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Mortality risk in infants receiving therapeutic care for malnutrition: A secondary analysis
Imteaz Mahmud1,2,3, Benjamin Guesdon4, Marko Kerac1
1Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Insights
Multiple anthropometric deficits, including wasting and underweight, are common in infants under six months. Severely wasted and underweight infants, and male infants, face higher mortality risks in therapeutic care.
Area of Science:
- Nutritional Science
- Pediatrics
- Global Health
Background:
- Infants under six months (<6 months) are highly vulnerable to mortality.
- Identifying at-risk infants requires better evidence on anthropometric indicators.
- Existing nutritional assessments may not fully capture combined risks.
Purpose of the Study:
- To determine the association between anthropometric deficits and mortality in infants <6 months.
- To evaluate the prevalence and severity of single and multiple anthropometric failures.
- To assess the utility of anthropometric indicators for inpatient therapeutic care admission and prognosis.
Main Methods:
- Secondary analysis of data from 5034 infants <6 months across 12 countries (2002-2008).
- Estimation of prevalence, concurrence, and severity of underweight, wasted, and stunted.
- Utilized the Composite Index of Anthropometric Failure (CIAF) and logistic regression to analyze mortality associations.
Main Results:
- High prevalence of underweight (95.8%), wasting (82.8%), stunting (77.8%), and CIAF (96.8%) among infants with complete data.
- Infants with multiple deficits exhibited more severe anthropometric impairments.
- Severely wasted and underweight infants, and male infants, had significantly higher odds of inpatient mortality.
Conclusions:
- Multiple anthropometric deficits (CIAF) are prevalent in infants <6 months and should be reported in nutrition programs.
- Weight-for-length/height and weight-for-age z-scores are valuable for program admission and prognosis.
- Male infants are at higher risk of mortality during malnutrition treatment, necessitating timely, evidence-based care.
Abstract:
Small and nutritionally at-risk infants aged under 6 months (<6 months) are at high risk of death, but important evidence gaps exist on how to best identify them. We aimed to determine associations between anthropometric deficits and mortality among infants <6 months admitted to inpatient therapeutic care. A secondary analysis of 2002-2008 data included 5034 infants aged <6 months from 12 countries. We estimated the prevalence, concurrence, and severity of wasted, stunted, and underweight, as stand-alone indicators, and using the Composite Index of Anthropometric Failure (CIAF), which combines these indicators into six subgroups of single and multiple anthropometric deficits and into one combined indicator called CIAF. We used logistic regression to examine the association of different anthropometric deficits with in-programme mortality. Among 3692 infants aged <6 months with complete data, 3539 (95.8%) were underweight, 3058 (82.8%) were wasted, 2875 (77.8%) were stunted and 3575 (96.8%) had CIAF. Infants with multiple anthropometric deficits were presented with significantly lower anthropometric indices, that is, they were more severely wasted, stunted and underweight. A total of 141 infants died during inpatient therapeutic care. Among these, severely wasted (116) and severely underweight (138) infants had higher odds of mortality than normal infants (odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.2-2.7, p = 0.009, and OR = 3.3, 95% CI: 0.8-13.6, p = 0.09, respectively). Boys had higher odds of inpatient mortality than girls (OR = 1.40, 95% CI: 1.02-1.92, p = 0.03). Mortality was only observed in infants <6 months presenting multiple anthropometric deficits, although their odds of mortality were not significant, for example, OR = 2.4, 95% CI: 0.5-10.0, p = 0.21 for stunted, wasted and underweight infants <6 months. In conclusion, multiple anthropometric deficits (CIAF) is common among infants <6 months and may be reported in nutrition care programmes and surveys. Both weight-for-length/height z-score and weight-for-age z-score were found to be useful indicators for programme admission and in-programme prognosis. Future work needs to explore which better accounts for admission bias. Boys appear to be most at-risk of dying while receiving malnutrition therapeutic care. Programmes should ensure that all infants receive timely, evidence-based, effective care.
