Dissertations / Theses on the topic 'Malnutrition – Treatment'
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1
Collins, Stephen. "The assessment and treatment of severe adult malnutrition during famine." Thesis, University College London (University of London), 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.249218.
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Leung, Ho-kin Vincent, and 梁浩堅. "The effectiveness of the use of "ready-to-use" therapeutic food (RUTF) in treating malnourished children in developing countries and the way forward." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hdl.handle.net/10722/193780.
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WHO and UNICEF recommend the use of “ready-to-use therapeutic food” (RUTF) in the treatment of severely acute malnourished (SAM) children with no complicated medical background. This research paper aims to review the evidence on the use of RUTF in the treatment of SAM children, explore the potential issues with the use of RUTF, and provide suggestions for future research. A total of 7 studies were included for the review on the effectiveness of RUTF treatment. Evidences showed a general improvement in the health outcomes of SAM children, yet failed to yield high-quality evidences to prove its benefits. Potential problems with the reliance on RUTF were identified, further research on the use of RUTF are required.published_or_final_version
Public Health
Master
Master of Public Health
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Glosz, Cambria M. "Assessment of micronutrient status in pregnant Malawian women before and after treatment for moderate malnutrition." DigitalCommons@CalPoly, 2016. https://digitalcommons.calpoly.edu/theses/1641.
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Background: Multiple micronutrient deficiencies are prevalent in pregnant women in developing countries and can result in adverse effects to both the mother and infant. Multiple micronutrient supplements or supplementary foods may be a way to combat micronutrient deficiencies.
Objective: To assess change in micronutrient and protein levels in moderately malnourished pregnant Malawian women after receiving one of three nutritional interventions.
Methods: Serum retinol, 25-hydroxyvitamin D, ferritin, vitamin B12, folate, zinc, albumin and C-reactive protein concentrations were measured in pregnant women with MUAC >20.6 cm and
Results: Baseline micronutrient concentrations indicated high rates of deficiency in zinc (29-39%) and albumin (37-46%), and marginal status of retinol (26-37%) and vitamin D (31-32%). Adjusted mean changes in vitamin B12 concentrations from week 0 to week 10 were -17.1, -36.1, and -52.9 pg/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.007). Adjusted mean changes in vitamin D concentrations from week 0 to week 10 were 6.1, 3.1, and 1.7 ng/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.007). Adjusted mean changes in folate concentrations from week 0 to week 10 were 2.2, 1.7, and 4.0 ng/mL for RUSF, CSB-UNIMMAP, and CSB-IFA, respectively (p=0.37 for effect of treatment; p=0.06 for the interaction effect of time*treatment). Changes in ferritin, zinc, albumin, retinol, and CRP were not significantly different between treatment groups.
Conclusions: Deficiencies in zinc and albumin, and marginal status of vitamin D and retinol, are common among this population of moderately malnourished pregnant Malawian women. Significant changes in vitamin D and vitamin B12were observed from week 0 to week 10, with the RUSF group having the greatest improvements compared to the CSB-UNIMMAP and CSB-IFA treatments.
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Jesson, Julie. "Malnutrition et infection pédiatrique par le VIH en Afrique de l'Ouest." Thesis, Bordeaux, 2016. http://www.theses.fr/2016BORD0308/document.
