Fecal gut microbiome among acutely malnourished rural Gambian children

This was a cross-sectional observational sub-study of a quasi-experimental study that aimed to investigate the role of energy regulating hormones in the variable growth responses of rural Gambian children during nutritional rehabilitation. The baseline characteristics of the participants are published elsewhere (Nabwera et al., 2018). In summary, children from 6 to 24 months of age who had presented to three rural primary health care services including the Medical Research Council Unit, The Gambia [MRCG] Keneba field station clinic, Soma Health Centre or villages covered by the Kwinella trekking team, from June 2013 to October 2014 were recruited. All participants recruited into the study underwent clinical assessments and assigned to one for the following groups: MAM, SAM, and well-nourished [WN (WHZ > -2)]; WN control participants were based on the anthropometric measurements (World Health Organization, 2006). MAM is classified as WHZ between 2 and 3 standard deviations below the WHO growth reference standard or a mid-upper arm circumference [MUAC] between 115 and 125 mm while SAM is classified as WHZ less than 3 standard deviations below or MUAC < 115 mm or bilateral oedema (World Health Organization, 2006). Children were who HIV-infected or had significant medical complications requiring transfer secondary or tertiary level care were excluded.All children with SAM and MAM received 28 days of ready to use therapeutic foods (RUTF) according to the WHO and Gambian guidelines for the integrated management of acute malnutrition (World Health Organization, 2013). All children with SAM received broad spectrum antibiotics including amoxycillin for 7 days according to international guidance for management of SAM. In addition, 11 (61%) controls and 9 (41%) children with MAM had antibiotics prescribed at recruitment. Pre-and 1-hour post prandial venous blood samples for analysis of energy-regulating hormones were collected from all children at recruitment and for children in the MAM and SAM groups at days 14 and 28. Stool samples were collected from all the children at recruitment and at follow up visits at days 14 and 28 for children that presented with MAM or SAM.