{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:19:06Z","timestamp":1787941146734,"version":"build-2784847793"},"reference-count":81,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009187","name":"Medical Research Foundation","doi-asserted-by":"publisher","award":["MR\/K012711\/1"],"award-info":[{"award-number":["MR\/K012711\/1"]}],"id":[{"id":"10.13039\/501100009187","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009187","name":"Medical Research Foundation","doi-asserted-by":"publisher","award":["MR\/R019436\/1"],"award-info":[{"award-number":["MR\/R019436\/1"]}],"id":[{"id":"10.13039\/501100009187","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["108065\/Z\/15\/Z"],"award-info":[{"award-number":["108065\/Z\/15\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["206225\/Z\/17\/Z"],"award-info":[{"award-number":["206225\/Z\/17\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["107634\/Z\/15\/Z"],"award-info":[{"award-number":["107634\/Z\/15\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Mortality following severe acute malnutrition (SAM) remains high in Africa. Some children with SAM have altered immune responses and impaired neurodevelopment; however, whether vitamin D deficiency contributes to these poor outcomes remains unclear. We conducted a cross-sectional analysis of circulating 25-hydroxyvitamin D [25(OH)D] concentrations at hospital discharge (25(OH)D) in 442 children aged 0\u201359 months with SAM at one hospital in Lusaka, Zambia, and two hospitals in Harare, Zimbabwe. Also, we investigated the relationship between 25(OH)D concentrations and host factors. In 442 children, plasma 25(OH)D concentrations were measured using ELISA. Vitamin D deficiency was identified in 33\/442 (7.5%; 95% CI: 5.2\u201310.3) children, all of whom were from Zimbabwe. A multivariable regression model that included age, sex, HIV status, season, oedema, cerebral palsy, and country demonstrated significantly higher 25(OH)D levels among children aged 6\u201311 months (adjusted (adj) ratio; 1.3; 95% CI: 1.1, 1.6; P\u2009=\u20090.003), 12\u201323 months (adj ratio; 1.5; 95% CI: 1.3, 1.8; P\u2009&lt;\u20090.001), and 24\u201359 months (adj ratio; 1.5; 95% CI: 1.3, 1.8; P\u2009&lt;\u20090.001) compared with those &lt;6 months. Sampling during the cool season (adj ratio; 1.2; 95% CI: 1.1, 1.3; P\u2009=\u20090.002), absence of cerebral palsy (adj ratio; 1.2; 95% CI: 1.1, 1.4; P\u2009=\u20090.002) and residence in Zambia (adj ratio; 1.2; 95% CI: 1.1, 1.2; P\u2009&lt;\u20090.001) were associated with higher concentrations of 25(OH)D, even after excluding children &lt;6 months. These findings indicate that vitamin D status among children with SAM is significantly influenced by age, seasonality, cerebral palsy, and geographical location. To facilitate management and improve clinical outcomes in these children, we recommend further investigation into whether the current vitamin D content in ready-to-use therapeutic foods is sufficient for all children and whether additional supplementation improves clinical outcomes, especially in high-risk groups. If deficiency is present, we recommend that children be managed in accordance with local guidelines and policies.<\/jats:p>","DOI":"10.1371\/journal.pone.0355404","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:40:50Z","timestamp":1787938850000},"page":"e0355404","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A cross\u2011sectional analysis of vitamin D status and associated factors in children recovering from severe acute malnutrition in Zambia and Zimbabwe"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7110-3347","authenticated-orcid":true,"given":"Tracy N.","family":"Phiri","sequence":"first","affiliation":[{"name":"Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine","place":["Lusaka, Zambia"]},{"name":"Centre for Immunobiology, University of Glasgow College of Medical Veterinary and Life Sciences","place":["Glasgow, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherlynn","family":"Dumbura","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health Research","place":["Harare, Harare Province, Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuda","family":"Mutasa","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health Research","place":["Harare, Harare Province, Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deophine","family":"Ngosa","sequence":"additional","affiliation":[{"name":"Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nivea","family":"Chuulu","sequence":"additional","affiliation":[{"name":"Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence D.","family":"Majo","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health Research","place":["Harare, Harare