Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia.

Autor: Sturgeon JP; Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe. jpsturgeon@cantab.net.; Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK. jpsturgeon@cantab.net., Mufukari W; Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe., Tome J; Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe., Dumbura C; Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe., Majo FD; Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe., Ngosa D; Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia., Chandwe K; Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia., Kapoma C; Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia., Mutasa K; Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe., Nathoo KJ; Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe., Bourke CD; Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe.; Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK., Ntozini R; Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe., Bwakura-Dangarembizi M; Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe.; Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe., Amadi B; Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia., Kelly P; Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia.; Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK., Prendergast AJ; Zvitambo Institute for Maternal and Child Health Research, 16 Lauchlan Avenue, Harare, Zimbabwe.; Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
Jazyk: angličtina
Zdroj: European journal of clinical nutrition [Eur J Clin Nutr] 2023 Sep; Vol. 77 (9), pp. 895-904. Date of Electronic Publication: 2023 Aug 08.
DOI: 10.1038/s41430-023-01320-9
Abstrakt: Background/objectives: Malnutrition underlies 45% of deaths in children under-5 years annually. Children hospitalised with complicated severe acute malnutrition (SAM) have unacceptably high mortality. We aimed to identify variables from early hospital admission (baseline factors) independently associated with inpatient mortality in this cohort to identify those most at risk.
Subjects/methods: Observational study of 745 children aged 0-59 months admitted with complicated SAM at three hospitals in Zimbabwe/Zambia. Children underwent anthropometry and clinical assessment by a study physician within 72 h of enrolment, and caregivers provided sociodemographic data. Children were followed-up daily until discharge/death. A multivariable survival analysis identified the baseline factors independently associated with mortality.
Results: 70/745 (9.4%) children died in hospital. Age between 6-23 months [aHR 6.53, 95%CI 2.24-19.02], higher mid-upper arm circumference [aHR 0.73, 95%CI 0.59-0.89], presence of oedema [aHR 2.22, 95%CI 1.23-4.05], shock [aHR 8.18, 95%CI 3.79-17.65], sepsis [aHR 3.13, 95%CI 1.44-6.80], persistent diarrhoea [aHR 2.27, 95%CI 1.18-4.37], lack of a toilet at home [aHR 4.35, 95%CI 1.65-11.47], and recruitment at one Harare site [aHR 0.38, 95%CI 0.18-0.83] were all independently associated with inpatient mortality. Oedematous children had a significantly higher birthweight [2987 g vs 2757 g, p < 0.001] than those without oedema; higher birthweight was weakly associated with mortality [aHR 1.50 95%CI 0.97-2.31].
Conclusions: Children with oedema, low MUAC, baseline infections, shock and lack of home sanitation had a significantly increased risk of inpatient mortality following hospitalisation for complicated SAM. Children with high-risk features may require additional care. A better understanding of the pathophysiology of SAM is needed to identify adjunctive interventions.
(© 2023. The Author(s).)
Databáze: MEDLINE
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