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Les enfants infectés par le VIH en Afrique subsaharienne sont exposés à un risque de malnutrition élevé au cours de leur vie. Or, les données sur la nutrition chez ces enfants sont encore limitées en Afrique de l’Ouest. L’objectif global de cette thèse est d’étudier la relation entre nutrition et infection par le VIH, chez les enfants infectés vivant en Afrique de l’Ouest. Plus spécifiquement, il s’agit d’estimer la prévalence de la malnutrition, de décrire l’évolution de la croissance après l’initiation du traitement antirétroviral, et d’évaluer des interventions nutritionnelles à intégrer au sein de la prise en charge pédiatrique du VIH. Les principaux résultats montrent une prévalence élevée de la malnutrition chez ces enfants, proche de 50 % avant la mise sous traitement antirétroviral. L’initiation du traitement a des effets positifs sur la croissance, d’autant plus important que l’initiation se fait de façon précoce. Un déficit pondéral est plus facilement corrigeable qu’un déficit statural, mais une part non négligeable d’enfants continue d’être malnutrie même après deux ans de traitement. En complément du traitement antirétroviral, des interventions de soutien nutritionnel sont donc nécessaires pour lutter contre la malnutrition chez ces enfants. Celles évaluées sont efficaces pour ceux malnutris aigues, mais pas pour ceux avec une malnutrition chronique. De plus, la croissance peut être un marqueur utile de la progression du VIH pédiatrique.L’intégration de la prise en charge nutritionnelle au sein de la prise en charge globale du VIH pédiatrique est possible en Afrique de l’Ouest, mais d’autres études et des actions de plaidoyer sont à développer pour l’adapter au mieuxHIV-infected children in sub-Saharan Africa are exposed to high risk of malnutrition duringtheir life. However, data on the nutrition of HIV-infected children are still limited in West Africa.Thus, the main objective of this thesis is to better investigate the link between nutrition and HIVinfection among HIV-infected children in West Africa. More specifically, it is aimed to estimate theprevalence of malnutrition, to describe growth evolution after antiretroviral treatment initiation, andto assess proposed nutritional interventions to integrate to pediatric HIV care. The main results showa high prevalence of malnutrition among these children, around 50% before antiretroviral treatmentinitiation. This initiation had positive effects on growth evolution; all the more important whenantiretroviral treatment is early initiated. Weight deficiency is easier to recover than heightdeficiency, but a substantial part of children stay malnourished even after two years of treatment. Inaddition to antiretroviral treatment, nutritional support interventions are needed to fight againstmalnutrition among these children. Those assessed were efficient for acute malnourished children,but not for those with chronic malnutrition. Furthermore, growth could be a useful marker of HIVprogression. Integration of nutritional care into global pediatric HIV care is possible in West Africa,but further studies and advocacy work have to be developed to better adapt it
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Benyera, Oscar. "Outcomes in malnourished children at a tertiary hospital in Swaziland : post implementation of the WHO treatment guidelines." Diss., University of Pretoria, 2013. http://hdl.handle.net/2263/33347.
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Background. Swaziland adopted the World Health Organization’s (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007 to reduce case -fatality rates for childhood malnutrition. However, no follow-up studies have been conducted to determine the reduction in the case -fatality rate post-implementation of the guidelines.
Objectives. To determine the case -fatality rate for childhood malnutrition post-implementation of the WHO treatment guidelines and determine the level of adherence to the guidelines at Mbabane Government Hospital.
Methods. A retrospective observational study was undertaken. All children under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 had their demographic-, anthropometric- and clinical characteristics recorded and analysed, as well as the outcome of admission.
Results. Of the 227 children admitted during the study period, 179 (64.6%) were severely malnourished and 98 (35.4%) had moderate malnutrition. One-hundred-and-eleven children died during admission, an overall case -fatality rate of 40.1%. Mortality was significantly higher among severely malnourished children compared to those with moderate malnutrition, (46.9% vs 27.6%, OR 3.0 (95% CI 1.7 to 5.3)). Comorbid pneumonia and gastroenteritis were significant predictors of mortality – , OR 2.0 (95% CI 1.2 to 3.4) and 1.9 (95% CI 1.1 to 3.2) respectively.
Conclusion. Case -fatality rates for childhood malnutrition remain high, despite adoption of the WHO treatment guidelines. A need exists for improved adherence to the WHO guidelines and periodic clinical audits to reduce deaths from childhood malnutrition to meet the WHO mortality target of less than 5% and improve child survival.Dissertation (MSc)--University of Pretoria, 2013.
gm2014
Clinical Epidemiology
unrestricted
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Shipley, William. "Assessment of the effects of malaria and anemia in pregnant Malawian women before and after treatment of moderate malnutrition." DigitalCommons@CalPoly, 2020. https://digitalcommons.calpoly.edu/theses/2182.