Province, Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Rukobo","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health Research","place":["Harare, Harare Province, Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire D.","family":"Bourke","sequence":"additional","affiliation":[{"name":"Centre for Immunobiology, University of Glasgow College of Medical Veterinary and Life Sciences","place":["Glasgow, United Kingdom"]},{"name":"Institute for Maternal and Child Health Research","place":["Harare, Harare Province, Zimbabwe"]},{"name":"Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Amadi","sequence":"additional","affiliation":[{"name":"Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine","place":["Lusaka, Zambia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutsa","family":"Bwakura-Dangarembizi","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health Research","place":["Harare, Harare Province, Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian R.","family":"Martineau","sequence":"additional","affiliation":[{"name":"Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Prendergast","sequence":"additional","affiliation":[{"name":"Institute for Maternal and Child Health Research","place":["Harare, Harare Province, Zimbabwe"]},{"name":"Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Kelly","sequence":"additional","affiliation":[{"name":"Tropical Gastroenterology & Nutrition group, University of Zambia School of Medicine","place":["Lusaka, Zambia"]},{"name":"Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"pone.0355404.ref001","doi-asserted-by":"crossref","first-page":"17067","DOI":"10.1038\/nrdp.2017.67","article-title":"Severe childhood malnutrition","volume":"3","author":"ZA Bhutta","year":"2017","journal-title":"Nat Rev Dis 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Available from: https:\/\/www.who.int\/tools\/elena\/interventions\/sam-identification-inpatient"},{"key":"pone.0355404.ref004","doi-asserted-by":"crossref","first-page":"1336864","DOI":"10.3389\/fnut.2024.1336864","article-title":"The level of wasting and associated factors among children aged 6-59\u2009months in sub-Saharan African countries: multilevel ordinal logistic regression analysis","volume":"11","author":"HA Asebe","year":"2024","journal-title":"Front Nutr"},{"key":"pone.0355404.ref005","unstructured":"Zambia Statistics Agency, Ministry of Health (MoH) [Zambia], and ICF. Zambia Demographic and Health Survey 2024: Key Indicators Report. Lusaka, Zambia, and Rockville, Maryland, USA: Zambia Statistics Agency, MoH, and ICF; 2024. Available from: https:\/\/dhsprogram.com\/pubs\/pdf\/PR159\/PR159.pdf"},{"key":"pone.0355404.ref006","unstructured":"UNICEF. Preventing malnutrition in all forms; acute malnutrition has worsened since COVID-19, requiring treatment for severe wasting for 15,000 children. UNICEF; 2022. Available from: https:\/\/www.unicef.org\/zimbabwe\/reports\/preventing-malnutrition-all-forms"},{"issue":"2","key":"pone.0355404.ref007","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/MPG.0000000000003292","article-title":"Reduced fractional absorption of zinc in children with environmental enteropathy in Zambia","volume":"74","author":"K Zyambo","year":"2022","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"pone.0355404.ref008","unstructured":"Pocket book of hospital care for children: guidelines for the management of common childhood illnesses. 2nd ed. Geneva: World Health Organisation; 2013. 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single institution database study of patients pursuing metabolic\/bariatric surgery","volume":"41","author":"H Hays","year":"2022","journal-title":"Clin Nutr Open Sci"},{"key":"pone.0355404.ref063","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/B978-0-12-809963-6.00061-4","article-title":"Determinants of vitamin D deficiency from sun exposure.","author":"WB Grant","year":"2018","journal-title":"Vitamin D. Elsevier"},{"issue":"1","key":"pone.0355404.ref064","doi-asserted-by":"crossref","first-page":"10723","DOI":"10.1038\/s41598-026-46541-7","article-title":"Harnessing natural sunlight indoors: sensor-regulated therapeutic approach to enhance vitamin D status in humans","volume":"16","author":"MK Hakeem","year":"2026","journal-title":"Sci Rep"},{"issue":"10","key":"pone.0355404.ref065","doi-asserted-by":"crossref","first-page":"155","DOI":"10.3390\/land8100155","article-title":"Dynamics of land use and land cover changes in Harare, Zimbabwe: a case study on the linkage between drivers and the axis of urban expansion","volume":"8","author":"AK Marondedze","year":"2019","journal-title":"Land"},{"key":"pone.0355404.ref066","unstructured":"World Bank. Solar resource and PV potential of Zambia: Solar Resource Atlas. Washington (DC): World Bank; 2019 [cited 2024 Jul 25]. Available from: