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Risk factors for mortality in under-five children with complicated severe acute malnutrition at Woldia Comprehensive

Netsanet Fentahun Moges1, Atitegeb Abera Kidie1, Fentaw Wassie Feleke2,3

  • 1Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia.

BMJ Open
|August 11, 2026
PubMed

Insights

Inpatient mortality in under-five children with complicated severe acute malnutrition (cSAM) is linked to factors like nutritional edema, bottle feeding, vomiting, pale conjunctiva, shock, and lack of vaccination. Improving vaccination coverage and cSAM protocols can reduce deaths.

Area of Science:

  • Pediatrics
  • Public Health
  • Nutrition

Background:

  • Complicated severe acute malnutrition (cSAM) poses a significant threat to under-five children globally.
  • Identifying specific risk factors for inpatient mortality in cSAM is crucial for targeted interventions.

Purpose of the Study:

  • To determine the independent predictors of inpatient mortality among children under five admitted with cSAM.
  • To inform strategies for reducing mortality in this vulnerable population.

Main Methods:

  • A hospital-based unmatched case-control study was conducted.
  • Data from 588 medical records (147 cases, 441 controls) were analyzed using logistic regression.
  • Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (CIs) were calculated.

Main Results:

  • Independent predictors of mortality included grade I nutritional edema, history of bottle feeding, vomiting, pale conjunctiva, shock, and no vaccination history.
  • Intravenous fluid administration was also associated with increased mortality risk.
  • Children in the initial treatment phase had significantly lower odds of death.

Conclusions:

  • Bottle feeding, specific clinical signs (nutritional edema, pale conjunctiva, shock), and lack of vaccination are key predictors of mortality in cSAM.
  • Adherence to cSAM management protocols and enhanced routine immunization programs are recommended to decrease inpatient mortality.
Abstract

Keywords:
EthiopiaMortalityNUTRITION & DIETETICSNutritional support

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