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Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective

Damalie Nalwanga1, Victor Musiime2,3, Samuel Kizito4

  • 1Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda. damalielwanga@gmail.com.

BMC Pediatrics
|April 26, 2020
PubMed

Insights

Mortality among children with severe acute malnutrition (SAM) in Uganda remains high at 25.2%, despite reduced HIV prevalence. HIV infection, bacteraemia, and low estimated glomerular filtration rate (eGFR) are key factors associated with increased mortality in these children.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Public Health

Background:

  • High mortality rates persist among children under five admitted to malnutrition units in sub-Saharan Africa.
  • While HIV infection's impact on mortality in severe acute malnutrition (SAM) has decreased, anecdotal evidence suggests continued high mortality in routine care settings.
  • Uganda recently adopted revised World Health Organization (WHO) guidelines for SAM treatment, necessitating updated data on mortality.

Purpose of the Study:

  • To determine the magnitude of mortality among children under five admitted for routine care of SAM at Uganda's National Referral Hospital (NRH).
  • To identify factors associated with mortality in children with SAM receiving routine care.

Main Methods:

  • A cohort study was conducted involving all severely malnourished children admitted to the NRH between June and October 2017.
  • The primary outcome was two-week mortality, calculated using simple proportions.
  • Cox regression analysis identified factors associated with time to mortality; data were analyzed using Stata v14.

Main Results:

  • A total of 260 children completed two weeks of follow-up, with an overall mortality rate of 25.2%.
  • In-hospital mortality was 20.7%, and the prevalence of HIV infection was 12.2%.
  • Factors significantly associated with mortality included positive HIV status (AHR 2.2), bacteraemia (AHR 9), and low estimated glomerular filtration rate (eGFR) (AHR 3.2).

Conclusions:

  • A 25% mortality rate in children with SAM is unacceptably high, even with reduced HIV prevalence.
  • Children with SAM who are HIV-infected, have bacteraemia, or an eGFR below 60 mL/min/1.73m² face a higher risk of death.
  • Further research on the eGFR-mortality relationship and effective antibiotic treatments for SAM is urgently needed to inform clinical guidelines.
Abstract

Keywords:
ChildrenMortalitySevere acute malnutritionUganda

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