Roseline A., 1

Roseline is a seven-month-old infant and the youngest child in her family. She lives with her parents and siblings in a two-room mud-walled house. Her mother earns a living by selling charcoal, while her father relies on irregular casual jobs to support the family. Their limited income makes it difficult to access specialized healthcare and meet the family's basic needs. At three months of age, Roseline was admitted with abdominal distension and poor weight gain and was diagnosed with congenital heart disease. She was stabilized and discharged with advice to seek specialized follow-up care, but this was not possible due to financial constraints. Four months later, she returned with abdominal pain, increasing irritability, and episodes of drawing her legs toward her abdomen, prompting referral to Siaya County Referral Hospital. On assessment, Roseline was found to have severe acute malnutrition, marked wasting, poor weight gain, generalized weakness, and delayed developmental milestones. Her condition was attributed to chronic illness, inadequate nutritional intake, and lack of specialized follow-up, necessitating admission for nutritional rehabilitation, medical management, and close monitoring.

Roseline was brought to the hospital with complaints of abdominal pains, and distended stomach. She was Sick looking and appeared tired. She was diagnosed with severe anemia, severe acute malnutrition, severe dehydration which warranted admission to the ward.. In the ward she was transfused blood, administered ceftriaxone, ORS after every loose stool, pcm among other drugs to which she responded well. She was eventually discharged on orals with a follow up clinic booked for her

**Doctor's Opinion and Prognosis** Roseline's severe acute malnutrition is likely the result of increased nutritional demands associated with congenital heart disease, compounded by inadequate weight gain and interruption of specialized follow-up care. Her developmental delay further suggests the impact of chronic illness and prolonged undernutrition. She requires comprehensive management, including nutritional rehabilitation, treatment of any associated medical conditions, and review by a pediatric cardiology team. With consistent nutritional support, appropriate cardiac care, regular developmental assessment, and close follow-up, Roseline's nutritional status and overall health are expected to improve. However, her long-term prognosis will largely depend on timely management of the underlying congenital heart disease and sustained multidisciplinary care.:::