Malnourished Children

Intestinal parasitic infections (IPIs) are highly prevalent worldwide, particularly among children living in lowresource settings. (1) These infections pose a significant public health challenge due to their widespread distribution and their impact on vulnerable populations, especially preschool and school-aged children. (2) Common intestinal parasites include protozoa such as Giardia lamblia and Entamoeba histolytica, as well as helminths like Ascaris lumbricoides, Trichuris trichiura, and hookworms.(3) IPIs contribute to a range of health problems in children, including diarrhea, anemia, general weakness, and impaired physical development. These infections often cause malabsorption of nutrients and chronic blood loss, which can severely affect children's growth and overall health status. (2) Malnutrition has been defined by the World Health Organization as a major global health challenge with significant implications for morbidity and mortality worldwide.(4) It is characterized by conditions such as stunting, wasting, and underweight, all of which reflect inadequate nutrition and impaired growth. . (Yoseph \& Beyene, 2020).Malnutrition is influenced by multiple interconnected factors including socioeconomic status, inadequate feeding practices, lack of exclusive breastfeeding, recurrent infections, limited healthcare access, and poor environmental conditions such as unsafe water and sanitation. (5) Persistent and/or recurring IPIs are considered important contributors to adverse developmental outcomes depending on parasite species and infection dynamics.(6) They may contribute to malnutrition through both direct and indirect mechanisms. Directly, they can induce chronic subclinical systemic inflammation and modulate the host immune response to ensure persistence, resulting in adverse effects on growth.(7) For example, infection with Cryptosporidium spp. has been linked to reduced length-for-age, mediated by increased systemic inflammation and decreased circulating IGF-1 concentrations.(8) Indirectly, they may promote environmental enteric dysfunction (EED), which is subclinical disorder of the small intestine that can contribute to malnutrition. It involves villous atrophy and crypt hyperplasia, reducing nutrient absorption, and infections such as G. lamblia may play a key role in its development.(6) Additionally IPIs may interact with the normal gut microbiota, with each influencing the other's pathogenic potential, and this interaction can contribute to malnutrition.(7) IPIs can reduce food intake by causing illness, abdominal discomfort, or altering appetite regulation.(8) They may affect neuroendocrine signals, modifying taste perception and satiety hormones, such as elevated leptin levels observed in children infected with E. histolytica, Strongyloides spp., and G. lamblia. Infections like Trichuris trichiura have also been linked to lower intake of protein, energy, iron and riboflavin.(6) While parasites like hookworm directly cause nutrient loss through blood and iron depletion, often resulting in anaemia. (1) Deficiencies in zinc, vitamin D and omega-3 fatty acids are common in children affected by malnutrition and parasitic infections. Zinc and vitamin D is essential for gut integrity, immune function, and growth, while omega-3 fatty acids support intestinal structure and have anti-inflammatory effects. Low levels of these nutrients may worsen intestinal dysfunction, including EED, and contribute to impaired growth.(9) In the light of the previously discussed mechanisms, a strong bidirectional relationship exists between parasitic infections and malnutrition, whereby each condition aggravates the other, forming a vicious cycle that increases the risk of stunting, poor growth, anaemia, and impaired immune function.(3)

The goal of this clinical trial is to learn if intervention with channa striata extract or inbumin forte sachet as a food supplement can improve intestinal damage and nutritional status in malnourished children aged 1.5-5 years. The main questions it aims to answer are: * Whether there is a change in calprotectin and AAT levels after administration of snakehead fish extract of inbumin forte sachet? * Whether there is a difference in changes in nutritional status after administration of snakehead fish extract or inbumin forte sachet? Researchers will compare snakehead fish extract or inbumin forte sachet to a placebo (a look-alike substance that contains no drug) to see if snakehead fish extract or inbumin forte sachet works to treat children malnutrition. Participants will take snakehead fish extract or inbumin forte sachet or placebo every day for 3 months. Researchers will visit study participants every month to check their weight and height and monitor vitamin administration through photos, notes and videos sent every day and records complaints or symptoms that may arise and at the end of 3 months, researchers will collect stool and blood samples and check nutritional status.

The goal of this clinical trial is to learn if health workers training on growth promotion and monitoring guideline and Female Community Health Volunteers mobilization for increasing demand for growth monitoring and promotion, GMP through growth monitoring and promotion day, GMP day) can enhance the growth monitoring and promotion practices in mothers and caretaker having under two years children. The main questions it aims to answer are: * Does health workers training on GMP guideline enhances the growth monitoring and promotion practices in mothers and caretakers having under two years children? * Does FCHV mobilization enhances growth monitoring and promotion practices in mothers and caretakers having under two years children? Participants will * Health workers of the Joshipur rural municipality will have to attend Training session on GMP guideline, * Mothers and caretakers having under two years children will have to visit to the nearest health facility for GMP visits for their children

The Outcome Of malnourished children who receive probiotics (Lactobacillus and Bifidobacterium