Contribution of Dehydration and Malnutrition to the Mortality of Children 0-59 Month of Age in a Senegalese Pediatric Hospital

Abstract

In-hospital mortality is an indicator of the quality of care. We analyzed the mortality of under five years children of Pediatric ward of Aristide Le Dantec teaching hospital to update our data, after an previous study conducted ten years earlier. Methods: This was a retrospective study involving children 0-59 months of age, hospitalized from January 1, 2012 to December 31, 2012. For each child, nutritional status was assessed according to 2006 World Health Organization growth standards; clinical and biological data were recorded. The outcome of the disease was specified. Bivariate and multivariable were used to identify risk factors for death. Results: 393 children were included. Overall mortality rate was 10% (39/393). Factors associated with death were severe wasting [OR = 8.27, 95% CI [3.79-18], male gender (OR = 2.98, 95% CI [1.25-7.1]), dehydration (OR = 5.4, 95% CI [2.54-13.43]) in the model using the weight-for-height z score, male gender (OR = 2.5, 95% CI [1.11-5.63]), dehydration (OR = 8.43, 95% CI [3.83-18.5]) in using the height-forage z score, male gender (OR = 2.7, 95% CI [1.19-6.24]), dehydration (OR = 7.5, 95% CI [3.39-16.76]), severe underweight (OR = 2.4, 95% CI [1.11-5.63]), in the model using the weight-forage z score, and male gender (OR = 2.5, 95% CI [1.11-5.63]), dehydration (OR = 8.43, 95% CI [3.83-18.5]) in that using MUAC. Dehydration and malnutrition are two independent factors of mortality. Our management protocols of dehydration and malnutrition have to be updated. Screening malnutrition has to be done systematically for each child by anthropometric measurements using WHO growth standards.

Factors associated with hospital mortality of children aged 1 to 60 months in Guédiawaye, Senegal

“…The hospital mortality found in this study seems low compared to those found in Dakar (10%), Ivory Coast (10.64%) and Togo (15.6%) [3,4,5] . This mortality was higher for the 1 to 12 month age group (68.18%) with a statistically significant link (p<0.001 and 0R=5.33).…”

“…Acute malnutrition was statistically associated with death with p=0.007 and OR=3.37. Seck and Sylla found in their studies that malnutrition was the main factor in mortality in children less than 5 years of age (31%) [3,7] , whereas Asse et al in Ivory Coast found that malnutrition accounted for only 1% of deaths [4] . Severe acute malnutrition, through its complications, is still a major public health problem and is an independent risk factor for death in hospitalized Senegalese children [3] .…”

“…Seck and Sylla found in their studies that malnutrition was the main factor in mortality in children less than 5 years of age (31%) [3,7] , whereas Asse et al in Ivory Coast found that malnutrition accounted for only 1% of deaths [4] . Severe acute malnutrition, through its complications, is still a major public health problem and is an independent risk factor for death in hospitalized Senegalese children [3] . Deficiency malnutrition is associated directly or indirectly with one third of child deaths in Senegal, compared to 45% of such deaths worldwide [6] .…”