Clinical and growth outcomes of severely malnourished children following hospital discharge in a South African setting

Abstract

Background Data on outcomes of children with severe acute malnutrition (SAM) following treatment are scarce with none described from any upper-middle-income country. This study established mortality, clinical outcomes and anthropometric recovery of children with SAM six months following hospital discharge. Methods A prospective cohort study was conducted in children aged 3–59 months enrolled on discharge from two hospitals in the Tshwane district of South Africa between April 2019 and January 2020. The primary outcome was mortality at six months. Secondary outcomes included relapse rates, type(s) and frequency of morbidities experienced and the anthropometric changes in children with SAM following hospital discharge. Standard programmatic support included nutritional supplements. Results Forty-three children were enrolled with 86% of participants followed up to six months. Only a third of the participants had normal anthropometry at hospital discharge–a quarter still had ongoing SAM. There were no deaths, although four children (9%) were re-hospitalised including two for complicated SAM. Mean weight-for-length z-scores (WLZ) and wasting rates improved at one month but deteriorated by three months. At three months, six children (14%) either had ongoing or relapsed SAM–a SAM incidence rate of 20 per 1000 person-months despite more than half of the participants still receiving nutritional supplements at the time. Risk factors associated with persistent malnutrition at three months included a low WLZ on admission (relative risk [RR] 3.3, 95% confidence interval [95%CI] 1.2–9.2), being discharged from hospital before meeting WHO SAM treatment discharge criteria (RR 5.3, 95%CI 1.3–14.8) or having any illness by three months (RR 8.6, 95%CI 1.3–55.7). Conclusion Post-discharge mortality and morbidity was lower than in other less resourced settings. However, anthropometric recovery was poorer than expected. Modifying discharge criteria, optimising the use of available nutritional supplements and better integration with community-based health and social services may improve outcomes for children with SAM post-hospitalisation.

Outcome after Discharge from Hospital of Children with Complicated Severe Acute Malnutrition and Predictors Factors of Non-Response during Outpatient Treatment, in Senegal

“…In our study, delayed recovery was associated with ablactation before two years of age and the existence of pulmonary tuberculosis at admission. The existence of disease or infection during follow-up has been reported in Burkina Faso [20], South Africa [21], and Ethiopia [22].…”

The double burden of malnutrition in individuals: Identifying key challenges and re‐thinking research focus

“…While the global prevalence of stunted growth remains alarmingly high, there has been a gradual reduction in cases since 1990 (‘Reduce stunting | UNICEF Eastern and Southern Africa,’, n.d.). However, the same cannot be said for wasting and its severe forms, since instances of these conditions have persisted without substantial improvement, particularly in children hospitalised with SAM presenting with complications, where even with strict adherence to guidelines, mortality rates continue to exceed the recommended <5% indicated by the WHO protocols (Grimbeek & Saloojee, 2022; Karunaratne et al., 2020; Tickell & Denno, 2016). Within this latter group of malnourished children are those with multiple comorbidities, which adds to the complexity of care and increases the risk of poor outcomes (Munthali et al., 2015).…”