The Association of Malnutrition and Disease Conditions in Mortality of Pediatric Patients Presenting to a Rural Emergency Department in Uganda.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
01 Dec 2021
01 Dec 2021
Historique:
pubmed:
14
5
2020
medline:
18
12
2021
entrez:
14
5
2020
Statut:
ppublish
Résumé
The main objectives of this study were to determine the effect of concurrent malnutrition on disease condition and the primary outcome of mortality in children younger than 5 years hospitalized after presenting to a rural emergency department (ED) in Uganda and to identify a high-risk patient population who may benefit from acute ED intervention. A retrospective, observational study was performed to examine the effect of any form of malnutrition on the primary disease conditions of lower-respiratory tract infection (LRTI), malaria, and diarrheal illness. This study was conducted via review of a quality assurance database between January 2010 and July 2014. Of 3428 hospitalized children, the mean age (SD) was 19.8 months (13.9 months) and 56% were boys. Children diagnosed with malaria, an LRTI, or diarrheal illness all had a higher rate of mortality with concurrent malnutrition versus those without malnutrition (malaria, 6.2% [3.6-8.8%] vs 2.8% [2.0-3.7%]; P < 0.01; LRTI, 8.7% [5.0-12.4%] vs. 3.7% [2.6-4.9%], P < 0.01; and diarrheal illness, 10.9% [1.9-19.9%] vs 1.7% [0.1-3.4%], P < 0.01). In children with an LRTI or malaria with concurrent malnutrition, they were statistically significantly less likely to have abnormal temperature and heart rate during the ED encounter than those without concurrent malnutrition. Based on these results, children with malnutrition and concurrent diseases with known high morbidity may not present with abnormal vital signs. This may have clinical relevance in patient management to the acute care provider in identifying and triaging children with malnutrition and acute disease conditions.
Identifiants
pubmed: 32398596
pii: 00006565-202112000-00149
doi: 10.1097/PEC.0000000000002102
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1515-e1520Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: The authors declare no conflict of interest.
Références
World Health Organization. Global Health Observatory (GHO) data: Child health. http://www.who.int/gho/child-malnutrition/en . Accessed May 15, 2018.
Pelletier DL, Frongillo EA Jr., Schroeder DG, et al. The effects of malnutrition on child mortality in developing countries. Bull World Health Organ . 1995;73:443–448.
Blössner M, de Onis M. Malnutrition—quantifying the health impact at national and local levels . Geneva: World Health Organization; 2005. Environmental burden of disease series no. 12.
Rytter MJ, Kolte L, Briend A, et al. The immune system in children with malnutrition—a systematic review. PLoS One . 2014;9:e105017.
Caulfield LE, Richard SA, Black RE. Undernutrition as an underlying cause of malaria morbidity and mortality in children less than five years old. Am J Trop Med Hyg . 2004;71(suppl 2):55–63.
Katona P, Katona-Apte J. The interaction between nutrition and infection. Clin Infect Dis . 2008;46:1582–1588.
Caulfield LE, de Onis M, Blossner M, et al. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr . 2004;80:193–198.
Rice AL, Sacco L, Hyder A, et al. Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries. Bull World Health Organ . 2000;78:1207–1221.
Rice B, Periyanayagam U, Chamberlain S, et al. Mortality in children under five receiving nonphysician clinician emergency care in Uganda. Pediatrics . 2016;137:e20153201.
Hammerstedt H, Maling S, Kasyaba R, et al. Addressing WHO resolution 60.22: a pilot project to create access to acute care services in Uganda. Ann Emerg Med . 2014;64:461–468.
World Health Organization. Pocket book of hospital care for children: Second Edition. 2013. ISBN: 978 92 4 154837 3.
Brent B, Obonyo N, Akech S, et al. Assessment of myocardial function in Kenyan children with severe, acute malnutrition: the Cardiac Physiology in Malnutrition (CAPMAL) study. JAMA Netw Open . 2019;2:e191054.
Silverman JA, Chimalizeni Y, Hawes SE, et al. The effects of malnutrition on cardiac function in African children. Arch Dis Child . 2016;101:166–171.
World Health Organization. Treatment of hypothermia in children with severe acute malnutrition. https://www.who.int/elena/titles/hypothermia_sam/en/ Accessed April 26, 2019.
Talbert A, Atkinson S, Karisa J, et al. Hypothermia in children with severe malnutrition: low prevalence on the tropical coast of Kenya. J Trop Pediatr . 2009;55:413–416.
Ashworth A, Chopra M, McCoy D, et al. WHO guidelines for management of severe malnutrition in rural South African hospitals: effect on case fatality and the influence of operational factors. Lancet . 2004;363:1110–1115. Khanum S et al. Controlled trial of three approaches to the treatment of severe malnutrition. Lancet 1994;344:1728–1732.
Khanum S, Ashworth A, Huttly SR. Controlled trial of three approaches to the treatment of severe malnutrition. Lancet . 1994;344:1728–1732.
Ahmet T, Ali M, Ullah MM, et al. Mortality in severely malnourished children with diarrhea; use of a standardized management protocol. Lancet . 1999;353:1919–1922.
Schofield C, Ashworth A. Severe malnutrition in children: high case-fatality rates can be reduced. Afr Health . 1997;19:17–18.
World Health Organization. Global Health Observatory (GHO) data: Child malnutrition. http://www.who.int/gho/child_health/en . Accessed August 21, 2017.