Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia.
Journal
European journal of clinical nutrition
ISSN: 1476-5640
Titre abrégé: Eur J Clin Nutr
Pays: England
ID NLM: 8804070
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
03
05
2022
accepted:
21
07
2023
revised:
19
07
2023
medline:
4
9
2023
pubmed:
9
8
2023
entrez:
8
8
2023
Statut:
ppublish
Résumé
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. 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. 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]. 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.
Sections du résumé
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.
Identifiants
pubmed: 37553508
doi: 10.1038/s41430-023-01320-9
pii: 10.1038/s41430-023-01320-9
pmc: PMC10473959
mid: EMS184993
doi:
Types de publication
Observational Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
895-904Subventions
Organisme : Wellcome Trust
ID : 107634
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 206225
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/K012711/1
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 206225/Z/17/Z
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 108065
Pays : United Kingdom
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 220566
Pays : United Kingdom
Investigateurs
Jonathan P Sturgeon
(JP)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2023. The Author(s).
Références
Nutr J. 2011 Oct 11;10:110
pubmed: 21989455
Pediatr Res. 2018 Jul;84(1):92-98
pubmed: 29795207
PLoS One. 2012;7(6):e38321
pubmed: 22675542
J Clin Epidemiol. 2008 Oct;61(10):1009-17.e1
pubmed: 18539429
PLoS One. 2020 Apr 9;15(4):e0230502
pubmed: 32271790
Bull World Health Organ. 2016 Sep 01;94(9):642-651
pubmed: 27708469
J Pediatr. 2013 Mar;162(3):515-521.e3
pubmed: 23092531
Lancet. 2008 Apr 12;371(9620):1305-7
pubmed: 18406865
EBioMedicine. 2022 Jan;75:103791
pubmed: 35030356
Lancet Glob Health. 2015 Dec;3(12):e735-6
pubmed: 26566743
Ethiop J Health Sci. 2011 Nov;21(3):175-82
pubmed: 22434997
Public Health Nutr. 2013 Sep;16(9):1565-74
pubmed: 23635423
Cent Afr J Med. 2007 May-Aug;53(5-8):30-4
pubmed: 20355679
Am J Clin Nutr. 2020 Oct 1;112(4):1069-1079
pubmed: 32885807
Lancet Glob Health. 2018 Mar;6(3):e316-e329
pubmed: 29396219
Ther Clin Risk Manag. 2017 Jan 23;13:101-110
pubmed: 28176953
BMC Res Notes. 2019 Jul 15;12(1):409
pubmed: 31307556
Neuroimage. 2011 Apr 15;55(4):1519-27
pubmed: 21167288
Curr Opin Infect Dis. 2016 Jun;29(3):229-36
pubmed: 26967147
Paediatr Int Child Health. 2019 Nov;39(4):240-248
pubmed: 30451103
Gastroenterol Clin North Am. 2018 Dec;47(4):813-827
pubmed: 30337034
Nat Microbiol. 2021 Apr;6(4):445-454
pubmed: 33589804
Lancet. 2013 Aug 3;382(9890):427-451
pubmed: 23746772
Am J Clin Nutr. 2005 Oct;82(4):792-800
pubmed: 16210708
BMC Nutr. 2022 Jul 12;8(1):63
pubmed: 35820965
Am J Clin Nutr. 2021 Mar 11;113(3):665-674
pubmed: 33471057
J Thorac Cardiovasc Surg. 2001 Sep;122(3):430-9
pubmed: 11547291
N Engl J Med. 2005 Jan 6;352(1):39-47
pubmed: 15635111
BMJ Open. 2019 Feb 1;9(1):e023077
pubmed: 30782694
PLoS One. 2012;7(4):e35907
pubmed: 22558267
Lancet Glob Health. 2019 Jan;7(1):e132-e147
pubmed: 30554749
Am J Clin Nutr. 2017 Feb;105(2):494-502
pubmed: 28031190
J Am Coll Nutr. 1999 Aug;18(4):303-8
pubmed: 12038472
BMC Pediatr. 2006 Mar 16;6:7
pubmed: 16542415
J Pediatr Gastroenterol Nutr. 2001 May;32(5):550-4
pubmed: 11429515
Trends Immunol. 2016 Jun;37(6):386-398
pubmed: 27237815
BMC Pediatr. 2010 May 06;10:31
pubmed: 20459633