The total number of the study population was 90 patients divided equally between the 2 hospitals (45 in each). Age of enrolled patients ranged from 2 to 5 years with mean ± SD of 3.56 ± 0.943 years in Bolaque hospital and 3.37 ± 1.00 years in El-Badrashine hospital. Age showed no significant difference between the two groups. Regarding gender distribution, each group involved 22 females (48.9%) and 23 males (51.1%).
On comparing between the anthropometric measurements at the initial and follow up visits of the study group in Bolaque hospital, there was highly significant increase in weight and height and non-significant change in the rest of the parameters as seen in table 1. Although there was a non-significant difference between the three visits as regards STAMP score, there was a slight increase in numbers of patients at low and intermediate-risk and a slight decrease in the patients at high risk of malnutrition.
Comparison between the nutritional analysis at the initial and follow up visits of the study group in Bolaque hospital showed highly significant increase in caloric intake, sodium, carbohydrates, fat, water, fibre, protein, and calcium. Additionally, there was non-significant increase in the intake of zinc and iron as shown in table 2.
On comparing between the anthropometric measurements at the initial and follow up visits of the study group in El-Badrashine hospital, weight and height showed significant increase, while the rest of the parameters showed non-significant change as shown in table 3. Regarding the STAMP score, there was a distinct but non-significant increase in numbers of patients who were at intermediate risk as well as a slight decrease in patients at high risk of malnutrition.
Comparison between the nutritional analysis at the initial and follow up visits of the study group in El-Badrashine hospital showed significant increase in caloric intake, sodium, carbohydrates, calcium, fiber, fat and water. In addition, there was non-significant increase in the intake of zinc, iron and protein as shown in table 4.
Comparing the anthropometric measurements in the initial visit between the two hospitals showed significant difference in only the height z-score and BMI. The rural area group showed a higher number of patients who were marginally stunted (33.3%), and a higher number of patients who were stunted (20%). Moreover, only the rural area group showed severely stunted patients (4.4%). Regarding BMI the urban group showed significantly lower BMI. Initial STAMP score results showed no significant difference between the two studied groups.
When comparing both groups as regards nutritional analysis in the initial visit, there was no significant difference in the intake of calories, nor any of the macronutrients or the micronutrients.
Comparing the anthropometric measurements in the first month follow up visit between the two hospitals showed significantly higher height values in the urban group with p-value 0.019. Regarding the height z score, it was significantly higher in the urban group with p-value 0.005 since the rural group had 33.3% marginally stunted which was higher than the urban group (15.6%) and 20% stunted patients which was higher ae well (6.7% in the urban patients) and uniquely had severely stunted patients.
Regarding STAMP score, there was a significant difference between the two groups at the first month follow up visit with p-value 0.038. The rural group showed a higher number of patients who were at high risk (22.2%), compared to the urban one (11.1%) and more patients at intermediate risk as well (33.3% and 17.8% respectively).
On comparing urban and rural study groups in the first follow up visit as regards nutritional analysis, there was a significantly higher fat intake in the urban group with p-value 0.027. Although there was no significant difference between the two groups in the other nutrients, the rural group showed distinctly higher zinc intake, and the urban group showed higher intake in total calories, sodium, CHO, Ca, water, iron, fiber, and protein.
When comparison was done between the two studied groups in the second follow up visit, results were similar to the first follow up visit. There was a significantly higher height values in the urban group with p-value 0.012. Regarding STAMP score, there was a significant difference between the two groups with p-value 0.019. The urban group showed a higher number of patients at low risk (75.6%), compared to the other group (46.7%). The rural group showed a higher number of patients at intermediate risk (33.3%), compared to the urban group (15.6%) and a higher number of patients at high risk (20%), compared to urban one (8.9%).
On comparing both studied groups as regards nutritional intake in the second follow up visit, there was significantly higher intake of fat and protein in the urban group with p values of 0.024 and 0.018 respectively
Comparison between the groups as regards the effect of nutritional intervention showed non-significant changes in the studied anthropometric measurements and nutritional analysis parameters (table 5).
Correlation between STAMP score and all study parameters of the total study group in the total of the three visits was done. There was significant inverse correlation between STAMP score and all study parameters in the first visit. Additionally, there was significant inverse correlation in the first follow up visit but it didn`t reach significant difference with age. Regarding correlation between STAMP and the study parameters in the second follow up visit, there was significant inverse correlation except with age and BMI where the correlations were distinctly inverse but without significant difference.
