Determinants of mortality among under-five children admitted with severe acute malnutrition in Addis Ababa, Ethiopia
Zebenay Workneh Bitew1, Ermias Getaneh Ayele2, Teshager Worku3
1St. Paul's Hospital Millennium Medical College, P.O. Box 1271, Addis Ababa, Ethiopia. zedo2015@gmail.com.
Insights
Severe acute malnutrition (SAM) in Ethiopian children has a 5.6% mortality rate. Shock and IV fluid infusion increased death risk, while F100 and zinc supplementation reduced it.
Area of Science:
- Pediatrics
- Public Health
- Global Health
Background:
- Severe acute malnutrition (SAM) is a major cause of mortality in Ethiopian children under five.
- Despite program priorities, effective management strategies for SAM remain critical.
Purpose of the Study:
- To determine the incidence density rate of mortality among children with SAM.
- To identify key determinants of death in under-five children with SAM.
Main Methods:
- Retrospective cohort study analyzing 610 patient charts from 2012-2019.
- Kaplan-Meier survival analysis and Cox proportional hazard regression models were used.
- Statistical methods assessed survival time and identified predictors of mortality.
Main Results:
- The incidence density rate of death was 5.6 per 1000 child-days (10% overall mortality).
- Shock (AHR=3.2) and IV fluid infusion (AHR=5.2) significantly increased mortality risk.
- F100 (AHR=0.12) and zinc supplementation (AHR=0.45) were associated with decreased mortality.
Conclusions:
- Mortality rates align with Sphere standards and national protocols.
- Clinical management of shock and IV fluid administration requires careful attention.
- Nutritional interventions like F100 and zinc are crucial for reducing SAM-related deaths.
Background:
Management of severe acute malnutrition (SAM) has been a program priority in Ethiopia, but it remains the leading cause of mortality in under-five children. Hence, this study aimed to identify the incidence density rate of mortality and determinants among under-five children with severe acute malnutrition in St. Paul's Hospital Millennium Medical College, 2012 to 2019.
Methods:
A retrospective cohort study was conducted and data were collected using a structured checklist from 673 charts, of which 610 charts were included in the final analysis. The Kaplan-Meier survival curve with Log-rank test was used to estimate the survival time. Bi-variable and multi-variable Cox proportional hazard regression models were fitted to identify determinants of death. Schoenfeld residuals test was used to check a proportional hazard assumption. Goodness of fit of the final model was checked using Nelson Aalen cumulative hazard function against Cox-Snell residual.
Results:
In this study, 61 (10%) children died making the incidence density rate of death 5.6 (95% CI: 4.4, 7.2) per 1000 child-days. Shock (Adjusted Hazard Ratio) [AHR] =3.2; 95% CI: 1.6, 6.3)), IV fluid infusion (AHR = 5.2; 95% CI: 2.4, 10.4), supplementing F100 (AHR = 0.12; 95%CI: 0.06, 0.23) and zinc (AHR = 0.45; 95% CI: 0.22, 0.93) were determinants of death.
Conclusion:
The overall proportion of deaths was within the range put forth by the Sphere standard and the national SAM management protocol. Shock and IV fluid infusion increased the hazard of death, whereas F100 & zinc were found to decrease the likelihood death. Children with SAM presented with shock should be handled carefully and IV fluids should be given with precautions.
Related Concept Videos
01:28Anorexia Nervosa
Symptoms and Physical Effects
Individuals with anorexia nervosa commonly exhibit extreme...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:15Assumptions of Survival Analysis
01:18Factors Affecting Illness
For instance, risk factors are connected to illness,...
01:29Drug Dosing: Infants and Children