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ABSTRACT
Assessment of the Effects of Malaria and Anemia in Pregnant Malawian Women Before and After Treatment of Moderate Malnutrition
William Shipley
Background: Moderate acute malnutrition (MAM) can lead to adverse maternal and infant outcomes and possibly further complications. Supplementary foods or treatments with high quality nutrients should be administered to those with MAM in hopes to increase the chance of healthy maternal and infant outcomes. Sometimes supplementary food is not enough to overcome MAM and disease may play a role, particularly in pregnant malnourished women.
Objective: To determine if the effects of malaria and anemia moderated the effect of nutritional treatments (one of the three given nutritional interventions) used to improve malnutrition and achieve a MUAC ≥ 23 cm during study participation. Additionally, this research serves to assess whether the relationship between malaria and anemia is associated with malnutrition status.
Methods: Women were given a dose of IPTp at each antenatal visit between zero and four total IPTp doses. Infant anthropometrics – length, weight, head circumference, and MUAC were taken at birth, 6 weeks, and 3 months. Maternal hemoglobin levels were assessed at enrollment and after 10 weeks of enrollment as well as infant hemoglobin at 3 months. Anemia was defined by a hemoglobin less than 11.0 g/dL. Mild anemia was defined as hemoglobin greater than 7.0 but less than 9.9 g/dL and moderate anemia was defined by hemoglobin values 9.9 or greater but less than 11.0 g/dL. Analysis was completed using ANOVA, and if any significant differences were observed, they were compared via Tukey HSD (continuous) or Chi-squared test (categorical).
Results: Total number of IPTp doses was found to be a more statistically significant predictor of maternal weight gain during treatment than timing of the doses. It stands to reason that women receiving three or more IPTp doses was the most beneficial for women during treatment as it saw the highest increases in maternal weight gain. At baseline, women that achieved a MUAC > 23 cm during the study was 32.0% (n = 1805). The greatest proportion of women, after adjustment, that achieved a MUAC ≥ 23 cm was seen in women receiving four (47.3 %) and three (37.8 %) total IPTp doses during pregnancy. Maternal weight gain correlated closely with hemoglobin at enrollment (p-value = 0.0111). Total number of IPTp doses received during pregnancy was not found to have a statistical effect on infant hemoglobin or anemia at three months. Infant length at six weeks was higher in infants from mothers that received two or three IPTp doses compared to mothers that received one IPTp dose (p-value = 0.0218). A p-value below 0.05 by total number of IPTp doses was observed for infant weight, head circumference, and MUAC at birth, six weeks, and three months.
Conclusion: At least three IPTp was effective in improving maternal weight gain and achievement of MUAC > 23 cm as well as improved many infant outcomes. Hemoglobin at enrollment was a predictor of maternal weight gain during tx but was not associated with any other outcomes.
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Navaratnarajah, Paramalingam Kandasamy. "Child malnutrition mortality at St Barnabas Hospital is high - is it due to practices and attitudes of staff?: a study in a rural district hospital." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
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The case fatality rate for malnutrition at St Barnabas Hospital over the past years has been around 38%. The rates in other district hospitals in the Eastern Cape province were found to be in excess of 30%. In June 2000, the Eastern Cape Department of Health introduced a protocol for in-patient management of children with severe malnutrition, with the aim of reducing case fatality rate below 10%. St Barnabas Hospital introduced the Eastern Cape protocol in August 2003. An evaluation was done in November 2003 to assess the protocol's impact on the case fatality rate. The rate remained high, at 37.5%. This study descibed the current practices and attitudes of the nurses as St Barnabas Hospital paediatric ward, in the management of severely malnourished childen.
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Kerac, M. "Improving the treatment of severe acute malnutrition in childhood : a randomized controlled trial of synbiotic-enhanced therapeutic food with long term follow-up of post-treatment mortality and morbidity." Thesis, University College London (University of London), 2011. http://discovery.ucl.ac.uk/1306755/.
