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

Abstract

Background Mortality among children under five years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under five years of age admitted to the NRH for routine care of SAM. Methods This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14. Results: Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2% (95% CI 19.9-30.4%) died. In-hospital mortality was 20.7% (95% CI15.9-25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2-4.2), p=0.014), bacteraemia (AHR 9 (95% CI 3.4-23.0), p<0.001, and low glomerular filtration rate (eGFR), AHR 3.2; (95% CI 1.7-6.3), p=0.001). Conclusions A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have eGFR below 60 mL/min/1.73m 2 or have bacteraemia, are more likely to die. Further studies to explore the relationship between eGFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.

Survival and Predictors of Mortality among Severe Acute Malnourished under-five children admitted at Felege-Hiwot Comprehensive Specialized Hospital, Northwest, Ethiopia: A retrospective cohort study

“…This nding is consistent with studies done, in Uganda (14), in Egypt (27) and studies conducted in Ethiopia, Jimma university (17), Gondar university (4) and Gedio Zone (28). On the other hand, this nding is lower than a study done in South Africa (12) and other study in Uganda (15). The discrepancy might be due to high proportion of HIV positive cases, in South Africa, 43% were HIV infected and this in turn increases the mortality due to the complexity of the management and opportunist infections.…”

“…This might be due to the difference in methodology which was a prospective cohort in the previous study. As a result, it included patients discharge following against medical advice and prior co-morbidities, for example in Uganda of the children were HIVinfected (15).…”

“…The mortality rate due to SAM in Sub-Saharan Africa ranges from 9.8-46% (11)(12)(13)(14). Evidences indicated that the likely cause of high mortality rate could be HIV infection (11,15), lack of appetite, chest in drawing (14), co-morbidities and altered consciousness at admission (16,17).…”

Low generalizability of polygenic scores in African populations due to genetic and environmental diversity

“…Across traits, the differences in PRS accuracy across cohorts but within the same ancestry are much smaller than the differences across ancestries but within the UK Biobank, indicating that ancestry has a larger impact on genetic risk prediction than cross-cohort differences analyzed here. Smaller effects on genetic prediction accuracy differences across cohorts may be attributable to environmental differences, such as higher rates of malnutrition and infectious diseases previously reported in Uganda and in the GPC (Asiki et al, 2013; Nalwanga et al, 2020).…”

Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study

“…The mortality rate due to SAM in Sub-Saharan Africa ranges from 9.8 to 46% [11][12][13][14]. Evidences indicated that the likely cause of high mortality rate could be HIV infection [11,15], lack of appetite, chest in drawing [14], co-morbidities and altered consciousness at admission [13,16].…”