https:\/\/www.moe.gov.zm\/wp-content\/uploads\/2022\/06\/Solargis_Solar_Resource_Atlas_Zambia_128-09-2019_WBG-ESMAP-1.pdf"},{"key":"pone.0355404.ref067","unstructured":"The World Bank. Climate Change Knowledge Portal: Zambia; 2021. Available from: https:\/\/climateknowledgeportal.worldbank.org\/country\/zambia\/climate-data-historical"},{"key":"pone.0355404.ref068","unstructured":"The Zambia & Zimbabwe Food Region \u2013 Objective List. Available from: https:\/\/objectivelists.com\/the-zambia-zimbabwe-food-region\/"},{"key":"pone.0355404.ref069","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.ebiom.2016.07.030","article-title":"Environmental enteropathy: elusive but significant subclinical abnormalities in developing countries","volume":"10","author":"K Watanabe","year":"2016","journal-title":"eBioMedicine"},{"issue":"1","key":"pone.0355404.ref070","doi-asserted-by":"crossref","first-page":"2839","DOI":"10.1038\/s41598-025-87101-9","article-title":"Effects of HIV exposure on anemia and vitamin D nutritional status in children aged 6-24 months: a hospital-based cross-sectional study","volume":"15","author":"H Li","year":"2025","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0355404.ref071","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s11904-014-0218-8","article-title":"Vitamin D deficiency and altered bone mineral metabolism in HIV-infected individuals","volume":"11","author":"AR Eckard","year":"2014","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"1","key":"pone.0355404.ref072","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s12981-017-0162-y","article-title":"Bone mineral density in people living with HIV: a narrative review of the literature","volume":"14","author":"MJ Kruger","year":"2017","journal-title":"AIDS Res Ther"},{"issue":"9","key":"pone.0355404.ref073","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1089\/aid.2012.0384","article-title":"Short communication: High prevalence of vitamin D deficiency in HIV-infected and HIV-uninfected pregnant women","volume":"29","author":"AR Eckard","year":"2013","journal-title":"AIDS Res Hum Retrovir"},{"issue":"11","key":"pone.0355404.ref074","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1017\/S0007114522000149","article-title":"Sex differences in vitamin D metabolism, serum levels and action","volume":"128","author":"A Wierzbicka","year":"2022","journal-title":"Br J Nutr"},{"key":"pone.0355404.ref075","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1159\/000458765","article-title":"Vitamin D status, gender differences, and cardiometabolic health disparities","volume":"70","author":"DK Sanghera","year":"2017","journal-title":"Ann Nutr Metab"},{"issue":"1","key":"pone.0355404.ref076","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1038\/ejcn.2011.140","article-title":"Impact of gender on vitamin D deficiency in morbidly obese patients: a cross-sectional study","volume":"66","author":"LK Johnson","year":"2012","journal-title":"Eur J Clin Nutr"},{"key":"pone.0355404.ref077","volume-title":"Reproductive, maternal, newborn, and child health: disease control priorities, vol. 2","author":"RE Black","year":"2016","edition":"3"},{"issue":"3","key":"pone.0355404.ref078","first-page":"203","article-title":"Vitamin D levels in malnourished children under 5 years in a tertiary care center at Muhimbili National Hospital, Dar es Salaam, Tanzania-A Cross-sectional study","volume":"63","author":"NZ Walli","year":"2017","journal-title":"J Trop Pediatr"},{"issue":"3","key":"pone.0355404.ref079","doi-asserted-by":"crossref","first-page":"383","DOI":"10.3390\/ijerph16030383","article-title":"Vitamin D status and mortality: a systematic review of observational studies","volume":"16","author":"AK Heath","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0355404.ref080","article-title":"Vitamin D status at admission and its association with mortality in children admitted to the pediatric intensive care unit","author":"MK Kumar","year":"2020","journal-title":"Cureus"},{"key":"pone.0355404.ref081","article-title":"Association between serum vitamin D levels and mortality in children receiving chronic dialysis: a retrospective cohort study","volume":"9","author":"SS Khamene","year":"2026","journal-title":"Health Sci Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355404","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T17:41:02Z","timestamp":1787938862000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355404"}},"subtitle":[],"editor":[{"given":"Mohammed Hasen","family":"Badeso","sequence":"first","affiliation":[{"name":"PLOS: Public Library of Science","place":["ETHIOPIA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":81,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0355404","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]}}}