by infectious diseases
course9. Generally poverty and malnutrition effects
worldwide before they reach age 5 and 50% of these
children of a country and impairs their growth and
deaths occur due to malnutrition2,3. Immune system of an
development and this effect has been well documented
individual is intimately linked to the quantity and quality
and reviewed in both developed and developing
of food taken, and it is immune system that fights against
countries10,11. Whilst more than 30 countries are home
pathogenic organisms such as bacteria, fungi, viruses,
to 90% malnourished children, India stands distinct in
toxins, and allergic compounds4 and these pathogenic
having the largest number of malnourished children in
organisms are associated with high death rate5 but on the
the world12,13 ranks 100 out of 119 countries14. On the
other hand malnutrition impairs immune system and thus
other hand India has been counted in the list of counties
leads to many infectious diseases. Malnutrition has been
having the weakest commitment to ending child
defined as a “pathological state resulting from a relative
malnutrition15. Having the number double than Sub
or absolute deficiency or excess of one or more essential
Saharan Africa, malnourishment in India has negative
nutrients”6 or it may be a consequence of energy deficit
impact on productivity and economic growth, along with
or micronutrient deficiency7.
mortality rate being very high16.
As has been said earlier in this section, malnutrition
Corresponding author: and infectious diseases are closely interlinked, Japanese
Khushnoor Ansari Encephalitis and Acute Encephalitis Syndrome has
Email id: khushnooransari2019@gmail.com also been associated with malnourishment and or
Mob.No: +916006061575 poor immune system of children. Research shows that
396 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
children with JE/AES admitted in various hospitals of Table 1: Distribution of study subjects according
India were either malnourished or from poor socio- to age and gender
economic backgrounds, despite this very few researchers
have focused on nutritional aspect of this deadly virus. Age Group Boys Girls Total
The main objective of the present study was therefore to
assess the nutritional status of confirmed JE/AES cases 1-3 21 14 35
of Gorakhpur region of Uttar Pradesh, India.
4-7 31 17 48
Materials and Method
8-10 6 11 17
Anthropometric measurements (height and Weight)
were taken of 100 JE/AES confirmed children of
Total 58 42 100
Gorakhpur region of Uttar Pradesh. A list of patients
was obtained from District Hospital Gorakhpur. Phone
Data Analysis
number of the parents of Patients written against the
respective names of patients was extracted from the list Data of the children were grouped according to their
and phone calls were made to know the exact dwelling gender and age. BMI of every child was calculated from
address, since the dwelling units were scattered across his/her height and weight. BMI was calculated using
the region. Anthropometric measurements were taken online calculator of Centre for Disease Control and
by directly visiting the patient’s home as they were Prevention. The calculator also gives exact percentile
discharged from hospitals. The heights of above 2 along with BMI. Further to calculate Frequencies,
children were measured using a metal anthropometer of Percentages, Mean and Standard Deviation, and
two meters length. In case of those children who were Z-Scores, data was analyzed by using SPSS 16.0 and
below two years of age, were measured using an auto- Microsoft Excel 7.
recoiling tape made up of hard steel which was identical
to anthropometer in calibration. To measure weight of Results
the children, a portable weighing scale (capacity 100 kg) The study included 100 JE/AES patients (58 Boys
was used. Children were asked to wear minimum clothes and 42 Girls) aged 1-10 years (Table 1). Table 2 shows
during weight and were asked to take off shoes during age and sex wise mean and SD of height, weight and
measuring height. BMI of JE/AES confirmed children.
Table 2: Mean±SD of Anthropometric measurements of JE/AES Patients
Boys Girls
Age
Group
Mean Mean
Mean Height BMI Mean Mean Height BMI Mean
Weight Weight
(cm) (kg/m2) Z-Score (cm) (kg/m2) Z-Score
(kg) (kg)
1-3 87.02±5.96 10.93±2.14 14.39±2.29 0.08 83.78±6.33 9.45±1.13 13.54±1.49 -0.06
4-7 103.59±7.39 14.54±2.23 13.55±1.65 0.16 107.31±6.87 15.88±2.94 13.68±1.42 -0.27
8-10 128.93±4.55 22.65±3.32 13.59±1.55 -0.44 126.95±2.26 21.6±2.26 13.38±0.77 0.17Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 397
The mean and SD of anthropometric measurements (height and weight) of each age group is shown in table 2.
