TY - JOUR
T1 - Predictors of mortality among hospitalized children with severe acute malnutrition
T2 - a prospective study from Uganda
AU - Nabukeera-Barungi, Nicolette
AU - Grenov, Benedikte
AU - Lanyero, Betty
AU - Namusoke, Hanifa
AU - Mupere, Ezekiel
AU - Christensen, Vibeke Brix
AU - Michaelsen, Kim F
AU - Mølgaard, Christian
AU - Rytter, Maren Johanne
AU - Friis, Henrik
PY - 2018/7
Y1 - 2018/7
N2 - BACKGROUND: We determined the predictors of mortality among children admitted with severe acute malnutrition (SAM).METHODS: This was a prospective study nested in a randomized trial among 6-59-month-old children admitted with SAM. Socio-demographic and medical history data were collected using questionnaires and clinical examination, anthropometry and laboratory tests were performed. They were monitored daily until discharge or death during hospitalization while receiving care according to national guidelines. Predictors of death were assessed using Cox regression.RESULTS: Of 400 children, 9.8% (n = 39) died during hospitalization. Predictors of mortality included diarrhoea at admission [hazard ratio [HR] 2.19, 95% confidence interval (CI): 1.06; 4.51], lack of appetite [HR 4.50, 95% CI: 1.76; 11.50], suspected sepsis [HR 2.23, 95% CI: 1.18; 4.24] and skin ulcers [HR 4.23, 95% CI: 1.26; 4.17]. Chest indrawing [HR 5.0, 95% CI: 1.53; 16.3], oxygen saturation below 94% [HR 3.92, 95% CI: 1.42; 10.83] and confirmed HIV infection [HR 3.62, 95% CI: 1.69; 7.77] also predicted higher mortality.CONCLUSION: Infections were major contributors to mortality. This underscores the need for improved prevention and management of these infections among children with severe malnutrition.
AB - BACKGROUND: We determined the predictors of mortality among children admitted with severe acute malnutrition (SAM).METHODS: This was a prospective study nested in a randomized trial among 6-59-month-old children admitted with SAM. Socio-demographic and medical history data were collected using questionnaires and clinical examination, anthropometry and laboratory tests were performed. They were monitored daily until discharge or death during hospitalization while receiving care according to national guidelines. Predictors of death were assessed using Cox regression.RESULTS: Of 400 children, 9.8% (n = 39) died during hospitalization. Predictors of mortality included diarrhoea at admission [hazard ratio [HR] 2.19, 95% confidence interval (CI): 1.06; 4.51], lack of appetite [HR 4.50, 95% CI: 1.76; 11.50], suspected sepsis [HR 2.23, 95% CI: 1.18; 4.24] and skin ulcers [HR 4.23, 95% CI: 1.26; 4.17]. Chest indrawing [HR 5.0, 95% CI: 1.53; 16.3], oxygen saturation below 94% [HR 3.92, 95% CI: 1.42; 10.83] and confirmed HIV infection [HR 3.62, 95% CI: 1.69; 7.77] also predicted higher mortality.CONCLUSION: Infections were major contributors to mortality. This underscores the need for improved prevention and management of these infections among children with severe malnutrition.
KW - Anthropometry
KW - Bifidobacterium animalis
KW - Child
KW - Child, Hospitalized
KW - Child, Preschool
KW - Diarrhea/complications
KW - Female
KW - HIV Infections/complications
KW - Hospitalization/statistics & numerical data
KW - Humans
KW - Infant
KW - Lactobacillus rhamnosus
KW - Male
KW - Prevalence
KW - Probiotics/therapeutic use
KW - Proportional Hazards Models
KW - Prospective Studies
KW - Sepsis/complications
KW - Severe Acute Malnutrition/complications
KW - Skin Ulcer/complications
KW - Surveys and Questionnaires
KW - Uganda/epidemiology
U2 - 10.1038/s41390-018-0016-x
DO - 10.1038/s41390-018-0016-x
M3 - Article
C2 - 29795207
SN - 0031-3998
VL - 84
SP - 92
EP - 98
JO - Pediatric Research
JF - Pediatric Research
IS - 1
ER -