Risk factors for death in children during inpatient treatment of severe acute malnutrition: a prospective cohort study ,

Rytter, Maren Johanne Heilskov; Babirekere-Iriso, Esther; Namusoke, Hanifa; Christensen, Vibeke Brix; Michaelsen, Kim F.; Ritz, Christian; Mortensen, Charlotte; Mupere, Ezekiel; Friis, Henrik

doi:10.3945/ajcn.116.140822

Cited by 42 publications

(61 citation statements)

References 28 publications

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“…Age, diarrhoea, hypoglycaemia, hypothermia, electrolyte imbalance, pneumonia and oral thrush were not associated with mortality in this cohort of children with SAM.This mortality is similar to the 24% recorded by Bachou et al over ten years earlier among patients receiving the standard of care at Mulago hospital[5]. However, the mortality recorded in this study is much higher than that reported by more recent studies conducted in elected populations: 14% in 2017 and 9.8% in 2018 by Rytter et al and Nabukeera et al respectively[6,7]. Our observational study included all severely malnourished children receiving routine care.…”

supporting

confidence: 82%

“…The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. *N=Number of participants in each category whose outcome was known, 7 One of the HIV positive patients was lost to follow One of the HEU children was lost to follow up The Kaplan Meier survival curve for children with and without HIV…”

Section: Availability Of Data and Materialsmentioning

confidence: 99%

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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

Nalwanga¹,

Musiime

Kizito

et al. 2020

Preprint

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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/1.73m2 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.

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supporting

confidence: 82%

Section: Availability Of Data and Materialsmentioning

confidence: 99%

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

Nalwanga¹,

Musiime

Kizito

et al. 2020

Preprint

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“…Hypophosphatemia was more common in those failing the weight‐independent appetite test, but it has been argued that phosphate levels are a more relevant predictor for outcome when measured after initiation of treatment . Although the appetite test was correlated with reduced calcium levels, this could be confounded by the fact that we did not test the appetite in children with convulsions or lethargy.…”

Section: Discussionmentioning

confidence: 93%

“…As an alternative to the appetite test, the Integrated Management of Childhood Illnesses (IMCI) guidelines recommend using a list of medical complications as part of an algorithm to identify children with SAM in need of hospitalisation. To our knowledge, this IMCI algorithm has never been evaluated, although studies have assessed the prognostic value of some of the clinical signs and symptoms included in it . This set of medical complications tended to indicate a lower weight gain during follow‐up and to be associated with abnormal biochemistry results at admission.…”

Section: Discussionmentioning

confidence: 99%

Critical evaluation of the appetite test for children with severe acute malnutrition

Zangenberg

Abdissa

Johansen

et al. 2020

Tropical Med Int Health

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objectives The appetite test is used to risk stratify for children with severe acute malnutrition (SAM) in inpatient or outpatient care. The test is recommended in guidelines despite lack of evidence. We evaluated its ability to identify children at risk of a poor treatment outcome.methods We conducted an observational study of children diagnosed with SAM at three health facilities in Ethiopia. The appetite test was done independently, and the result did not affect decisions about hospitalisation and clinical care. Data were analysed using mixed linear and logistic regression models.results Appetite was tested in 298 (89%) of 334 children enrolled; 56 (19%) passed. Children failing the appetite test had a 6.6% higher weight gain per day (95% CI: 2.6, 10.8) adjusted for type of treatment, oedema, duration of follow-up and age than children passing the test. We found medical complications in 179 (54%) children. Medical complications were associated with blood markers of metabolic disturbance. Children with medical complications tended to have lower weight gain than those without complications (3.5%, 95% CI: À0.25, 7.0). Neither the appetite test nor medical complications were correlated with bacteraemia or treatment failure.conclusions Our findings question the use of the appetite test to identify children who need inpatient care. An assessment of medical complications alone could be a useful risk indicator but needs to be evaluated in other settings.keywords severe acute malnutrition, appetite, community management, risk assessment, therapeutic foods Sustainable Development Goals (SDGs): SDG 2 (zero hunger), SDG 3 (good health and well-being), SDG 17 (partnerships for the goals)

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“…This refeeding oedema seems to be a part of the so called refeeding syndrome with a significant mortality in highly developed medical systems but most of all in starved children in the developing world [2]. The metabolic disturbances of the refeeding syndrome are well understood and investigated.…”

Section: Editorialmentioning

confidence: 99%

Propranolol is Highly Effective to Treat Refeeding Oedema in a Girl with Anorexia Nervosa - A Case Report

Buchhorn¹

2017

Ann Nutr Disord & Ther

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Risk factors for death in children during inpatient treatment of severe acute malnutrition: a prospective cohort study ,

Cited by 42 publications

References 28 publications

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

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

Critical evaluation of the appetite test for children with severe acute malnutrition

Propranolol is Highly Effective to Treat Refeeding Oedema in a Girl with Anorexia Nervosa - A Case Report

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