The mean height of boys ranged from 128±4.55.4- 87.02±5.96 and among girls the mean height range was found to
be 126.95±2.26-83.78.8±6.33. In the age groups of 1-3 and 8-10 boys weighed (10.93±2.14 and 22.65±3.32) more
than girls except in the age group of 4-7 where girls both mean height and weight (107.31±6.87 and 15.88±2.94) were
slightly more and better than boys. The mean BMI ranged from 14.39±2.29 to 13.59±1.55 in case of boys and girls
had a mean BMI of 13.54±1.49 to 13.38±0.77. The mean BMI Z-Score for boys ranged from 0.08 to -0.44 and girl
patients had mean BMI Z-Scores ranging from -0.06 to 0.17.
Fig 1. Showing Comparison of mean height and weight of Boys and Girls398 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
The mean height of the patients was compared with WHO (World Health Organization) reference range, a
significant difference was found in both sexes and in all age groups. Fig. 2 (C, D, E and F) shows variation between
mean height and weight of boys and girls with WHO standard. It was observed that in all age groups both genders
showed lesser average weight and height than the respective standard of WHO and the difference was significant.
The difference is assumed to be a result of their poor economic background and food habits.
Fig. 2. Showing comparison of mean Height and weight of Boys with WHO reference.
Table 3. Shows prevalence of malnutrition based on SD
Moderate
Severe Malnutrition Overweight/Obesity
Gender Malnutrition Normal Total
+1SD/>+2SDIndian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 399
Discussion the selected subjects, approval was sought from District
Hospitals and University Research Cell and later the
Overall nutritional status of the host affect immune
consent of both parents and adult subjects was taken.
function and a result has profound effect on the virus
itself 17. Malnourished children suffer more from viral Funding Agency: Self
infections, viral diarrhoea, measles and malaria, with a
prolonged course and intensified disease. Similarly, poor References
nutrition represents a significant risk factor for JE / AES, 1. Neumann CG. Interaction of malnutrition and
records National Programme for Prevention and Control infection: a neglected clinical concept. Archives of
of Japanese Encephalitis/ Acute Encephalitis Syndrome, internal medicine. 1977 Oct 1;137 (10):1364-5.
Government of India18,19. India Today on June 2019
2. Brundtland GH. Nutrition and infection:
reported that about 48% of children under the age of 5 in
malnutrition and mortality in public health.
Muzzafarpur, Bihar are stunted (short for their height),
Nutrition reviews. 2000 Feb 1;58 (suppl_1):S1-4.
17.5% are wasted (too thin for their height), and 42%
are underweight-a conspicuous sign of chronic under- 3. Walson JL, Berkley JA. The impact of malnutrition
nutrition, which is worse than most African countries. on childhood infections. Current opinion in
This trend of under and malnourishment seems to infectious diseases. 2018 Jun;31 (3):231.
be directly linked with encephalitis and child deaths. 4. Jolly CA, Fernandes G. Protein-energy malnutrition
Another record showed the association of under- and infectious disease. InNutrition and immunology
nutrition and poor outcomes in the patients with viral 2000 (pp. 195-202). Humana Press, Totowa, NJ.
encephalitis20. As a neurotropic virus, JEV attacks the 5. Machado PR, Araújo MI, Carvalho L, Carvalho
central nervous system and the clinical picture vary with EM. Immune response mechanisms to infections.
the degree of central nervous system’s involvement, An Bras Dermatol. 2004 Nov;79 (6):17.
age and nutritional status of the person affected21.
6. Jelliffe DB, World Health Organization. The
Mosquitoes that proliferate in close association with
assessment of the nutritional status of the
pigs & other animal reservoirs are found to spread
community (with special reference to field surveys
virus of Japanese encephalitis in malnourished children
in developing regions of the world. World Health
of poor families22. So, while the cause of AES is still
Organization; 1966.
being studied, hypoglycaemic AES can be caused by
7. França TG, Ishikawa LL, Zorzella-Pezavento SF,
malnutrition. Malnutrition is high in Bihar and UP and
Chiuso-Minicucci F, da Cunha ML, Sartori A.
children who are malnourished are prone to infection.
