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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...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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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. |
format | Online Article Text |
id | pubmed-7948837 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
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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