Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective cohort study from Kampala, Uganda

Nalwanga, Damalie; Musiime, Victor; Kizito, Samuel; Kiggundu, John Baptist; Batte, Anthony; Musoke, Philippa; Tumwine, James K

doi:10.1186/s12887-020-02094-w

Cited by 23 publications

(14 citation statements)

References 25 publications

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“…Malnutrition was the leading underlying cause of death among HIV-uninfected decedents but was more frequent in the causal chain of HIV-infected decedents as HIV disease with wasting syndrome or as morbid conditions. This finding is in line with recent studies from Asia and Uganda that reported increased mortality among HIV-infected children who have severe acute malnutrition [52,53]. The increased risk of death could be because of the synergistic immunosuppressive effects of both diseases rendering the child vulnerable to fatal infections.…”

Section: Discussionsupporting

confidence: 91%

Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya

Onyango

Akelo

Sande

et al. 2021

Aids

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Objectives: Describe the causes of death among infants and children less than 5 years stratified by HIV status.Design: Cross-sectional analysis of causes of death ascertained through minimally invasive tissue sampling (MITS) in the Kenya Child Health and Mortality Prevention Surveillance site. Methods:We included decedents aged 28 days to less than 5 years, whose death was reported within 36 h, underwent MITS, and had HIV test results and causes of death determined. MITS specimens were tested using Taqman Array Cards, culture, cytology, histopathology and immunohistochemistry and HIV PCR. A panel evaluated epidemiologic, clinical, verbal autopsy and laboratory data to assign causes of death using ICD-10 guidelines. Causes of death and etiological agents were stratified by HIV status.Results: Of 176 included decedents, 14% (n ¼ 25) were HIV-infected, median viral load was 112 205 copies/ml [interquartile range (IQR) ¼ 9349-2 670 143). HIV-disease (96%; n ¼ 24) and malnutrition (23%; n ¼ 34) were the leading underlying causes of death in HIV-infected and HIV-uninfected decedents, respectively. Malnutrition was more frequent in the causal chain of HIV-infected (56%; n ¼ 14) than HIV-uninfected decedents (31%; n ¼ 49) (P value ¼ 0.03). Viral pneumonia was twice as common in HIV-infected (50%; n ¼ 9) than HIV-uninfected decedents (22%; n ¼ 7) (P value ¼ 0.04). Conclusion:Nearly all HIV-infected decedents' underlying cause of death was HIV disease, which was associated with malnutrition. Our findings underscore the need for strengthening early identification and management of HIV-infected children. Prevention, early diagnosis and treatment of malnutrition could be instrumental in improving the survival of HIV-infected and HIV-uninfected children.

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Section: Discussionsupporting

confidence: 91%

Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya

Onyango

Akelo

Sande

et al. 2021

Aids

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“…The analysis also indicated the causes of malnutrition among different under-five age groups: aged 0-23 months who were not breastfed within 1 h of birth; did not continue breastfeeding up to 6 months; and who were not fed an acceptable diet during 6-23 months of age. These findings are comparable to the other studies that investigated the malnourishment in under-five children in urban households (Ahsan et al 2017;Billah et al 2017;Gavhi et al 2020;Nalwanga et al 2020). Concerning nutritional services use, the number of children [aged 6-23 months] consumed Micro-Nutrient Powder and the children [aged 0-59 months] screened for nutrition status at facility and community levels were lower (0.02 to 0.05) in our both study areas, and the rates were lowest in Kashimpur.…”

Section: Discussionsupporting

confidence: 85%

Status and utilization of child health and nutritional services among low-income urban households in Bangladesh

Islam

Hamiduzzaman

2021

SN Soc Sci

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The main aim of this study is to report the prevalence of Diarrhoea, Acute Respiratory Symptoms (ARS), and malnutrition in Bangladeshi among the low-income urban households' under-five children; and explore the health and nutritional services use and determine service gaps. The study used a quantitative research approach where a social survey was employed to collect data from 378 household heads (non-slum 228 and slum 152) through a structured interview method in Zone 5 (Kashimpur and Konabari) of the Gazipur City Corporation, Bangladesh. Results show that the overall prevalence of Diarrhoea and ARS was 13% and 50%, respectively. About 65% of diarrhoea-affected children did not intake Oral Rehydration Saline and continue food, and only 4% of mothers sought treatment from health facility for their ARS-affected children. Malnourishment was prevalent in different age groups: 0-6 months [Kashimpur: 75%; Konabari: 77%]; 0-23 months [Kashimpur: 58%; Konabari: 67%]; 6-23 months [Kashimpur: 70%; Konabari: 72%]. All Wards had a minimum of one health centre and staff number ranged from 1 to 15, but 86% of newborns had no health and nutrition check-ups. The study concludes by discussing challenges and proposing recommendations for targeted health literacy campaign and preventive care interventions.