Table (1): Comparison between anthropometric measurements at initial and follow up visits for patients from the urban hospital
Bolaque hospital (urban area)
|
Initial visit
|
1st month visit
|
3rd month visit
|
One way
|
p-value
|
Sig.
|
No. = 45
|
No. = 45
|
No. = 45
|
ANOVA Test
|
Weight (kg)
|
Mean±SD
|
15.17 ± 2.90
|
15.37 ± 2.94
|
15.78 ± 2.95
|
477.809
|
<0.001
|
HS
|
Range
|
10.2 – 21.5
|
10.3 – 21.8
|
10.7 – 22.3
|
Weight z Score
|
Mild underweight
|
7 (15.6%)
|
7 (15.6%)
|
6 (13.3%)
|
0.117
|
0.998
|
NS
|
Underweight
|
0 (0.0%)
|
0 (0.0%)
|
0 (0.0%)
|
Normal
|
38 (84.4%)
|
38 (84.4%)
|
39 (86.7%)
|
Height (cm)
|
Mean±SD
|
97.46 ± 8.82
|
98.08 ± 8.76
|
99.25 ± 8.66
|
1466.687
|
<0.001
|
HS
|
Range
|
80 – 113
|
80.7 – 113.6
|
82 – 114.5
|
Height z Score
|
Normal
|
34 (75.6%)
|
35 (77.8%)
|
35 (77.8%)
|
0.110
|
0.998
|
NS
|
Mild stunted
|
8 (17.8%)
|
7 (15.6%)
|
7 (15.6%)
|
Moderate Stunting
|
3 (6.7%)
|
3 (6.7%)
|
3 (6.7%)
|
Severe stunted
|
0 (0.0%)
|
0 (0.0%)
|
0 (0.0%)
|
BMI
|
Mean±SD
|
15.86 ± 1.09
|
15.88 ± 1.12
|
15.93 ± 1.11
|
2.711
|
0.088
|
NS
|
Range
|
13.9 – 18.9
|
14 – 18.9
|
14 – 18.8
|
BMI z Score
|
Normal
|
22 (48.9%)
|
20 (44.4%)
|
20 (44.4%)
|
0.267
|
0.991
|
NS
|
Overweight
|
17 (37.8%)
|
18 (40.0%)
|
18 (40.0%)
|
Obese
|
6 (13.3%)
|
7 (15.6%)
|
7 (15.6%)
|
STAMP Score
|
Low risk
|
32 (71.1%)
|
32 (71.1%)
|
34 (75.6%)
|
3.783
|
0.436
|
NS
|
Intermediate risk
|
4 (8.9%)
|
8 (17.8%)
|
7 (15.6%)
|
High risk
|
9 (20.0%)
|
5 (11.1%)
|
4 (8.9%)
|
Table (2): Comparison between nutritional analysis at initial and follow up visits for patients from the urban hospital
Bolaque hospital (urban area)
|
Initial visit
|
1st month visit
|
3rd month visit
|
One-way AVOVA test
|
p-value
|
Sig.
|
No. = 45
|
No. = 45
|
No. = 45
|
Calories (Kcal)
|
Mean±SD
|
1282.85 ± 542.53
|
1494.92 ± 447.38
|
1539.97 ± 390.25
|
15.677
|
<0.001
|
HS
|
Range
|
344 – 2334
|
505 – 2411.5
|
712.3 – 2616.2
|
Sodium (mg)
|
Mean±SD
|
2265.54 ± 1399.63
|
2753.45 ± 1274.44
|
2887.13 ± 1246.38
|
8.053
|
0.001
|
HS
|
Range
|
414 – 6003.7
|
521.5 – 6373
|
589 – 6018.9
|
CHO (g)
|
Mean±SD
|
186.32 ± 94.39
|
213.22 ± 73.04
|
219.84 ± 70.49
|
6.532
|
0.004
|
HS
|
Range
|
18.1 – 387.5
|
54.4 – 341.4
|
52.6 – 434
|
Ca (mg)
|
Mean±SD
|
675.72 ± 387.05
|
842.90 ± 352.94
|
874.37 ± 417.46
|
4.319
|
0.016
|
S
|
Range
|
71.9 – 1636.2
|
159.3 – 1624.5
|
155.5 – 1997.6
|
Fat (g)
|
Mean±SD
|
36.98 ± 14.18
|
46.18 ± 15.59
|
46.24 ± 12.03
|
11.131
|
<0.001
|
HS
|
Range
|
16.2 – 68.7
|
19.4 – 101.8
|
16.7 – 68.2
|
Water (ml)
|
Mean±SD
|
473.42 ± 191.44
