Comorbidities and Factors Associated with Mortality among Children under Five Years Admitted with Severe Acute Malnutrition in the Nutritional Unit of Jinja Regional Referral Hospital, Eastern Uganda

Abstract

Background. Mortality among children with severe acute malnutrition remains an immense health concern in the hospitals in developing countries, but its attributes are not completely assessed in various hospital settings. The aim of this study was to determine the proportion of mortality, the comorbidities, and factors associated with in-hospital mortality among children under five years of age admitted with severe acute malnutrition at Jinja Regional Referral Hospital, Eastern Uganda. Methods. This was a hospital-based analytical and descriptive prospective cohort study conducted in the nutritional unit of Jinja Regional Referral Hospital. A total of 338 children and their caretakers who met the criteria were consecutively enrolled into the study. Descriptive statistics were used to each of the independent factors, and comorbidities were subjected to chi-squared test followed by logistic regression analysis to assess its association incidence of mortality among children. All independent variables with p values ≤ 0.05 were entered into a multivariate model for factors and comorbidities independently. Factors and comorbidities with p values ≤ 0.05 were considered as associates of mortality among children. Results. Of the 338 children under 5 years of age enrolled, 49 (14.5%) died, although the majority of children were diagnosed with dehydration, 128 (37.9%); pneumonia, 127(37.6%); and malaria, 87(25.7%). Anemia ( aRR = 2.9 , 95% CI: 1.23-6.62, p = 0.01 ), bacteremia ( aRR = 10.0 , 95% CI: 3.62-29.01, p = 0.01 ), HIV ( aRR = 4.8 , 95% CI: 1.42-16.30, p < 0.01 ), TB ( aRR = 4.3 , 95% CI: 1.28-14.49, p < 0.02 ), and shock ( aRR = 60.9 , 95% CI: 9.05-410.28, p < 0.01 ) were the comorbidities significantly associated with a likelihood of mortality. Conclusions. The mortality among children under 5 years of age admitted with severe acute malnutrition is still high (14.5% versus 5%). The comorbidities are significantly associated with mortality. The clinicians are recommended to follow-up closely patients with severe acute malnutrition and to focus on the critical comorbidities identified.

Morbidity and mortality profile of children admitted in pediatric department – A single center study

“…Desire B et al reported malnutrition is significantly associated with mortality in less than five years children. 21 Vaccine preventable diseases are still prevalent in community as reported in current study. It suggests that immunization is still lagging behind expectations.…”

Determinants of Mortality Among Severely Malnourished Children in Northern Nigeria

“…Similar outcomes of complicated SAM were reported in Egypt, 34 in South Africa, 35 and Uganda. 36 Diarrhea was the most common comorbidity in patients at the CMAM centers. Treatment outcomes of patients without diarrhea are better than those with diarrhea.…”

Incidence and predictors of severe acute malnutrition mortality in children aged 6–59 months admitted at Pawe general hospital, Northwest Ethiopia

“…Other factors that may be important in our setting include serving a poor pastoralist community, delayed presentation, lack of maternal participation in feeding programs, over prescription of intravenous therapies, early discontinuation of treatment due to insufficient financial means [2], and poor adherence of WHO SAM treatment guidelines [11,30]. One study from Uganda also identified WHO defined danger signs on admission, namely, lethargy, hypoglycemia, hypothermia, bradycardia, capillary refill > 2 seconds, weak pulse volume and impaired level of consciousness [12]. We did not record these clinical details nor did we collect data on biochemical indices and the socioeconomic status of caregivers.…”

“…Despite the availability of outpatient treatment, 50% of SC admitted children with SAM die due to inappropriate care [10] and one important reason is poor adherence to SAM therapeutic guidelines [11]. Other factors include the presence of danger signs seen in sicker children like lethargy, hypoglycemia and hypothermia as well as bradycardia, capillary refill > 2 seconds, weak pulse volume and impaired level of consciousness [12].…”