A cohort analysis of survival and outcomes in severely anaemic children with moderate to severe acute malnutrition in Malawi

Abstract

Introduction Moderate to severe acute malnutrition (SAM/MAM) and severe anaemia are important and associated co-morbidities in children aged less than five years. Independently, these two morbidities are responsible for high risk of in-hospital and post-discharge deaths and hospital readmissions. The primary objective of this study is to investigate the risk of death among severely anaemic children with moderate to severe acute malnutrition compared to children with severe anaemia alone. Methods This was a retrospective analysis of data collected from a large prospective study that was investigating severe anaemia in children aged less than 5 years old. The study was conducted at Queen Elizabeth Central Hospital in Blantyre and Chikhwawa district hospital in southern Malawi. Children aged less than five years old; with severe anaemia were screened and enrolled. Each child was followed up for eighteen months at one, three, six, twelve and eighteen months after enrolment. Data were analysed using STATA 15. Results Between July 2002 and July 2004, 382 severely anaemic children were enrolled in the main study. A total of 52 children were excluded due to missing anthropometric data. Out of the 330 included, 53 children were moderately to severely malnourished and 277 were not. At the end of the 18-month follow period, 28.3% of children with MAM/SAM died compared to 13% of children without MAM/SAM (RR 2.1, CI 0.9–4.2, p = 0.03). Similarly, children with moderate to severe malnutrition reported a significantly higher number of malaria infection cases (33.9%) compared to children with severe anaemia alone (27.9%, p = 0.02). However, the number of hospitalizations and recurrence of severe anaemia was similar and not statistically significant between the two groups (RR 0.8 (0.4–1.4), p = 0.6 and RR 1.1 (0.3–2.8), p = 0.8). Conclusion Among children with severe anaemia, those who also had moderate to severe malnutrition had a twofold higher risk of dying compared to those who did not. It is therefore crucial to investigate acute malnutrition among severely anaemic children, as this might be treatable factor associated with high mortality.

Pathogenicity and virulence of malaria: Sticky problems and tricky solutions

“…Severe anaemia, defined as haemoglobin <7 g/dL in adults and <5 g/dL in children, is a common cause of death in Africa [ 1 ], particularly in malnourished children [ 308 ] and malaria is a significant risk factor for severe anaemia, particularly in children under five years of age [ 309 ]. According to a large household survey conducted in 16 malaria endemic African countries, 79% of children under five years of age with malaria had anaemia (haemoglobin <12 g/dL) and 8% had severe anaemia [ 1 ].…”

Pediatric post-discharge mortality in resource-poor countries: a systematic review and meta-analysis

“…These were combined with 22 previously identified articles, resulting in a total of 64 articles eligible for inclusion in this review. 2 , 3 , 4 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 Of these 64 publications, data from 46 unique patient cohorts were represented. The study reporting the most comprehensive post-discharge mortality data was chosen as the primary publication ( Fig.…”

Time to death and predictors of mortality among under-five children with severe acute malnutrition hospitalized at Mulanje District Hospital in Southern Malawi: a retrospective cohort study

“…In Malawi, 37% of children under ve years of age are stunted, 3% are wasted, and 12% are underweight [8], and a mortality rate of up to 42% has been reported among children with SAM at Queen Elizabeth Central Hospital in Blantyre (9). In view of this, researchers in Malawi have conducted several studies to investigate predictors of mortality in children with SAM [10,11,12]. Studies have identi ed human immunode ciency virus (HIV) infection (AOR 5.32 (95% CI 1.76-16.09)), Kwashiorkor (AOR 5.14 (95% CI 1.27-20.78)), shock (AOR 18.54 (95% CI 3.87-88.90)), and acute respiratory infections (ARI) (OR 3.06, p = 0.02) as independent risk factors for the high death rate among children with SAM [10].…”