Children between 5 to 12 years of age admitted in the
Pediatrics ward and also those
children coming to the outpatient department, were diagnosed
as severe thinness after
an anthropometric screening. Every alternate child diagnosed
as severe thinness was
included in the study group after ruling out other chronic
illnesses (except tuberculosis).
Age and sex matched healthy siblings of these children and
other children hospitalized
for various illnesses, with normal nutritional status were
included as controls. A written
informed consent from the parents (Annexure III) and ascent
of the patient was
obtained.
A detailed history including demographic information such as
age, gender , socio
economic status(SES) and community was recorded in a
predesigned case record form
(Annexure IV).A detailed dietary history, birth history,
immunization history and
developmental history were also obtained.
The socioeconomic status was categorized using
Kuppuswamy Scale .
A detailed general physical examination ( including
associated clinical findings like anemia,
clubbing, pedal edema) and systemic examination was done
with special emphasis on
anthropometric measurements and nutritional status which was
derived based on weight and
height. Weight was determined using electronic weighing
scale and height was determined by
stadiometer.Body Mass Index was calculated using the
formula( weight in kg)/( height in
metre)2
Children with BMI for age less than or equal to three
standard deviations WHO 2007 reference
value were designated to have Severe Thinness . Those
children falling between two and
three standard deviations below the median were designated
to have Thinness. The height for
age and weight for age less than or equal to three standard
deviations were designated as
severely stunted and severe underweight respectively. Those
falling between two and three
standard deviations below the median were designated as
stunted and moderately under
weight respectively
Baseline investigations including complete hemogram, liver
function test ( SGOT/SGPT ,
serum albumin) , renal function test ( blood urea nitrogen /
serum creatinine) were done.
Special investigations : chest xray,sputum for AFB, mantoux,
USG abdomen , CT scan
chest/abdomen were done as indicated. These investigations
were reviewed and documented.
The quality of life assessment was performed using the
Pediatric Quality of Life Inventory
(PedsQL) 4.0 Generic Core Scale. A user agreement was signed
with the MAPI research
Institute, Lyon, France, prior to the use of the
questionnaire. The Peds QoL4.0 Generic Core
Scale includes parallel child self-reports and parent
proxy-reports (Annexure VI). We used this
questionnaire in 3 languages, UK English, Hindi and Marathi.
Two separate questionnaires
were administered for children aged 5 to 7 years and 8 to 12
years. Children between 7 to 8
years were given the questionnaire used by children in the
age group 8 to 12 years. These
were completed independently by children and their parents.
Peds QoL items ask how much of a problem a particular issue
has been for the patient during
certain period. Item responses are measured on 5 point
rating scale ranging from 0 (almost
always problem) to 100 (never a problem). These 23 items
consist of 8 items on physical
functioning, 5 on emotional, 5 on social, and 5 on school
,yielding a total score ranging from 0
to 100 with higher score indicating higher quality of life
(83)(54). Additionally, the Peds QoL 4.0
questionnaire contains a Psychosocial Health Summary score
which represents the sum of
items over the number of items answered in the emotional,
social and school functioning
scales.
The scores for each dimension are calculated as follows: the
mean score is represented by the
sum of the items over the number of items answered; missing
values are replaced by the
mean score of the remaining items; if more than 50% of the
items in a given scale are missing,
the scale scores are not computed. Raw scores are
transformed into standardized scores on a
scale from 0 to 100 with higher scores representing higher
functioning levels.
The reliability, internal consistency and validity of the
PedsQL questionnaire have been
assessed in pediatric populations with acute and chronic
health conditions, besides in
physically healthy pediatric populations.
A study of physical, social, emotional and scholastic scores
was performed on children
between 5 and 12 years with severe thinness and it was
compared against the same
for normal children in the same age group. For children who
were hospitalized, they
were interviewed after recovering from acute illness and
before discharge from hospital.
Also the socio-economic status of the child and his parents
(parent’s education,
occupation and income) and the basic details
(age/gender/community/presenting
complaints etc) were collected and compared. The sample size
was estimated as 60
subjects and 45 controls (Total = 105). Socio-demographic
variables were recorded
and the HRQOL was assessed with PedsQL 4.0. |