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BACKGROUND: Tackling severe acute malnutrition (SAM) is a global public health priority. This thesis explores two major influences on treatment outcomes: -Treatment efficacy -Patient-related risk factors OBJECTIVES: 1. To explore whether a pre/probiotic mixture (Synbiotic2000 Forte™) improves treatment outcomes (nutritional and clinical) in children affected by SAM. 2. To describe long term outcomes from SAM and identify key mortality risk factors. METHODS: All 1024 malnourished children admitted to a therapeutic feeding centre in Malawi from July 2006 to March 2007 were eligible for: The PRONUT study (Pre and PRObiotics in the treatment of severe acute malNUTrition): 795 were recruited into a randomised, double-blind, placebo-controlled trial. They received Readyto- Use Therapeutic Food either with or without Synbiotic2000 Forte™. Primary outcome was nutritional cure (weight-for-height >80% of NCHS median). The FUSAM study (Long term Follow-Up after Severe Acute Malnutrition): all children known to be still alive were followed up ≥1 year post discharge. RESULTS: In PRONUT, nutritional cure was similar in both groups: 54%(215/399) for Synbiotic-enhanced RUTF and 51%(203/396) for controls (p=0.40). Main secondary outcomes were also similar (p>0.05). Overall mortality from SAM was 41%(427/1024). Mortality was highest during initial inpatient treatment: 23%(238/1024). In FUSAM, 8%(84/1024) more died within 90 days of admission and 10%(105/1024) during long term follow-up. Cox regression identified HIV, low weight-forheight, low mid-upper arm circumference and low weight-for-age as major risk factors for death (p<0.001). CONCLUSIONS: In this high-mortality setting, Synbiotic2000 ForteTM, did not improve clinical or nutritional outcomes from SAM. A more promising strategy to improve outcomes might be to tackle the major risk factors for SAM mortality: HIV and severity of malnutrition disease. It is likely that earlier treatment would be beneficial. This is a focus of current strategies for both HIV and malnutrition. Rollout of such programmes should be supported and their impact on SAM evaluated.
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Dibari, F. "Design and pre-testing of lipid-based, ready-to-use foods for the prevention and treatment of malnutrition in low-resource settings." Thesis, University College London (University of London), 2015. http://discovery.ucl.ac.uk/1447208/.
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Background: Managing child and adult undernutrition is a global public health priority. In poor settings, improved specialised products are needed for treatment and prevention, including for chronic disease/HIV. Objective: To develop a method for the design and pre-clinical testing of novel, low-cost Ready-to-Use Therapeutic Foods (RUTF), to be also applied to supplementary/complementary feeding interventions. A method was developed and tested, using four sequential studies, with HIV-positive Kenyan adults with severe acute malnutrition (case-study). A qualitative study explored adherence and consumption barriers with the current UN standard peanut/milk-powder-based therapeutic formulation (P‐RUTF). A study using Linear Programming (LP) designed an improved, cheaper formulation soy/maize/sorghum-based (SMS-RUTF), considered accurate if: its manufactured prototype, compared to calculated values; it had a measured energy density difference (EDD) < 10%; a protein or lipid difference (P/LD) < 5g/100g. An acceptability study (4-weeks-cross-over design; washout one-week) compared use of SMS-RUTF against P-RUTF (n=41), using 18 consumption/safety/preference criteria. Based on a literature review (28 randomized controlled trials of micronutrient supplementation; outcomes: increased survival and CD4 cell count, reduced viral load), four criteria to determine micronutrient specifications for the SMS-RUTF fortification were developed and applied. The reported compliance with the prescribed RUTF was relatively low, and informed the necessary formulation improvements. The LP-determined formulation was accurate (EDD: 7%; PD and LD: 2.3 and 1.0g/100g). The LP-based prototype was acceptable and safe, but with an average number of days of nausea and vomit (0.16 and 0.04 d) occurred with a higher frequency (P < 0.05) than in the control (0.09 and 0.02 d). The existing evidence for determining micronutrient specifications for SMS-RUTF posed some challenges for the development of manufacturing specifications. Twelve of the micronutrient specifications developed for SMS-RUTF fortificant premix were equivalent to the UN minimum standards; eleven were 2 to 10 times higher. Conclusions: The proposed set of methods can be used to design and pre-clinically test improved/cheaper RUTF products, targeting malnourished adults. Novel formulations should be clinically trialled before widespread-use.
