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

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 assoc...

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Autores principales: Sturgeon, Jonathan P., Mufukari, Wadzanai, Tome, Joice, Dumbura, Cherlynn, Majo, Florence D., Ngosa, Deophine, Chandwe, Kanta, Kapoma, Chanda, Mutasa, Kuda, Nathoo, Kusum J., Bourke, Claire D., Ntozini, Robert, Bwakura-Dangarembizi, Mutsa, Amadi, Beatrice, Kelly, Paul, Prendergast, Andrew J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473959/
https://www.ncbi.nlm.nih.gov/pubmed/37553508
http://dx.doi.org/10.1038/s41430-023-01320-9
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author Sturgeon, Jonathan P.
Mufukari, Wadzanai
Tome, Joice
Dumbura, Cherlynn
Majo, Florence D.
Ngosa, Deophine
Chandwe, Kanta
Kapoma, Chanda
Mutasa, Kuda
Nathoo, Kusum J.
Bourke, Claire D.
Ntozini, Robert
Bwakura-Dangarembizi, Mutsa
Amadi, Beatrice
Kelly, Paul
Prendergast, Andrew J.
author_facet Sturgeon, Jonathan P.
Mufukari, Wadzanai
Tome, Joice
Dumbura, Cherlynn
Majo, Florence D.
Ngosa, Deophine
Chandwe, Kanta
Kapoma, Chanda
Mutasa, Kuda
Nathoo, Kusum J.
Bourke, Claire D.
Ntozini, Robert
Bwakura-Dangarembizi, Mutsa
Amadi, Beatrice
Kelly, Paul
Prendergast, Andrew J.
author_sort Sturgeon, Jonathan P.
collection PubMed
description 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.
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spelling pubmed-104739592023-09-03 Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia Sturgeon, Jonathan P. Mufukari, Wadzanai Tome, Joice Dumbura, Cherlynn Majo, Florence D. Ngosa, Deophine Chandwe, Kanta Kapoma, Chanda Mutasa, Kuda Nathoo, Kusum J. Bourke, Claire D. Ntozini, Robert Bwakura-Dangarembizi, Mutsa Amadi, Beatrice Kelly, Paul Prendergast, Andrew J. Eur J Clin Nutr Article 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. Nature Publishing Group UK 2023-08-08 2023 /pmc/articles/PMC10473959/ /pubmed/37553508 http://dx.doi.org/10.1038/s41430-023-01320-9 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Sturgeon, Jonathan P.
Mufukari, Wadzanai
Tome, Joice
Dumbura, Cherlynn
Majo, Florence D.
Ngosa, Deophine
Chandwe, Kanta
Kapoma, Chanda
Mutasa, Kuda
Nathoo, Kusum J.
Bourke, Claire D.
Ntozini, Robert
Bwakura-Dangarembizi, Mutsa
Amadi, Beatrice
Kelly, Paul
Prendergast, Andrew J.
Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia
title Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia
title_full Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia
title_fullStr Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia
title_full_unstemmed Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia
title_short Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia
title_sort risk factors for inpatient mortality among children with severe acute malnutrition in zimbabwe and zambia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473959/
https://www.ncbi.nlm.nih.gov/pubmed/37553508
http://dx.doi.org/10.1038/s41430-023-01320-9
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