Impact of malnutrition on immunity and infection.
Conclusion Journal of Venomous Animals and Toxins including
Tropical Diseases. 2009;15 (3):374-90.
From the study, it is clear that a large number of
8. Vorster HH, Kruger A. Poverty, malnutrition,
JE/AES patients from Gorakhpur UP suffer are severely
underdevelopment and cardiovascular disease: a
malnourished. The nutritional status of both boys and
South African perspective. Cardiovascular journal
girls is lower than the WHO standard both in terms of
of Africa. 2007 Jul;18(5):321.
overall bodily development and BMI. This is assumed
to be a direct outcome of their low socio-economic 9. Pena M, Bacallao J. Malnutrition and poverty.
status and poor food that they eat. Therefore need of Annual review of nutrition. 2002 Jul;22(1):241-53.
the hour seems to implement intervention programme 10. Grantham-McGregor, S.M., Fernald, L.C. and
more effectively to improve overall nutritional status Sethuraman, K., 1999. Effects of health and
of children to keep them away from getting infected or nutrition on cognitive and behavioural development
falling prey to JE/AES or any such deadly virus. in children in the first three years of life: Part 1:
Low birthweight, breastfeeding, and protein-energy
Conflict of Interest: Nil
malnutrition. Food and nutrition Bulletin, 20(1),
Ethical Approval: Before conducting research on pp.53-75.400 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
11. Nelson M. Childhood nutrition and poverty. 18. Operational Guidelines: National Programme for
Proceedings of the nutrition society. 2000 Prevention and Control of Japanese Encephalitis/
May;59(2):307-15. Acute Encephalitis Syndrome. 2014. Government
12. Paruchuri, A., Ahmad, A., & Kumaran, S. of India, Ministry of Health & Family Welfare
Malnutrition in India: A Major Problem with Directorate General of Health Services National
Minor Attention. Journal of Hospital and Clinical Vector Borne Disease Control Programme,22-
Pharmacy. 2012, 2(9), pp. 27-35 Sham NathMarg, Delhi- 110054
13. Deb P, Dhara PC. Anthropometric measurements 19. Jaiswal RK, Dhariwal AC, Sen PK, Lal S, Raina VK.
and undernutrition: A case on school children of National Programme for Prevention and Control
South Tripura, India. Journal of Life Sciences. of Japanese Encephalitis (JE)/Acute Encephalitis
2013 Jul 1;5(1):47-51. Syndrome (AES)-An Update. J. Commun. Dis.
2014 Oct 7;46(1):119-27.
14. World Vision. 2012. Top 9 countries fighting
child malnutrition. Retrieved from: https://www. 20. Singh P, Bhatt GC, Singh V, Kushwaha KP, Mittal
worldvision.org/hunger-news-stories/top-nine- M, Mehta A, Sharma B, Pakhare AP, Kumar A.
countries-fighting-child-malnutrition Influence of malnutrition on adverse outcome
in children with confirmed or probable viral
15. Narayan J, John D, Ramadas N. Malnutrition in
encephalitis: a prospective observational study.
India: status and government initiatives. Journal of
BioMed research international. 2015;2015.
public health policy. 2019 Mar 6;40(1):126-41.
21. Saxena SK. Japanese encephalitis: perspectives and
16. Gueri M, Gurney JM, Jutsum P. The Gomez
new developments.3(5), 515-521
classification. Time for a change?. Bulletin of the
World Health Organization. 1980;58(5):773. 22. Kumar AR, Kumar RA, Kaur JA. Japanese
encephalitis: medical emergency in India. Asian J
17. Beck MA. The role of nutrition in viral disease.
Pharm Clin Res. 2012;5(3):9-12.
The Journal of Nutritional Biochemistry. 1996 Dec
1;7(12):683-90.You can also read
