Mortality is still high among children with severe acute malnutrition who require hospitalization. This study investigated the factors independently related to the mortality among hospitalized children with severe acute malnutrition. A cross-sectional study was conducted in a single tertiary referral hospital in Bali, Indonesia from January 2017 to December 2018. A logistic regression test was used to analyze the factors independently related to mortality. Significantly differences were considered if P-value less than 0.05. A total of 138 children with severe acute malnutrition was fulfilled the study criteria, 83 children (60.1%) were male, 79 children (57.2%) were a toddler and 133 children (96.4%) were classified as marasmus. The mortality was found in 60 children (43.4%). On multivariate logistic regression analysis found anemia (aOR 8.6, 95%CI: 2.4 to 30.5, P = 0.001) and metabolic acidosis (aOR 3.4, 95%CI: 1.3 to 9.1, P = 0.01) were statistically significant. It can be concluded that the mortality rate among children with severe acute malnutrition is still high and anemia as well as metabolic acidosis are factors independently related to this mortality.
Nowadays tetanus is a rare disease in developed countries due to the success of immunization, but children who were not immunized are still at risk. Awareness of early clinical symptoms of tetanus is crucial since the diagnosis is based on clinical symptoms. Severe tetanus can occur and lead to sequelae if there was no timely diagnosis and proper treatment. This case report aimed to emphasize the importance of recognizing early symptoms of tetanus and immunization. An 8 year old boy complained stiffness all over his body since 4 days before admission to hospital. Stiffness was started with pain on his back and stomach since 7 days before admitted, 3 days later his neck and back became stiff and got worsen until his mouth became stiff too. His left toe was pricked by a plant thorn about 3-4 weeks before admission. Physical examination showed risus sardonicus, trismus, stiff hands and opisthotonus. He didn't get complete immunizations. He was admitted in Pediatric Iintensive Care Unit (PICU) with Human Immunoglobulin, metronidazole, and diazepam. He was treated for 14 days and given Td vaccine before discharged. He underwent physiotherapy in medical rehabilitation department for 1 month because of persisting stiffness in his legs and arms. The diagnosis of tetanus was made based on clinical findings. There was no laboratory test to confirm it. Without timely diagnosis and proper treatment, severe tetanus can be fatal causing sequelae. Tetanus treatment follows several principles such as initial stabilization, maintainance of airway, prevent absorption of tetanospasmin, eradicating organism and supportive therapy. Management of tetanus takes a long time because the irreversible bound of toxin to tissues. It takes 4-6 weeks for the growth of new nerve terminal which is required in recovery period. So it is very important to recognize the symptoms of tetanus and treat it immediately to prevent more toxin bind to neuron.
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