|
575.09 ± 197.72
|
592.45 ± 227.59
|
5.845
|
0.004
|
HS
|
Range
|
130.1 – 935
|
245.4 – 1119.1
|
175.7 – 1060.7
|
Zinc (mg)
|
Mean±SD
|
7.31 ± 3.89
|
7.65 ± 2.84
|
12.51 ± 27.29
|
1.623
|
0.210
|
NS
|
Range
|
1.2 – 15.3
|
2.2 – 15.5
|
3.5 – 190.5
|
Iron (mg)
|
Mean±SD
|
10.69 ± 9.02
|
11.51 ± 11.77
|
11.17 ± 4.93
|
0.108
|
0.898
|
NS
|
Range
|
0.8 – 50.8
|
1.4 – 84.2
|
2.8 – 24.6
|
Fiber (g)
|
Mean±SD
|
4.43 ± 3.08
|
5.66 ± 2.62
|
6.38 ± 3.14
|
10.222
|
<0.001
|
HS
|
Range
|
0.3 – 13.1
|
0.1 – 11
|
0.2 – 13.4
|
Protein (g)
|
Mean±SD
|
51.35 ± 23.56
|
58.46 ± 18.65
|
61.75 ± 15.09
|
7.874
|
0.001
|
HS
|
Range
|
12 – 104.7
|
22.9 – 105.9
|
24.5 – 102.7
|
Table (3): Comparison between anthropometric measurements at initial and follow up visits for patients from the rural hospital
El-Badrashine hospital (rural area)
|
Initial visit
|
1st month visit
|
3rd month visit
|
One-way AVOVA test
|
p-value
|
Sig
|
No. = 45
|
No. = 45
|
No. = 45
|
Weight (kg)
|
Mean ± SD
|
14.19 ± 2.44
|
14.38 ± 2.47
|
14.76 ± 2.50
|
182.673
|
<0.001
|
HS
|
Range
|
10.4 – 20
|
10.7 – 20.3
|
11.2 – 20.7
|
Weight z Score
|
Mild underweight
|
10 (22.2%)
|
10 (22.2%)
|
9 (20.0%)
|
0.089
|
0.999
|
NS
|
Underweight
|
2 (4.4%)
|
2 (4.4%)
|
2 (4.4%)
|
Normal
|
33 (73.3%)
|
33 (73.3%)
|
34 (75.6%)
|
Height (cm)
|
Mean ± SD
|
93.26 ± 8.07
|
93.85 ± 8.03
|
94.69 ± 8.23
|
9.181
|
0.004
|
HS
|
Range
|
71.5 – 109
|
72.2 – 109.5
|
73.5 – 110.5
|
Height z Score
|
Normal
|
19 (42.2%)
|
19 (42.2%)
|
19 (42.2%)
|
0.000
|
1.000
|
NS
|
Mild stunted
|
15 (33.3%)
|
15 (33.3%)
|
15 (33.3%)
|
Moderate Stunting
|
9 (20.0%)
|
9 (20.0%)
|
9 (20.0%)
|
Severe stunted
|
2 (4.4%)
|
2 (4.4%)
|
2 (4.4%)
|
BMI
|
Mean ± SD
|
16.26 ± 1.48
|
16.27 ± 1.49
|
16.30 ± 1.49
|
0.831
|
0.404
|
NS
|
Range
|
13.3 – 20.9
|
13.4 – 20.9
|
13.4 – 20.9
|
BMI z Score
|
Normal
|
16 (35.6%)
|
17 (37.8%)
|
16 (35.6%)
|
0.229
|
0.993
|
NS
|
Overweight
|
14 (31.1%)
|
13 (28.9%)
|
15 (33.3%)
|
Obese
|
15 (33.3%)
|
15 (33.3%)
|
14 (31.1%)
|
STAMP Score
|
Low risk
|
21 (46.7%)
|
20 (44.4%)
|
21 (46.7%)
|
5.068
|
0.280
|
NS
|
Intermediate risk
|
8 (17.8%)
|
15 (33.3%)
|
15 (33.3%)
|
High risk
|
16 (35.6%)
|
10 (22.2%)
|
9 (20.0%)
|
Table (4): Comparison between all visits of the study group in the rural hospital as regards the nutritional analysis
El-Badrashine hospital (rural area)
|
Initial visit
|
1st month visit
|
3rd month visit
|
One way
ANOVA test
|
p-value
|
Sig
|
No. = 45
|
No. = 45
|
No. = 45
|
Calories (Kcal)
|
Mean ± SD
|
1188.44 ± 409.13
|
1334.68 ± 357.98
|
1408.80 ± 339.99
|
22.920
|
