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Author Spotlight: A Multi-Depth Porcine Model for Comprehensive Study of Burn Injuries and Healing Processes
Published on: February 23, 2024
The effect of pre-existing malnutrition on pediatric burn mortality in a sub-Saharan African burn unit
Joanna Grudziak1, Carolyn Snock2, Stephen Mjuweni3
1Department of Surgery, University of North Carolina at Chapel Hill, United States; Kamuzu Central Hospital, Lilongwe, Malawi.
Insights
Malnutrition in children under five significantly increases burn mortality in sub-Saharan Africa. Aggressive nutritional support is crucial for improving survival rates in this vulnerable population.
Area of Science:
- Pediatric Burn Care
- Global Health
- Nutritional Epidemiology
Background:
- Nutritional status is a key predictor of burn outcomes in developed nations.
- In sub-Saharan Africa, burns disproportionately affect children, many of whom suffer from malnutrition.
- The impact of malnutrition on burn mortality in developing regions remains understudied.
Purpose of the Study:
- To determine the prevalence of malnutrition among pediatric burn patients in sub-Saharan Africa.
- To investigate the association between malnutrition and burn mortality in this population.
Main Methods:
- Retrospective review of pediatric patients (0-5 years) admitted to a burn unit (July 2011-May 2016).
- Calculation of age-adjusted Z-scores for height, weight, weight-for-height, and mid-upper arm circumference (MUAC).
- Logistic regression analysis to identify predictors of mortality, controlling for covariates.
Main Results:
- Of 839 pediatric patients analyzed, 16% experienced mortality.
- The average Z-score for malnutrition indicators was -1.45±1.66.
- Increased mortality was associated with higher Total Surface Area burned (TBSA), lower Z-scores (indicating malnutrition), and flame burns.
Conclusions:
- Preexisting malnutrition independently increases the odds of mortality in pediatric burn patients in sub-Saharan Africa.
- Improved survival comparable to developed countries necessitates aggressive nutritional support strategies for this population.
Introduction:
Nutritional status predicts burn outcomes in the developed world, but its effect on burn mortality in the developing world has not been widely studied. In sub Saharan Africa, burn is primarily a disease of children, and the majority of children in sub-Saharan Africa are malnourished. We therefore sought to determine the prevalence and effect of malnutrition on burn mortality at our institution.
Methods:
This is a retrospective review of children aged 0-5, with anthropomorphic measurements available, who were admitted to our burn unit from July 2011 to May 2016. Age-adjusted Z scores were calculated for height, weight, weight for height, and mid-upper arm circumference (MUAC). Following bivariate analysis, we used logistic regression to construct a fully adjusted model of predictors of mortality.
Results:
Of the 1357 admitted patients, 839 (61.2%) were aged 0-5. Of those, 512 (62.9%) had one or more anthropomorphic measurements available, and were included in the analysis. 54% were male, and the median age was 28 months. The median TBSA was 15%, with a majority of burns caused by scalds (77%). Mortality was 16%. Average Z-score for any of the indicators of malnutrition was -1.45±1.66. TBSA (OR: 1.08, 95% CI: 1.06, 1.11), decreasing Z-score (OR: 1.19, 95% CI: 1.00, 1.41), and flame burn (OR: 2.51, 95% CI: 1.40, 4.49) were associated with an increase in mortality.
Conclusion:
Preexisting malnutrition in burn patients in sub-Saharan Africa increases odds of mortality after controlling for significant covariates. Survival of burn patients in this region will not reach that of the developed world until a strategy of aggressive nutritional support is implemented in this population.
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