Acute malnutrition is a major global health problem [1,2]. According to the World Health report, 52 million children under 5 years around the world, were classified as having acute malnutrition in 2012, of which 33 million children had moderate acute malnutrition (MAM). Hence, MAM affects one in ten children under 5 years of age in underdeveloped and developing countries.

According to NFHS- 4, in India, 38% of under-5 children are stunted, suggestive of chronic undernutrition, 21% are wasted, which is a sign of acute undernutrition, while 36% are underweight [3].

There are significant regional variations in the prevalence of MAM. Prevalence of wasting in Karnataka is 26.1% and Severe Acute Malnutrition (SAM) is 10.5% [3]. One in six under-5 children in South Asia suffered from MAM in 2013. India has the highest-burden, with over 25 million children under 5 with MAM or SAM [1]. Prevalence of diarrhoea and pneumonia in Karnataka is 4.5% and 1.2% respectively [3]. Children with malnutrition, have roughly three times higher risk of mortality from common communicable diseases than if they were well-nourished.

Both SAM and MAM have serious consequences, contributing to increased morbidity and mortality and also impaired intellectual development, suboptimal adult work capacity and increased risk of disease in adulthood. Interventions to address undernutrition should, therefore, include a strong component of MAM management which is often neglected. As the present national programmes are focussed more on children with SAM, the present study was undertaken to find out the proportion of MAM amongst the two leading causes of under 5 mortality, namely pneumonia and diarrhoea.

To study the prevalence and severity of malnutrition (SAM and MAM) amongst children (1 month to 5 years of age) admitted with community-acquired pneumonia and acute diarrhoea.

1. Setting: Paediatrics ward, Cheluvamba Hospital (tertiary care teaching hospital), Mysuru, Karnataka.

Table-1: Gender distribution among the severity of malnutrition

More number of females were malnourished, and a greater number of males were well-nourished, which was statistically significant (p = 0.018)

Table 2: Age distribution among the severity of malnutrition.

There was no statistically significant association between age and severity of malnutrition. (p-value 0.065).

Table-3: Severity of diarrhoea versus severity of malnutrition.

There was no statistically significant association between the severity of diarrhoea and malnutrition. (p-value 0.586). Therefore the prevalence of diarrhoea was the same among both MAM and SAM children.

Diarrhoea and pneumonia contribute to a third of worldwide childhood mortality. Both the infections are part of a vicious cycle of malnutrition and infection. Children who are undernourished are more prone to infections and have a higher morbidity and mortality rate [7]. A study by Christi MJ et al showed an association between complications, morbidities and severity of malnutrition [8]. Even in the present study, the statistically significant association between complications and severity of malnutrition was noted.

In a study by Isanaka et al, it was concluded that on the basis of prevalence of undernutrition, the current global projections of mortality associated with SAM and MAM could be underestimated [9]. Programmes for the management of MAM have not been revised for the past 3 decades unlike those with respect to SAM, and hence needs appropriate and urgent amendments [10].

Nutrition care in children and mother will essentially contribute to national development. According to The Global Nutrition Report, the benefit-to-cost ratio is 16:1 for investment in nutrition among 40 middle and low -income countries. Preventing undernutrition at the earliest and throughout life is important [11].

In a study in Bangladesh, among 209 boys and 191 girls with pneumonia and diarrhoea, 17% were found to have SAM. high prevalence of pneumonia (62.72%) and diarrhoea were found in infancy, and in 1-2-year age group [12]. In the present study, SAM was found in 18.5%, which is comparable, even the prevalence of pneumonia (66%) was comparable. In the present study, more number of girls were undernourished. A positive association was noted between the duration of hospital stay and severity of malnutrition.

Diarrhoea has short-term effects on nutrition and long-term consequences on the growth of the child [12]. In the present study, the prevalence of diarrhoea was same in SAM and MAM group.

In a study by Brown KH et al, among 100 children admitted for SAM, 90% had evidence of infection at the time of admission, 75% had pneumonia, 43% had diarrhoea and death rate was 21%, the most frequent cause being infections. Mortality was more in younger children [13].

In a study conducted in South Africa, Bamford et al, analysed the improvements in case fatality rates in under-5 children. Required measures to reduce under-5 mortality include a reduction in mother-to-child HIV transmission, improvement in infant and young child feeding, better immunization coverage, earlier and easier access to health care, the betterment of social and community health as a whole [19].

Jones DK, et al, in their study concluded that along with nutrition, addressing the infection and inflammation plays a key role; along with anthropometric measurements, it is important to assess the child’s health in-toto [20].

In a study by Tickell KD et al, children with a MUAC of < 12.5cm had more severe diarrhoea and danger signs when compared to better-nourished counterparts. Diarrhoeal pathogens such as cryptosporidium, virulent E.coli, Entamoeba histolytica, Shigella, Salmonella, Campylobacter, Pleisiomonas shigelloides have been associated with acute malnutrition.

However, the higher disease severity is more likely to be due to socio-economic constraints and increased vulnerability associated with acute malnutrition, than due to different pathogenic flora. [21].

According to Williams PCM and Berkley JA, in their study in 2018, it was suggested that irrespective of uncomplicated or complicated SAM, a broad-spectrum antibiotic should be used, namely, amoxicillin via oral and parenteral route respectively. All the children in the present study were similarly started with Amoxicillin by parenteral route as per the WHO guidelines [22].

In a systematic review and meta-analysis in 2020, F 100 was similar in effect to Ready-to-use therapeutic food, prophylactic antibiotic usage had better recovery in terms of disease as well as weight gain; high and low dose vitamin A supplementation were comparable in terms of mortality and gain in weight [23].

In a study in Afghanistan, it was concluded that parental education and income status, availability of safe drinking water, sanitary latrines, hygiene all play a key role in reducing the prevalence of acute nutrition among under-5 children [24]. Hence, in improving the nutritional status in children, national programs, programmatic policies in the betterment of the community in entirety are necessary.

It is important to monitor and take a necessary intervention to treat MAM as seriously as in SAM both by the treating Paediatrician and in National Health Programmes.

1. Children with severe acute malnutrition are more prone to Pneumonia and Diarrhoea and their complications. The prevalence of diarrhoea and pneumonia, which are the leading causes of under-five mortalities, were found to be same in both children with Moderate Acute Malnutrition and Severe Acute Malnutrition.
2. Hence, it is important to diagnose MAM and treat it vigilantly as in SAM

All the authors contributed to the study. Dr. M R Savitha conceived and designed the study and revised the manuscript for important intellectual content. Dr. M R Prashanth designed the study proforma, sample collection process, helped design the study and revised the manuscript. Dr. B. Thanuja collected and compiled the data and drafted the paper. Dr. M R Savitha, Dr. M R Prashanth, Dr. B. Thanuja analysed the data, edited, reviewed and approved the final paper.