Social, dietary and clinical correlates of oedema in children with severe acute malnutrition: a cross-sectional study

Abstract

BackgroundSevere acute malnutrition is a serious public health problem, and a challenge to clinicians. Why some children with malnutrition develop oedema (kwashiorkor) is not well understood. The objective of this study was to investigate socio-demographic, dietary and clinical correlates of oedema, in children hospitalised with severe acute malnutrition.MethodsWe recruited children with severe acute malnutrition admitted to Mulago Hospital, Uganda. Data was collected using questionnaires, clinical examination and measurement of blood haemoglobin, plasma c-reactive protein and α1-acid glycoprotein. Correlates of oedema were identified using multiple logistic regression analysis.ResultsOf 120 children included, 77 (64%) presented with oedematous malnutrition. Oedematous children were slightly older (17.7 vs. 15.0 months, p = 0.006). After adjustment for age and sex, oedematous children were less likely to be breastfed (odds ratio (OR): 0.19, 95%-confidence interval (CI): 0.06; 0.59), to be HIV-infected (OR: 0.10, CI: 0.03; 0.41), to report cough (OR: 0.33, CI: 0.13; 0.82) and fever (OR: 0.22, CI: 0.09; 0.51), and to have axillary temperature > 37.5°C (OR: 0.28 CI: 0.11; 0.68). Household dietary diversity score was lower in children with oedema (OR: 0.58, CI: 0.40; 85). No association was found with plasma levels of acute phase proteins, household food insecurity or birth weight.ConclusionChildren with oedematous malnutrition were less likely to be breastfed, less likely to have HIV infection and had fewer symptoms of other infections. Dietary diversity was lower in households of children who presented with oedema. Future research may confirm whether a causal relationship exists between these factors and nutritional oedema.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0341-8) contains supplementary material, which is available to authorized users.

Paediatric HIV testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis

“…7 Paediatric inpatient programmes were the most common context (17), 6,7,10,[13][14][15][16][17][18][19][21][22][23][24][25]29,30 followed by nutrition centres (four), 9,11,12,27 EPI centres (three), 20 programmes (three). 8,20,31 The assessment for quality showed that most of the included studies (20) [9][10][11][12][15][16][17][18][19][20][22][23][24][25][26][27][28][29][30][31] were of fair or good quality and the remainder (six) [6][7][8]13,…”

“…We did a stratifi ed analysis of paediatric HIV prevalence in southern and eastern Africa (20 studies) 8,[10][11][12][13][14][15][16][17][18][19][20][21][22][24][25][26][27]28,29 versus that in west and central Africa (four). 9,23,28,31 Paediatric HIV prevalence across contexts in southern and eastern Africa was 17·8% (95% CI 12·8-22·7) and prevalence in west and central Africa was 9·8% (95% CI 4·2-15·3).…”

Characterization and scoring of skin changes in severe acute malnutrition in children between 6 months and 5 years of age

“…BED was the only skin sign exclusively observed among oedematous patients in our cohort, but there was a strong tendency also pointing towards LSC and ISC as oedema‐specific signs. Other details on oedema and its relation to clinical characteristics in the study group, has been presented in another article related to the FeedSAM study …”

“…Other details on oedema and its relation to clinical characteristics in the study group, has been presented in another article related to the FeedSAM study. 16 Telogenic effluvium The children in our cohort had various grades of telogenic effluvium combined with depigmentation and/or straightening of the curls. The flag sign, where the nutritional status of a child over time is reflected through light bands in the hair, was only observed in four cases.…”

Clinical spectrum of severe acute malnutrition among children admitted to nutritional rehabilitation centre of a tertiary care hospital with special reference to incidence of bilateral pitting pedal oedema in children with severe acute malnutrition

“…Although various explanations are given for pathophysiology of oedema in malnutrition, mortality still remains high in children with oedematous malnutrition, but little is known about burden of oedematous malnutrition and few large-scale surveys are yet to measure it. 8,9 This study was intended to study the clinical correlates with severe acute malnutrition and to know the incidence of oedematous malnutrition among children with severe acute malnutrition.…”