Follow-up of a historic cohort of children treated for severe acute malnutrition between 1988 and 2007 in Eastern Democratic Republic of Congo

Abstract

Background It is well documented that treatment for severe acute malnutrition (SAM) is effective. However, little is known about the long-term outcomes for children treated for SAM. We sought to trace former SAM patients 11 to 30 years after their discharge from hospital, and to describe their longer-term survival and their growth to adulthood. Methods A total of 1,981 records of subjects admitted for SAM between 1988 and 2007 were taken from the archives of Lwiro hospital, in South Kivu, DRC. The median age on admission was 41 months. Between December 2017 and June 2018, we set about identifying these subjects (cases) in the health zones of Miti-Murhesa and Katana. For deceased subjects, the cause and year of death were collected. A Cox proportional hazards multivariate regression analysis was used to identify the death-related factors. For the cases seen, age-and gender-matched community controls were selected for a comparison of anthropometric indicators. Results A total of 600 subjects were traced, and 201 subjects were deceased. Of the deceased subjects, 65�6% were under 10 years old at the time of their death. Of the deaths, 59�2% occurred within 5 years of discharge from hospital. The main causes of death were malaria (14�9%), kwashiorkor (13�9%), respiratory infections (10�4%), and diarrhoeal diseases (8�9%). The risk of death was higher in subjects with SAM, MAM combined with CM, and in male subjects, with HRs* of 1�83 (p = 0�043), 2.35 (p = 0�030) and 1.44 (p = 0�013) respectively. Compared with their controls, the cases had a low weight (-1�7 kg, p = 0�001), short

Association between Severe Acute Malnutrition during Childhood and Variability in Blood Pressure during Adulthood in Low- and Middle-income Countries: The Lwiro Cohort Study in the Democratic Republic of the Congo

“…In HICs, undernutrition was defined based on a reduction in weight gain whereas, in our population, undernutrition was defined on the basis of weight-to-height ratio, mid-upper arm circumference and/or the presence of nutritional edema. In addition, more than 90% of our subjects had delayed growth during childhood (22). Consequently, the effect of weight gain could be different in children who gained weight and height in a balanced way compared to those who gained weight and BMI, but had delayed growth.…”

“…Firstly, there is the survival bias: only those subjects who survived to adulthood and were still present in the villages two decades after the episode of SAM were studied. There is, however, no obvious reason to consider that the association between nutritional state of children admitted for SAM and BP would be different among those lost to follow up, due to the fact the hospital admission characteristics did not differ between subjects lost to follow up and subjects included (22).…”

“…During the follow-up of these subjects who became adults in the meantime, ie. 11 to 30 years after nutritional rehabilitation, 524 subjects from the initial cohort who were still living in the HZs of Miti-Murhesa and Katana were surveyed (22). To assess long-term growth, these survivors (exposed) were compared to 407 unexposed randomly-selected from the community (22).…”

“…However, unexposed proved harder to recruit than exposed, as many feared the social stigma associated with childhood malnutrition. The selection of unexposed was also limited by the number of eligible adults in the community (22).…”

“…Data collectionData were collected over a period of five months (August 2018-December 2018), and the collection took place in two steps, carried out by 20 trained community health workers (CHW) and 2 supervisors, assisted by local leaders, qualified nurses and community liaisons. The CHWs were the same as those who had helped identify the subjects during the gathering of the cohort(22).…”