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Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia

BACKGROUND: Children discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk of mortality, especially HIV-positive children. Few studies have examined mortality in the antiretroviral therapy (ART) era. OBJECTIVES: Our objectives were to ascertain...

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Autores principales: Bwakura-Dangarembizi, Mutsa, Dumbura, Cherlynn, Amadi, Beatrice, Ngosa, Deophine, Majo, Florence D, Nathoo, Kusum J, Mwakamui, Simutanyi, Mutasa, Kuda, Chasekwa, Bernard, Ntozini, Robert, Kelly, Paul, Prendergast, Andrew J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948837/
https://www.ncbi.nlm.nih.gov/pubmed/33471057
http://dx.doi.org/10.1093/ajcn/nqaa346
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author Bwakura-Dangarembizi, Mutsa
Dumbura, Cherlynn
Amadi, Beatrice
Ngosa, Deophine
Majo, Florence D
Nathoo, Kusum J
Mwakamui, Simutanyi
Mutasa, Kuda
Chasekwa, Bernard
Ntozini, Robert
Kelly, Paul
Prendergast, Andrew J
author_facet Bwakura-Dangarembizi, Mutsa
Dumbura, Cherlynn
Amadi, Beatrice
Ngosa, Deophine
Majo, Florence D
Nathoo, Kusum J
Mwakamui, Simutanyi
Mutasa, Kuda
Chasekwa, Bernard
Ntozini, Robert
Kelly, Paul
Prendergast, Andrew J
author_sort Bwakura-Dangarembizi, Mutsa
collection PubMed
description BACKGROUND: Children discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk of mortality, especially HIV-positive children. Few studies have examined mortality in the antiretroviral therapy (ART) era. OBJECTIVES: Our objectives were to ascertain 52-wk mortality in children discharged from hospital for management of complicated SAM, and to identify independent predictors of mortality. METHODS: A prospective cohort study was conducted in children enrolled from 3 hospitals in Zambia and Zimbabwe between July 2016 and March 2018. The primary outcome was mortality at 52 wk. Univariable and multivariable Cox regression models were used to identify independent risk factors for death, and to investigate whether HIV modifies these associations. RESULTS: Of 745 children, median age at enrolment was 17.4 mo (IQR: 12.8, 22.1 mo), 21.7% were HIV-positive, and 64.4% had edema. Seventy children (9.4%; 95% CI: 7.4, 11.7%) died and 26 exited during hospitalization; 649 were followed postdischarge. At discharge, 43.9% had ongoing SAM and only 50.8% of HIV-positive children were receiving ART. Vital status was ascertained for 604 (93.1%), of whom 55 (9.1%; 95% CI: 6.9, 11.7%) died at median 16.6 wk (IQR: 9.4, 21.9 wk). Overall, 20.0% (95% CI: 13.5, 27.9%) and 5.6% (95% CI: 3.8, 7.9%) of HIV-positive and HIV-negative children, respectively, died [adjusted hazard ratio (aHR): 3.83; 95% CI: 2.15, 6.82]. Additional independent risk factors for mortality were ongoing SAM (aHR: 2.28; 95% CI: 1.22, 4.25), cerebral palsy (aHR: 5.60; 95% CI: 2.72, 11.50) and nonedematous SAM (aHR: 2.23; 95% CI: 1.24, 4.01), with no evidence of interaction with HIV status. CONCLUSIONS: HIV-positive children have an almost 4-fold higher mortality than HIV-negative children in the year following hospitalization for complicated SAM. A better understanding of causes of death, an improved continuum of care for HIV and SAM, and targeted interventions to improve convalescence are needed.
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spelling pubmed-79488372021-03-16 Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia Bwakura-Dangarembizi, Mutsa Dumbura, Cherlynn Amadi, Beatrice Ngosa, Deophine Majo, Florence D Nathoo, Kusum J Mwakamui, Simutanyi Mutasa, Kuda Chasekwa, Bernard Ntozini, Robert Kelly, Paul Prendergast, Andrew J Am J Clin Nutr Original Research Communications BACKGROUND: Children discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk of mortality, especially HIV-positive children. Few studies have examined mortality in the antiretroviral therapy (ART) era. OBJECTIVES: Our objectives were to ascertain 52-wk mortality in children discharged from hospital for management of complicated SAM, and to identify independent predictors of mortality. METHODS: A prospective cohort study was conducted in children enrolled from 3 hospitals in Zambia and Zimbabwe between July 2016 and March 2018. The primary outcome was mortality at 52 wk. Univariable and multivariable Cox regression models were used to identify independent risk factors for death, and to investigate whether HIV modifies these associations. RESULTS: Of 745 children, median age at enrolment was 17.4 mo (IQR: 12.8, 22.1 mo), 21.7% were HIV-positive, and 64.4% had edema. Seventy children (9.4%; 95% CI: 7.4, 11.7%) died and 26 exited during hospitalization; 649 were followed postdischarge. At discharge, 43.9% had ongoing SAM and only 50.8% of HIV-positive children were receiving ART. Vital status was ascertained for 604 (93.1%), of whom 55 (9.1%; 95% CI: 6.9, 11.7%) died at median 16.6 wk (IQR: 9.4, 21.9 wk). Overall, 20.0% (95% CI: 13.5, 27.9%) and 5.6% (95% CI: 3.8, 7.9%) of HIV-positive and HIV-negative children, respectively, died [adjusted hazard ratio (aHR): 3.83; 95% CI: 2.15, 6.82]. Additional independent risk factors for mortality were ongoing SAM (aHR: 2.28; 95% CI: 1.22, 4.25), cerebral palsy (aHR: 5.60; 95% CI: 2.72, 11.50) and nonedematous SAM (aHR: 2.23; 95% CI: 1.24, 4.01), with no evidence of interaction with HIV status. CONCLUSIONS: HIV-positive children have an almost 4-fold higher mortality than HIV-negative children in the year following hospitalization for complicated SAM. A better understanding of causes of death, an improved continuum of care for HIV and SAM, and targeted interventions to improve convalescence are needed. Oxford University Press 2021-01-20 /pmc/articles/PMC7948837/ /pubmed/33471057 http://dx.doi.org/10.1093/ajcn/nqaa346 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research Communications
Bwakura-Dangarembizi, Mutsa
Dumbura, Cherlynn
Amadi, Beatrice
Ngosa, Deophine
Majo, Florence D
Nathoo, Kusum J
Mwakamui, Simutanyi
Mutasa, Kuda
Chasekwa, Bernard
Ntozini, Robert
Kelly, Paul
Prendergast, Andrew J
Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia
title Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia
title_full Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia
title_fullStr Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia
title_full_unstemmed Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia
title_short Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia
title_sort risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in zimbabwe and zambia
topic Original Research Communications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948837/
https://www.ncbi.nlm.nih.gov/pubmed/33471057
http://dx.doi.org/10.1093/ajcn/nqaa346
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