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Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia

BACKGROUND: Accurate and timely data on the health of a population are key for evidence-based decision making at both the policy and programmatic level. In many low-income settings, such data are unavailable or outdated. Using an electronic medical records system, we determined the association betwe...

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Autores principales: Mark, Henry, Been, Jasper V., Sonko, Bakary, Faal, Abdoulie, Ngum, Mohammed, Hasan, Jahid, Prentice, Andrew M., Unger, Stefan A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543667/
https://www.ncbi.nlm.nih.gov/pubmed/31146716
http://dx.doi.org/10.1186/s12889-019-6959-y
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author Mark, Henry
Been, Jasper V.
Sonko, Bakary
Faal, Abdoulie
Ngum, Mohammed
Hasan, Jahid
Prentice, Andrew M.
Unger, Stefan A.
author_facet Mark, Henry
Been, Jasper V.
Sonko, Bakary
Faal, Abdoulie
Ngum, Mohammed
Hasan, Jahid
Prentice, Andrew M.
Unger, Stefan A.
author_sort Mark, Henry
collection PubMed
description BACKGROUND: Accurate and timely data on the health of a population are key for evidence-based decision making at both the policy and programmatic level. In many low-income settings, such data are unavailable or outdated. Using an electronic medical records system, we determined the association between nutritional status and severe illness and mortality among young children presenting to a rural primary health care facility in the Gambia. METHODS: Clinical data collected over five years (2010–2014) on children aged under 60 months making acute visits to a primary health care clinic in the rural Gambian district of Kiang West were retrospectively extracted from the medical records system. Generalised estimating equation models were used to investigate associations between nutritional status and illness severity, accounting for repeat visits, gender, age and access to transport to the clinic. The Population Attributable Fraction (PAF) was used to determine the proportion of severe illness likely attributable to different grades of malnutrition. RESULTS: 3839/5021 (77%) children under 60 months of age living in Kiang West presented acutely to the clinic at least once, yielding 21,278 visits (47% girls, median age 20.2 months (Interquartile Range (IQR) 23.92 months)) and 26,001 diagnoses, 86% being infectious diseases. Severe illness was seen in 4.5% of visits (961/21,278). Wasting was associated with an increased risk of severe illness in a dose-dependent manner, (‘WHZ < -1’ adjusted Odds Ratio (aOR) 1.68, 95% CI:1.43–1.98, p < 0.001, ‘WHZ <-2 and ≥-3’ aOR 2.78, 95% CI:2.31–3.36, p < 0.001 and ‘WHZ < -3’ aOR 7.82, 95% CI:6.40–9.55, p < 0.001) the PAF for wasting (WHZ < -2) was 0.21 (95% CI: 0.18–0.24). Stunting, even in the most severe form (HAZ < -3), was not significantly associated with severe illness (aOR 1.19 95% CI:0.94–1.51) but was associated with a significantly increased risk of death (aOR 6.04 95% CI:1.94–18.78). CONCLUSION: In this population-based cohort of young children in rural Gambia, wasting was associated with disease severity in a dose-dependent manner. Further research is needed into strategies to identify and reach these children with effective interventions to improve their nutritional status. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-019-6959-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-65436672019-06-04 Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia Mark, Henry Been, Jasper V. Sonko, Bakary Faal, Abdoulie Ngum, Mohammed Hasan, Jahid Prentice, Andrew M. Unger, Stefan A. BMC Public Health Research Article BACKGROUND: Accurate and timely data on the health of a population are key for evidence-based decision making at both the policy and programmatic level. In many low-income settings, such data are unavailable or outdated. Using an electronic medical records system, we determined the association between nutritional status and severe illness and mortality among young children presenting to a rural primary health care facility in the Gambia. METHODS: Clinical data collected over five years (2010–2014) on children aged under 60 months making acute visits to a primary health care clinic in the rural Gambian district of Kiang West were retrospectively extracted from the medical records system. Generalised estimating equation models were used to investigate associations between nutritional status and illness severity, accounting for repeat visits, gender, age and access to transport to the clinic. The Population Attributable Fraction (PAF) was used to determine the proportion of severe illness likely attributable to different grades of malnutrition. RESULTS: 3839/5021 (77%) children under 60 months of age living in Kiang West presented acutely to the clinic at least once, yielding 21,278 visits (47% girls, median age 20.2 months (Interquartile Range (IQR) 23.92 months)) and 26,001 diagnoses, 86% being infectious diseases. Severe illness was seen in 4.5% of visits (961/21,278). Wasting was associated with an increased risk of severe illness in a dose-dependent manner, (‘WHZ < -1’ adjusted Odds Ratio (aOR) 1.68, 95% CI:1.43–1.98, p < 0.001, ‘WHZ <-2 and ≥-3’ aOR 2.78, 95% CI:2.31–3.36, p < 0.001 and ‘WHZ < -3’ aOR 7.82, 95% CI:6.40–9.55, p < 0.001) the PAF for wasting (WHZ < -2) was 0.21 (95% CI: 0.18–0.24). Stunting, even in the most severe form (HAZ < -3), was not significantly associated with severe illness (aOR 1.19 95% CI:0.94–1.51) but was associated with a significantly increased risk of death (aOR 6.04 95% CI:1.94–18.78). CONCLUSION: In this population-based cohort of young children in rural Gambia, wasting was associated with disease severity in a dose-dependent manner. Further research is needed into strategies to identify and reach these children with effective interventions to improve their nutritional status. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12889-019-6959-y) contains supplementary material, which is available to authorized users. BioMed Central 2019-05-30 /pmc/articles/PMC6543667/ /pubmed/31146716 http://dx.doi.org/10.1186/s12889-019-6959-y Text en © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided 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 Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Mark, Henry
Been, Jasper V.
Sonko, Bakary
Faal, Abdoulie
Ngum, Mohammed
Hasan, Jahid
Prentice, Andrew M.
Unger, Stefan A.
Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia
title Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia
title_full Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia
title_fullStr Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia
title_full_unstemmed Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia
title_short Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia
title_sort nutritional status and disease severity in children acutely presenting to a primary health clinic in rural gambia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543667/
https://www.ncbi.nlm.nih.gov/pubmed/31146716
http://dx.doi.org/10.1186/s12889-019-6959-y
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