Diarrhea is a Major killer of Children with Severe Acute Malnutrition Admitted to Inpatient Set-up in Lusaka, Zambia

Nutrition Journal

Veronica Mulenga²  Mwate Mwambazi²  Abel H Irena¹ 

[1] Valid International, Oxford, UK;Department of Pediatrics, School of Medicine, University of Zambia, Lusaka, Zambia

关键词: inpatient;    Zambia;    Severe Acute Malnutrition;    HIV/AIDS;    diarrhea;   

Others  :  828615
DOI  :  10.1186/1475-2891-10-110

 received in 2011-07-06, accepted in 2011-10-11,  发布年份 2011

【 摘 要 】

Introduction

Mortality of children with Severe Acute Malnutrition (SAM) in inpatient set-ups in sub-Saharan Africa still remains unacceptably high. We investigated the prevalence and effect of diarrhea and HIV infection on inpatient treatment outcome of children with complicated SAM receiving treatment in inpatient units.

Method

A cohort of 430 children aged 6-59 months old with complicated SAM admitted to Zambia University Teaching Hospital's stabilization centre from August to December 2009 were followed. Data on nutritional status, socio-demographic factors, and admission medical conditions were collected up on enrollment. T-test and chi-square tests were used to compare difference in mean or percentage values. Logistic regression was used to assess risk of mortality by admission characteristics.

Results

Majority, 55.3% (238/430) were boys. The median age of the cohort was 17 months (inter-quartile range, IQR 12-22). Among the children, 68.9% (295/428) had edema at admission. The majority of the children, 67.3% (261/388), presented with diarrhea; 38.9% (162/420) tested HIV positive; and 40.5% (174/430) of the children died. The median Length of stay of the cohort was 9 days (IQR, 5-14 days); 30.6% (53/173) of the death occurred within 48 hours of admission. Children with diarrhea on admission had two and half times higher odds of mortality than those without diarrhea; Adjusted OR = 2.5 (95% CI 1.50-4.09, P < 0.001). The odds of mortality for children with HIV infection was higher than children without HIV infection; Adjusted OR = 1.6 (95% CI 0.99-2.48 P = 0.5).

Conclusion

Diarrhea is a major cause of complication in children with severe acute malnutrition. Under the current standard management approach, diarrhea in children with SAM was found to increase their odds of death substantially irrespective of other factors.

