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Active renewal policies that required families to submit documentation to verify their continued eligibility were associated with substantial disenrollment. Requiring active eligibility redetermination every 6 months rather than every 12 months resulted in even higher levels of disenrollment over time. Up to one- quarter of children who disenrolled at renewal returned to SCHIP within 3 months (18 percent to 27 percent). A simplified renewal process that automatically reenrolled children in SCHIP unless their families submitted reenrollment forms indicating a change affecting their eligibility substantially reduced disenrollment at SCHIP renewal. In some States with separate SCHIP programs, SCHIP design limited coverage for certain specialty services that are needed by CSHCN. This was done directly by limiting the. | Annals of Tropical Paediatrics 2008 28 165-189 Growth and nutritional status of children with homozygous sickle cell disease A. -W. M. AL-SAQLADI R. CIPOLOTTI1 K. FIJNVANDRAAT B. J. BRABIN Faculty of Medicine Health Sciences Aden University Yemen Child Reproductive Health Group Liverpool School of Tropical Medicine Department of Community Child Health Royal Liverpool Children s Hospital Liverpool UK Department of Medicine Federal University of Sergipe Brazil and Academic Medical Centre Emma Kinderziekenhuis University of Amsterdam The Netherlands Accepted February 2008 Abstract Background Poor growth and under-nutrition are common in children with sickle cell disease SCD . This review summarises evidence of nutritional status in children with SCD in relation to anthropometric status disease severity body composition energy metabolism micronutrient deficiency and endocrine dysfunction. Methods A literature search was conducted on the Medline PUBMED SCOPUS SciELO and LILACS databases to July 2007 using the keywords sickle cell combined with nutrition anthropometry growth height and weight body mass index and specific named micronutrients. Results Forty-six studies 26 cross-sectional and 20 longitudinal were included in the final anthropometric analysis. Fourteen of the longitudinal studies were conducted in North America the Caribbean or Europe representing 78.8 2086 2645 of patients. Most studies were observational with wide variations in sample size and selection of reference growth data which limited comparability. There was a paucity of studies from Africa and the Arabian Peninsula highlighting a large knowledge gap for low-resource settings. There was a consistent pattern of growth failure among affected children from all geographic areas with good evidence linking growth failure to endocrine dysfunction metabolic derangement and specific nutrient deficiencies. Conclusions The monitoring of growth and nutritional status in children with SCD is an essential .