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Knight, Elizabeth. "Examining the impact of an emotional stimulation intervention on interactions between Ethiopian mothers and their infants in the context of treatment for malnutrition." Thesis, University of East Anglia, 2016. https://ueaeprints.uea.ac.uk/62988/.
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Infant malnutrition in developing countries, such as Ethiopia, has been linked to a number of negative outcomes (Grantham-McGregor et al., 2007). Evidence suggests that aspects of the relationship between mother and infant may be affected by malnutrition, in terms of attachment (Valenzuela, 1990) and the opportunities for emotional stimulation within the mother-infant relationship (Cravioto & Delicardie, 1975; 1976). This study examines whether an emotional stimulation intervention delivered in addition to emergency food supplementation, may improve the quality of mother-infant interactions. This study uses between-subjects post test and correlational designs. Interactions were recorded for 75 mother-infant dyads, who were enrolled on a randomised controlled trial, comparing the impact of an emotional stimulation intervention on infant weight gain during treatment for malnutrition. Mother-infant interactions were rated using two established coding systems, adapted for the current study. The results indicated that mothers who had received an emotional stimulation intervention in addition to infant nutritional supplementation, were rated as more positive in their interaction with their infants in comparison to the control group. The nature of the interaction was also rated as significantly more positive for mothers and infants in the intervention group. There were no differences between control and intervention groups on infant positive affect and behaviour. This may be attributable to timeliness and methods of measurement. A significant relationship was found between the rate of infant weight gain and the quality of the interaction. Path analysis failed to find support for pathway between the quality of maternal interaction and infant weight gain. This was an exploratory analysis and results were attributed to a lack of statistical power to detect an effect. The findings are considered in relation to theories of the mother-infant relationship, models of malnutrition, methodological rigor. Recommendations for further research are discussed.
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Palmer, R. A. C. "Emotional stimulation as an addition to therapeutic food intervention for treatment of young children with severe acute malnutrition in a low-income country." Thesis, University College London (University of London), 2016. http://discovery.ucl.ac.uk/1532876/.
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This thesis presents the results of a series of studies evaluating the potential of a short, low-cost intervention aiming to enhance the sensitivity of mothers of severely malnourished children in Ethiopia. The emotional stimulation (ES) intervention was integrated with the existing nutrition programme and delivered by local health workers and lay workers. There are five empirical chapters. 1) A pilot trial of the ES intervention, which demonstrated that it was feasible to implement the intervention in Ethiopia and provided preliminary evidence of the intervention’s potential. 2) A cluster randomised controlled trial (RCT) comparing the ES intervention to an attention placebo control. This study demonstrated that the ES intervention led to improvements in the rate of children’s BMI gain and to improvements in their socio-emotional functioning. The intervention had little impact on maternal psychosocial functioning, with the exception of on social symptoms. 3) A cross-sectional study with a subsample from the cluster RCT demonstrated that the ES intervention was associated with improved cognitive performance and behaviour of children. 4) Another cross-sectional study with a subsample from the cluster RCT found that the ES intervention was associated with higher quality parent–child interaction, but did not impact on children’s interactive behaviour. The improvements in maternal sensitivity did not mediate the effects of the intervention on BMI gain, but there was inadequate power to detect an effect. 5) A 1-year follow-up of the cluster RCT demonstrated that the group difference in children’s BMI was not maintained but that there were continued improvements in maternal social functioning in the ES group, and evidence for some benefits to depressive symptoms. The ES intervention may therefore be of benefit to children during the acute stages of malnutrition, but is unlikely to have an enduring impact. The improvements in maternal psychosocial functioning require further investigation.
