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Mortality in severe protein-energy malnutrition at Nchelenge, Zambia
H B Gernaat1, W H Dechering, H W Voorhoeve
1Regional Institute of Community Mental Health Care, Division Meppel, The Netherlands.
Insights
Severe malnutrition in children under five is a major concern. Early antibiotic use significantly reduces mortality, especially in cases of pneumonia and dehydration.
Area of Science:
- Pediatrics
- Public Health
- Nutrition Science
Background:
- Protein-energy malnutrition (PEM) is a critical health issue in developing countries.
- High mortality rates are associated with severe and complicated PEM in children.
Purpose of the Study:
- To monitor clinical management of severe PEM in children under five.
- To analyze predictors of mortality in severe PEM cases.
- To identify effective interventions for reducing PEM-related fatalities.
Main Methods:
- A prospective study monitored 299 children under five with severe PEM at St Paul's Hospital, Zambia.
- PEM was classified using a modified Wellcome classification.
- Mortality predictors were analyzed based on age groups and clinical factors.
Main Results:
- Overall mortality was 25.8%, with higher rates for marasmic kwashiorkor (28.0%) and untyped PEM (48.3%).
- In children under 18 months, mortality predictors included dehydration, pneumonia, infectious disorders, severe stunting, and low mid-upper arm circumference.
- Pneumonia was the primary mortality predictor in children aged 19-60 months.
Conclusions:
- Early and routine administration of broad-spectrum antibiotics is crucial for reducing mortality in severe PEM.
- Addressing infectious complications like pneumonia and dehydration is vital for improving outcomes.
- Interventions should focus on early detection and management of severe malnutrition and associated infections.
Abstract:
At St Paul's Hospital, Nchelenge district, north-eastern Zambia, routine clinical management of 299 children up to 5 years of age with severe and/or complicated protein-energy malnutrition (PEM) was monitored and predictors of outcome analysed. PEM was typed according to a modified Wellcome classification. Overall mortality was 25.8 per cent with 13.4 per cent for kwashiorkor, 17.8 per cent for marasmus, 28.0 per cent for marasmic kwashiorkor, and 48.3 per cent for untyped cases of PEM. Mortality up to 18 months of age was related to the presence of dehydration, pneumonia or another infectious disorder, severe stunting, and a mid-upper arm circumference < or = 104 mm, suggesting that these children may have been born pre- and/or dysmaturely. At ages 19-60 months, the main predictor of mortality was pneumonia, with other infectious disorders and dehydration showing less impact. Routine administration of broad-spectrum antibiotics, irrespective of clinical signs of infection, is most probably the single most effective measure to reduce the high case-fatality rate due to PEM in developing countries.