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“…More recent studies, in 2013 and 2017, at the unit have reported an HIV prevalence among the severely malnourished children of 24 and 12%, respectively. In these studies, a much higher mortality was observed among the CLHIV (33 and 47%, respectively) than in the CHUU (5 and 22%, respectively) (4,10). The mortality rate among the CHEU in the 2017 study was 36% (4).…”

Section: Introductionmentioning

confidence: 85%

“…In these studies, a much higher mortality was observed among the CLHIV (33 and 47%, respectively) than in the CHUU (5 and 22%, respectively) (4,10). The mortality rate among the CHEU in the 2017 study was 36% (4). Mortality therefore was more similar in CHEU and CLHIV than in CHUU.…”

Section: Introductionmentioning

confidence: 85%

Strategies to Reduce Mortality Among Children Living With HIV and Children Exposed to HIV but Are Uninfected, Admitted With Severe Acute Malnutrition at Mulago Hospital, Uganda (REDMOTHIV): A Mixed Methods Study

et al. 2022

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BackgroundChildren living with HIV (CLHIV) and children who are exposed to HIV but uninfected (CHEU) are at increased risk of developing malnutrition. Severely malnourished children have high mortality rates, but mortality is higher in CLHIV/CHEU. This study aims to investigate whether empiric use of an antibiotic with greater antimicrobial sensitivity (ceftriaxone) than standard-of-care (ampicillin plus gentamicin) will reduce mortality among CLHIV/CHEU admitted with severe acute malnutrition.MethodsThis is an open label randomized controlled trial involving 300 children; 76 CLHIV and 224 CHEU. The participants are being randomized to receive 1 week of ceftriaxone (n = 150) or standard-of-care (ampicillin/gentamicin) (n = 150), in addition to other routine care. The trial's primary outcome is in-hospital mortality. Secondary outcomes are: length of hospitalization; weight-for-height, weight-for-age and height-for-age z-scores; and pattern/antimicrobial sensitivity of pathogens. In addition, 280 severely malnourished children of unknown serostatus will be tested for HIV at admission to determine the prevalence and factors associated with HIV-infection. Furthermore, all the CLHIV on LPV/r will each provide sparse pharmacokinetic (PK) samples to evaluate the PK of LPV/r among malnourished children. In this PK sub-study, geometric means of steady-state LPV PK parameters [Area Under the Curve (AUC) 0−12h, maximum concentration (Cmax) and concentration at 12 h after dose (C12h)] will be determined. They will then be put in pharmacokinetic-pharmacodynamic (PK-PD) models to determine optimal doses for the study population.DiscussionThis study will ascertain whether antibiotics with higher sensitivity patterns to common organisms in Uganda and similar settings, will produce better treatment outcomes. The study will also provide insights into the current pattern of organisms isolated from blood cultures and their antimicrobial sensitivities, in this population. In addition, the study will ascertain whether there has been a significant change in the prevalence of HIV-infection among children presenting with severe malnutrition in the WHO recommended option B plus era, while determining the social/structural factors associated with HIV-infection. There will also be an opportunity to study PK parameters of antiretroviral drugs among severely malnourished children which is rarely done, and yet it is very important to understand the dosing requirements of this population.Trial RegistrationClinicalTrials.gov, identifier: NCT05051163.

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Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective cohort study from Kampala, Uganda

Cited by 23 publications

References 25 publications

Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya

Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya

Status and utilization of child health and nutritional services among low-income urban households in Bangladesh

Strategies to Reduce Mortality Among Children Living With HIV and Children Exposed to HIV but Are Uninfected, Admitted With Severe Acute Malnutrition at Mulago Hospital, Uganda (REDMOTHIV): A Mixed Methods Study

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