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Motswaledi, Mmabotsha. "Cultural issues in the treatment of hospitalised, malnourished children : an exploratory-descriptive study of the attitudes of health professionals and mothers in a rural hospital setting." Master's thesis, University of Cape Town, 1998. http://hdl.handle.net/11427/17314.
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Bibliography: p. 100-105.Culture plays a significant role in the treatment of certain illnesses and in the maintenance of good health in communities. In hospitals, professionals are constantly faced with medication non-compliance and other defaulting behaviour by health consumers or patients due to lack of their sensitivity towards cultural issues. It is true that most Africans are faced with a dilemma of choosing between Western treatment approaches and their own traditional healing. Therefore some may need still to adopt both Western and African approaches. The study examines the attitudes of both the professionals and mothers with malnourished children towards the cultural values linked to the treatment modalities. An exploratory- descriptive method is used as a focus for the study. Because of the illiteracy of the mothers, an interview schedule was used to collect data and get impressions about certain issues. A questionnaire was used to collect data from the professionals; which included nurses, an occupational therapist, a physiotherapist, and people working for the Kwashiorkor Centre. Both the literature review and other studies showed that there is a difference in attitudes regarding cultural issues in the treatment of malnourished children between the health consumers and the health professionals. Findings of this study revealed negative attitude towards mothers who used traditional medicine before coming to hospital. Mothers felt that they were reprimanded regarding their cultural value systems. This study includes recommendations that health professionals need to be sensitive to the cultural belief system of the health consumers for better compliance and service delivery. It is recommended that health care providers be aware of their value systems and above all respect those of the consumers. To facilitate better participation in health education programmes it is important that these programmes are culturally sensitive.
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Raven, Donna I. "Difference between calorie requirements of enterally fed trauma and burn patients and actual calories supplied." Virtual Press, 1998. http://liblink.bsu.edu/uhtbin/catkey/1101591.
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This study compared calorie needs, prescription and intake in enterally fed trauma and burn patients. Calorie needs of twenty-eight sequentially admitted patients were assessed by indirect calorimetry or by the Fick method. Caloric prescriptions were calculated from physicians orders. Following attainment of ordered goal rate, three day caloric intake was averaged. Caloric needs were not statistically different from caloric prescription. Caloric intake was significantly lower than caloric needs (p= 0.001). Intolerance and procedures were frequently cited reasons for withholding feedings. Results of this study suggest that trauma and burn patients may not receive the prescribed level of calories during the initial stage of enteral nutrition support.Department of Family and Consumer Sciences
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Cardenas, Diana. "La nutrition en médecine : approche épistémologique, problèmes ethiques et cas cliniques." Thesis, Besançon, 2016. http://www.theses.fr/2016BESA1012/document.
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Les progrès de la médecine permettent aujourd’hui de nourrir par nutrition artificielle toutes les personnes malades dès lors qu’elles ne peuvent pas s’alimenter par elles mêmes.Toutefois, la malnutrition se présente dans le cadre clinique comme une maladie d’une haute prévalence. Est-il alors possible de faire de la nutrition un sujet éthique de telle sorte qu'elle soit considérée en médecine comme un véritable soin ? Pour répondre à cela, l’approche épistémologique montre que la nutrition est une science autonome ayant ses origines dans l’Antiquité. Elle se différencie de la nutrition clinique, une discipline née au XX ème siècle et qui a recours aux techniques de nutrition artificielle ayant le statut de médicament. Sur le plan éthique, cela pose de vraies difficultés lorsque la nutrition artificielle s’applique à des situations cliniques particulières. En effet, alimenter les patients devient un soin mais aussi un traitement. Cela conduit alors à interroger les valeurs du soin et à élaborer des normes universalisables possédant une véritable légitimité dans le champ médical. Dans ce contexte, nous avons identifié une double vulnérabilité des patients dénutris,caractérisée par l’altérité du corps dénutri, mais aussi par la vulnérabilité induite par l’absence de