【 授权许可】

   
2011 Irena et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, et al.: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375(9730):1969-1987.
• [2]Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J: Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet 2008, 371(9608):243-260.
• [3]Pelletier DL, Frongillo EA Jr, Schroeder DG, Habicht JP: The effects of malnutrition on child mortality in developing countries. Bull World Health Organ 1995, 73(4):443-448.
• [4]Pelletier DL: The relationship between child anthropometry and mortality in developing countries: implications for policy, programs and future research. J Nutr 1994, 124(10 Suppl):2047S-2081S.
• [5]Community-based management of Severe Acute Malnutrition-A Joint Statement by the World Health Organization, the World Food Programme, the United Nations Standing Committee on Nutrition and the United Nations Children's Fund. 2007. Geneva, UN press.2007
• [6]Collins S, Dent N, Binns P, Bahwere P, Sadler K, Hallam A: Management of severe acute malnutrition in children. Lancet 368(9551)(pp 1992-2000), 2006 Date of Publication: 02 Dec 2006 2006.
• [7]Heikens GT: How can we improve the care of severely malnourished children in Africa? PLoS Med 2007, 4(2):e45.
• [8]Heikens GT, Bunn J, Amadi B, Manary M, Chhagan M, Berkley JA, Rollins N, Kelly P, Adamczick C, Maitland K, et al.: Case management of HIV-infected severely malnourished children: challenges in the area of highest prevalence. Lancet 2008, 371(9620):1305-1307.
• [9]Ashworth A, Khanum S, Jackson A, Schofield C: Guidelines for the inpatient treatment of severely malnourished children. Geneva: World Health Organization; 2003.
• [10]Anand K, Sundaram KR, Lobo J, Kapoor SK: Are diarrheal incidence and malnutrition related in under five children? A longitudinal study in an area of poor sanitary conditions. Indian Pediatr 1994, 31(8):943-948.
• [11]Ahmed T, Ali M, Ullah MM, Choudhury IA, Haque ME, Salam MA, Rabbani GH, Suskind RM, Fuchs GJ: Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol. Lancet 1999, 353(9168):1919-1922.
• [12]el Samani EF, Willett WC, Ware JH: Association of malnutrition and diarrhea in children aged under five years. A prospective follow-up study in a rural Sudanese community. Am J Epidemiol 1988, 128(1):93-105.
• [13]Roy SK, Buis M, Weersma R, Khatun W, Chowdhury S, Begum A, Sarker D, Thakur SK, Khanam M: Risk factors of mortality in severely-malnourished children hospitalized with diarrhoea. J Health Popul Nutr 29(3):229-235.
• [14]Amadi B, Mwiya M, Chomba E, Thomson M, Chintu C, Kelly P, Walker-Smith J: Improved nutritional recovery on an elemental diet in Zambian children with persistent diarrhoea and malnutrition. J Trop Pediatr 2005, 51(1):5-10.
• [15]Kessler L, Daley H, Malenga G, Graham S: The impact of the human immunodeficiency virus type 1 on the management of severe malnutrition in Malawi. Ann Trop Paediatr 2000, 20(1):50-56.
• [16]Fergusson P, Chinkhumba J, Grijalva-Eternod C, Banda T, Mkangama C, Tomkins A: Nutritional recovery in HIV-infected and HIV-uninfected children with severe acute malnutrition. Arch Dis Child 2009, 94(7):512-516.
• [17]World Health Organization (WHO). Management of severe malnutrition: a manual for physicians and other senior health workers Geneva; 1999.
• [18]Humanitarian Charter and Minimum Standards in Disaster Response Geneva: The Sphere Project; 2004.
• [19]Fergusson P, Tomkins A: HIV prevalence and mortality among children undergoing treatment for severe acute malnutrition in sub-Saharan Africa: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2009, 103(6):541-548.
• [20]Bachou H, Tylleskar T, Kaddu-Mulindwa DH, Tumwine JK: Bacteraemia among severely malnourished children infected and uninfected with the human immunodeficiency virus-1 in Kampala, Uganda. BMC Infect Dis 2006, 6:160. BioMed Central Full Text
• [21]Sunguya BF, Koola JI, Atkinson S: Infections associated with severe malnutrition among hospitalised children in East Africa. Tanzan Health Res Bull 2006, 8(3):189-192.
• [22]Maitland K, Berkley JA, Shebbe M, Peshu N, English M, Newton CR: Children with severe malnutrition: can those at highest risk of death be identified with the WHO protocol? PLoS Med 2006, 3(12):e500.
• [23]Heikens GT, Amadi BC, Manary M, Rollins N, Tomkins A: Nutrition interventions need improved operational capacity. Lancet 2008, 371(9608):181-182.
• [24]Wardlaw T, Salama P, Brocklehurst C, Chopra M, Mason E: Diarrhoea: why children are still dying and what can be done. Lancet 2010, 375(9718):870-872.
• [25]Luque Fernandez MA, Bauernfeind A, Jimenez JD, Gil CL, El Omeiri N, Guibert DH: Influence of temperature and rainfall on the evolution of cholera epidemics in Lusaka, Zambia, 2003-2006: analysis of a time series. Trans R Soc Trop Med Hyg 2009, 103(2):137-143.
• [26]Collins S, Dent N, Binns P, Bahwere P, Sadler K, Hallam A: Management of severe acute malnutrition in children. Lancet 2006, 368(9551):1992-2000.
• [27]Donnen P, Sylla A, Dramaix M, Sall G, Kuakuvi N, Hennart P: Effect of daily low dose of vitamin A compared with single high dose on morbidity and mortality of hospitalized mainly malnourished children in senegal: a randomized controlled clinical trial. Eur J Clin Nutr 2007, 61(12):1393-1399.