<0.001
|
HS
|
Range
|
354.6 – 2505.4
|
685 – 2325.5
|
734.2 – 2250
|
Sodium (mg)
|
Mean ± SD
|
2170.46 ± 1280.20
|
2550.02 ± 1087.19
|
2830.27 ± 1331.62
|
9.614
|
0.001
|
HS
|
Range
|
269.2 – 6855.8
|
697.3 – 6325
|
420.1 – 6200
|
CHO (g)
|
Mean ± SD
|
171.63 ± 67.32
|
192.28 ± 57.15
|
207.84 ± 62.42
|
13.793
|
0.000
|
HS
|
Range
|
37.6 – 375.2
|
84.9 – 355.20
|
73.5 – 361.9
|
Ca (mg)
|
Mean ± SD
|
535.41 ± 374.70
|
828.16 ± 406.62
|
825.01 ± 425.58
|
10.408
|
<0.001
|
HS
|
Range
|
56.7 – 1334.5
|
137.9 – 2442.2
|
126 – 2450
|
Fat (g)
|
Mean ± SD
|
34.57 ± 12.76
|
39.66 ± 11.74
|
40.86 ± 10.14
|
6.777
|
0.002
|
HS
|
Range
|
14.9 – 66.2
|
20.7 – 72.1
|
18.8 – 66.5
|
Water (ml)
|
Mean ± SD
|
447.65 ± 180.59
|
524.08 ± 162.21
|
549.34 ± 159.60
|
7.026
|
0.002
|
HS
|
Range
|
72.9 – 824.6
|
236.5 – 1033
|
246.5 – 912.4
|
Zinc (mg)
|
Mean ± SD
|
7.01 ± 3.05
|
9.15 ± 13.80
|
9.75 ± 13.70
|
0.749
|
0.453
|
NS
|
Range
|
1.8 – 15.9
|
2.5 – 97.9
|
1.3 – 97.9
|
Iron (mg)
|
Mean ± SD
|
9.55 ± 5.82
|
10.78 ± 14.24
|
9.91 ± 3.68
|
0.299
|
0.625
|
NS
|
Range
|
2.2 – 27.12
|
1.9 – 101.7
|
2.2 – 19.1
|
Fiber (g)
|
Mean ± SD
|
4.71 ± 2.76
|
5.47 ± 2.23
|
6.03 ± 3.04
|
5.361
|
0.010
|
S
|
Range
|
1.2 – 13.9
|
1.3 – 12.2
|
1.2 – 13.4
|
Protein (g)
|
Mean ± SD
|
48.67 ± 19.24
|
52.09 ± 17.98
|
53.83 ± 16.13
|
3.115
|
0.059
|
NS
|
Range
|
11.7 – 107.2
|
23.2 – 115.5
|
12.2 – 98.4
|
Table (5): Comparison between the study groups of the urban and rural hospitals as regards the increments in the anthropometric measurements and nutritional analysis parameters after 3 months follow up
Difference after 3rd visit
|
Bolaque (urban)
|
El Badrashine (rural)
|
t-test
|
p-value
|
Sig
|
Mean
|
SD
|
Mean
|
SD
|
Weight (kg)
|
0.61
|
0.17
|
0.57
|
0.26
|
0.864
|
0.390
|
NS
|
Height (cm)
|
1.78
|
0.29
|
1.43
|
2.77
|
0.843
|
0.401
|
NS
|
BMI
|
0.07
|
0.24
|
0.04
|
0.26
|
0.569
|
0.571
|
NS
|
STAMP score
|
-0.36
|
0.74
|
-0.40
|
1.29
|
0.180
|
0.857
|
NS
|
Calories
|
257.12
|
363.82
|
220.36
|
255.98
|
0.554
|
0.580
|
NS
|
Sodium
|
621.58
|
1090.17
|
671.51
|
1242.32
|
0.203
|
0.839
|
NS
|
CHO
|
33.53
|
63.69
|
36.21
|
50.08
|
0.222
|
0.824
|
NS
|
Ca
|
198.65
|
476.31
|
289.60
|
539.52
|
0.848
|
0.398
|
NS
|
Fat
|
9.25
|
15.03
|
6.28
|
12.22
|
1.029
|
0.307
|
NS
|
Water
|
119.03
|
232.10
|
101.68
|
187.40
|
0.390
|
0.697
|
NS
|
Zinc
|
5.20
|
26.51
|
2.74
|
14.06
|
0.550
|
0.584
|
NS
|
Iron
|
0.48
|
9.01
|
0.36
|
4.92
|
0.078
|
0.938
|
NS
|
Fiber
|
1.94
|
2.77
|
1.32
|
3.26
|
0.972
|
0.333
|
NS
|
Protein
|
10.40
|
20.08
|
5.16
|
15.48
|
1.386
|
0.169
|
NS
|