diagnostic et de formation des soignants en nutrition. Pour répondre à ces enjeux, il devient alors nécessaire de penser des institutions justes qui, dans les politiques de santé, intègrent la nutrition en la concevant comme un soin et en proposant une formation médicale adaptée à de tels défisMedical advances now allow to feed all sick people by artificial nutrition when they cannot feed themselves. However, malnutrition is still highly prevalent. Is it possible to make nutrition an ethical subject so that it be considered as real medical care? To respond to this, an epistemological approach shows that nutrition is an autonomous science that has its origins in Antiquity. It differs from Clinical Nutrition, a discipline born in the twentieth century and uses artificial nutrition techniques having the status of a drug. Ethically, this poses actual difficulties when artificial nutrition applies to particular clinical situations. Indeed, feeding patients becomes a form of care but also of treatment. This leads us to question the values of care and envision universalizable standards with a true legitimacy in the medical field. In this context, we have identified a double vulnerability of malnourished patients, characterized by the otherness of the malnourished body, but also a vulnerability induced by the lack of diagnosis and training of care givers in nutrition. To meet these issues, it becomes necessary to conceive of just institutions, that by health policy, integrate nutrition as a care and provide medical training adapted to these challenges
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Britton, Benjamin. "Eating As Treatment (EAT): psychological strategies to prevent malnutrition in head and neck cancer patients undergoing radiotherapy." Thesis, 2018. http://hdl.handle.net/1959.13/1393794.
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Research Doctorate - Doctor of Philosophy (PhD)Cancers of the nose, mouth and throat linings and their connected tissues are collectively known as Head and Neck Cancer (HNC). HNC is common and has relatively poor survival rates. Due to its association with alcohol and tobacco use, HNC occurs in a population with unique challenges distinct from other cancer groups. HNC patients are more likely to be males, of lower SES, and have a diagnosable mental illness. These challenges are compounded once patients begin treatment as the side effects of the radiotherapy in addition to the tumour itself begins to inhibit adequate intake of nutrition. It is estimated that up to 88% of HNC patients are malnourished during cancer treatment. Malnutrition is associated with poorer morbidity and mortality outcomes. Malnourished HNC patients can be successfully treated by oncology dietitians that have evidence-based interventions at their disposal, however these are only effective if the patient actually adheres to the dietetic protocol. Seen in this context it becomes clear that for dietetic interventions for HNC to be effective, they require significant behaviour change from the patient. Until now there have been no randomised trials of behavioural interventions to improve nutrition in HNC patients, despite evidence from other clinical populations in which psychological intervention has demonstrably improved patient nutrition. To address this gap, this thesis aimed to develop, refine and evaluate the effectiveness of a psychological intervention, to improve nutritional status in HNC patients undergoing radiotherapy. Specifically, the thesis aims were to: 1. Systematically review the acceptability and feasibility of psychological interventions that have been already used with HNC patients ; 2. Pilot test a behavioural intervention, delivered by a clinical psychologist, evaluating its efficacy to improve nutrition in HNC patients undergoing radiotherapy in a NSW radiation oncology department ; 3. Examine via a pre-post comparison of consultation room recordings, whether oncology dietitians could be trained in a refined version of the behavioural interventions Eating As Treatment (EAT) and measure the consequent changes in their routine clinical behaviour ; 4. Assess the effectiveness of the behavioural intervention EAT in improving nutrition in HNC patients on a larger scale, delivered by dietitians in Australian radiation oncology departments via a multi- centre stepped wedge randomised controlled trial ; 5. Evaluate dietitians’ fidelity to the intervention protocol by comparing blinded ratings of intervention and control condition audio recordings. The papers contained within demonstrate that psychological interventions for HNC patients are acceptable and feasible; that psychological interventions can improve HNC patients’ nutrition; that dietitians can be successfully trained in a refined version of the intervention; and that this delivery can significantly improve nutrition for HNC patients in Australian radiation oncology departments. Implications for clinical practice, implementation and future research are then discussed.
