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Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective cohort study from Kampala, Uganda
- Source :
- BMC Pediatrics, Vol 20, Iss 1, Pp 1-11 (2020), BMC Pediatrics
- Publication Year :
- 2020
- Publisher :
- Research Square Platform LLC, 2020.
-
Abstract
- BackgroundMortality among children under 5 years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under 5 years of age admitted to the NRH for routine care of SAM.MethodsThis was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14.ResultsTwo-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2% (95% CI 19.9–30.4%) died. In-hospital mortality was 20.7% (95% CI15.9–25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2–4.2),p = 0.014), bacteraemia (AHR 9 (95% CI 3.4–23.0),p p = 0.001).ConclusionsA 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have eGFR below 60 mL/min/1.73m2or have bacteraemia, are more likely to die. Further studies to explore the relationship between eGFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.
- Subjects :
- 0301 basic medicine
Male
Pediatrics
medicine.medical_specialty
Adolescent
Severe Acute Malnutrition
HIV Infections
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Medicine
Humans
Uganda
030212 general & internal medicine
Prospective Studies
Risk factor
Mortality
Prospective cohort study
Child
Children
030109 nutrition & dietetics
Under-five
business.industry
Proportional hazards model
Malnutrition
lcsh:RJ1-570
Infant
lcsh:Pediatrics
medicine.disease
Child mortality
Severe acute malnutrition
Child, Preschool
Pediatrics, Perinatology and Child Health
Female
business
Cohort study
Research Article
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- BMC Pediatrics, Vol 20, Iss 1, Pp 1-11 (2020), BMC Pediatrics
- Accession number :
- edsair.doi.dedup.....5a77176133995a4ab982d2839135dc0b