Factors Associated with Mortality Among Children Under Five Hospitalized with Severe Acute Malnutrition in Selected Provinces of Zambia: A Retrospective Review of Hospital Records

Abstract

Background: Malnutrition continues to take the lives of millions of children every year. Children under the age of five years are especially susceptible to high rates of malnutrition and more than half of the deaths in under five children are caused by undernutrition in low- and middle-income countries. Zambia continues to have one of the highest rates of malnutrition in Southern Africa, specifically Severe Acute Malnutrition (SAM). The country’s prevalence of under-five malnutrition is above the WHO Public Health threshold which may linked to the observed under-mortality. In this study, we assessed the factors associated with under-5 mortality in children with SAM. Methods: This was a cross-sectional study assessing the factors associated with under-5 mortality in children hospitalized with severe acute malnutrition. The study used data from a cross-sectional study which was assessing factors associated with SAM in under-5 children in five underperforming provinces of Zambia. In this study, we reviewed hospital records from 2014 to 2016 and recorded length of hospital stay, co-morbidities, and death among under-5 children presenting with SAM to select level-one hospitals. Stata version 13 was used for analysis. We conducted both descriptive and bivariate logistic regression to assess the association between mortality and select key factors. Results: We found that over half of the records we extracted listed SAM as the main cause of hospital stay. About one-fourth of under-5 children (24%) were recorded as being HIV positive at time of hospital stay. Malnourished under-5 children who were diagnosed as HIV positive were 3.5 times more likely to die than malnourished under-5 children who were HIV negative.Conclusions: Malnutrition continues to be a problem in Zambia. Undernourished children with existing co-morbidities such as HIV are at greater risk for mortality and poor health outcomes. To combat high rates of SAM, continued efforts are needed to provide adequate nutrition services and care especially in rural areas of Zambia.