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Karakochuk, Crystal D. "Evaluating the Relative Effectiveness of Two Supplemental Foods for the Treatment of Moderate Acute Malnutrition in Children 6 to 60 Months of Age in Southern Ethiopia." Thesis, 2010. http://hdl.handle.net/1807/25720.
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The purpose of this cluster-randomized equivalence trial was to investigate the effectiveness of two supplemental foods in children with moderate malnutrition by comparing: (i) time to recovery by survival analysis, and (ii) recovery rates (after 16 weeks of treatment). A total of 2,600 children 6-60 months of age were randomized by cluster (district) to receive 16 weeks of conventional (Corn-Soya Blended flour, CSB) or intervention (Ready-to-Use Supplemental Food, RUSF) foods. Overall, time to recovery from malnutrition (mean 74 days) and recovery rates (mean 76%) were equivalent with both foods. The time to recovery outcomes were equivalent, independent of location, whereas the recovery rate in children receiving CSB was significantly higher in the more food insecure southern region. Intra-household food sharing was significantly higher in the CSB group compared to RUSF. Overall, the response to the two different supplemental foods was equivalent for the treatment of moderately malnourished children in Ethiopia.
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Demisse, Bekele Negussie. "Performance of community-based management of children with severe acute malnutrition in a pastoral area of Ethiopia." Diss., 2013. http://hdl.handle.net/10500/13393.
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The purpose of the study was to assess the coverage and effectiveness of the management of severe acute malnutrition project implemented in Dhas district of Borena zone, Ethiopia, from July 2010 to December 2010.
Quantitative, descriptive study was conducted to assess the comparability of the outcome of community-based management of acute malnutrition in a pastoralist area to International Sphere standards using performance indicators. Data collection was done using data capturing sheet. Outpatient therapeutic programme (OPT) registers in all health facilities were the sources of data. Clinical records of children admitted to the programme (n=163) were analysed. Standard nutrition survey result was used to estimate the malnutrition prevalence and programme coverage.
International Sphere standard was achieved for mortality rate but not for recovery rate, defaulter rate, length of stay and weight gainHealth Studies
M.A. (Public Health)
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Sicotte, Maryline. "Malnutrition, VIH et traitement antirétroviral dans les pays à ressources limitées." Thèse, 2014. http://hdl.handle.net/1866/12310.
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Rigouts, L., N. Coeck, M. Gumusboga, Rijk W. B. de, K. J. Aung, M. A. Hossain, K. Fissette, et al. "Specific gyrA gene mutations predict poor treatment outcome in MDR-TB." 2015. http://hdl.handle.net/10454/17328.
Full textAbstract:
YesMutations in the gyrase genes cause fluoroquinolone resistance in Mycobacterium tuberculosis. However, the predictive value of these markers for clinical outcomes in patients with MDR-TB is unknown to date. The objective of this study was to determine molecular markers and breakpoints predicting second-line treatment outcomes in M. tuberculosis patients treated with fourth-generation fluoroquinolones. We analysed treatment outcome data in relation to the gyrA and gyrB sequences and MICs of ofloxacin, gatifloxacin and moxifloxacin for pretreatment M. tuberculosis isolates from 181 MDR-TB patients in Bangladesh whose isolates were susceptible to injectable drugs. The gyrA 90Val, 94Gly and 94Ala mutations were most frequent, with the highest resistance levels for 94Gly mutants. Increased pretreatment resistance levels (>2 mg/L), related to specific mutations, were associated with lower cure percentages, with no cure in patients whose isolates were resistant to gatifloxacin at 4 mg/L. Any gyrA 94 mutation, except 94Ala, predicted a significantly lower proportion of cure compared with all other gyrA mutations taken together (all non-94 mutants + 94Ala) [OR = 4.3 (95% CI 1.4-13.0)]. The difference in treatment outcome was not explained by resistance to the other drugs. Our study suggests that gyrA mutations at position 94, other than Ala, predict high-level resistance to gatifloxacin and moxifloxacin, as well as poor treatment outcome, in MDR-TB patients in whom an injectable agent is still effective.