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Malnutrition and anaemia associated with severe Covid in infants: BJMC study

The study findings, published in the Journal of Tropical Paediatrics, shows how infants who had a severe form of the disease also had comorbidities.

Written by Anuradha Mascarenhas | Pune | December 15, 2020 9:23:09 pm
One in 4 Indian men in 15-54 yrs age group has anaemia: StudyA significant finding was that some infants suffered from malnutrition and anaemia, some had sickle cell anaemia and some had congenital anomalies,” said Dr Kinikar. (Photo: Getty Images/Thinkstock)

Malnutrition and anaemia are associated with severe Covid in infants, according to a new study by researchers from the B J Medical College and Sassoon General Hospital in Pune. The study findings, published in the Journal of Tropical Paediatrics, shows how infants who had a severe form of the disease also had comorbidities.

From March till date, the Sassoon General Hospital has registered a total of 384 critically ill children (from neonates till 12 year olds). Of these, 105 children were Covid positive and nearly 80 per cent required ICU care. There were two deaths – one of an 11-year-old who was Covid positive and suffered from chronic kidney disease, with multi-organ dysfunction, while the second patient was a baby who was Covid positive and also suffered from severe malnutrition with haemoglobin levels of less than one gram per cent.

In the current study, a total of 13 infants admitted at Sassoon General Hospital, who tested positive for Covid-19 between April and August this year, were included. Nine were male, and the youngest infant was aged 3 months and the oldest was 13 months old. They all exhibited some common symtopms like fever, poor feeding, irritability, and runny nose.

In three of the cases, the infants with severe Covid-19 also had the comorbidity of severe acute malnutrition (SAM), Dr Aarti Kinikar, professor and head of the Department of Paediatrics, B J Medical College and Sassoon General Hospital, told The Indian Express.

“Our study focussed exclusively on infants with Covid-19. Nine of our cases had co-morbidities, of which four developed a severe form of the disease. A significant finding was that some infants suffered from malnutrition and anaemia, some had sickle cell anaemia and some had congenital anomalies,” said Dr Kinikar.

While it is known that Covid-19 is less common in children, including infants, researchers said this could also be due to a lower risk of exposure or incomplete identification due to mild or asymptomatic disease, rather than resistance to infection. “We can’t say that Covid-19 is not serious in children,” said Dr Kinikar.

Studies from Europe have shown that majority of infants have a mild form of the disease, while infants with comorbidities may have a higher risk of severe disease.

In India, this study is among the first ones that show malnutrition and anaemia are associated with severe Covid in infants. Dr Kinikar said that the study was significant as the findings of the fifth round of the National Family Health Survey (NFHS), released last week, show a substantial rise in malnutrition and anaemia.

“Compared to the developed world, India still has a huge burden of severe malnutrition and anemia in children.The mortality in our case series occurred in a severely malnourished child, who also had severe megaloblastic anaemia,” said Dr Kinikar.

According to the NFHS 2019-20 data, more than 50 per cent of children and women were found to be anaemic in 13 states and union territories. Maharashtra is among the states that have registered a jump in the percentage of stunted children under five years of age, in comparison to NFHS 2015-16.

A recent report in The Lancet had also pointed out that one in 10 deaths among children younger than 5 years in low and middle-income countries is attributable to severe wasting because wasted children are at increased risk of mortality from infectious diseases.

Before the Covid-19 pandemic, an estimated 47 million children younger than 5 years were moderately or severely wasted across the world, most of them living in sub-Saharan Africa and south Asia.

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