Mortality and morbidity patterns in under-five children with severe acute malnutrition (SAM) in Zambia: a five-year retrospective review of hospital-based records (2009–2013)

Abstract

BackgroundSevere acute malnutrition has continued to be growing problem in Sub Saharan Africa. We investigated the factors associated with morbidity and mortality of under-five children admitted and managed in hospital for severe acute malnutrition.MethodsIt was a retrospective quantitative review of hospital based records using patient files, ward death and discharge registers. It was conducted focussing on demographic, clinical and mortality data which was extracted on all children aged 0–60 months admitted to the University Teaching Hospital in Zambia from 2009 to 2013. Cox proportional Hazards regression was used to identify predictors of mortality and Kaplan Meier curves where used to predict the length of stay on the ward.ResultsOverall (n = 9540) under-five children with severe acute malnutrition were admitted during the period under review, comprising 5148 (54%) males and 4386 (46%) females. Kwashiorkor was the most common type of severe acute malnutrition (62%) while diarrhoea and pneumonia were the most common co-morbidities. Overall mortality was at 46% with children with marasmus having the lowest survival rates on Kaplan Meier graphs. HIV infected children were 80% more likely to die compared to HIV uninfected children (HR = 1.8; 95%CI: 1.6-1.2). However, over time (2009–2013), admissions and mortality rates declined significantly (mortality 51% vs. 35%, P < 0.0001).ConclusionsWe find evidence of declining mortality among the core morbid nutritional conditions, namely kwashiorkor, marasmus and marasmic-kwashiorkor among under-five children admitted at this hospital. The reasons for this are unclear or could be beyond the scope of this study. This decline in numbers could be either be associated with declining admissions or due to the interventions that have been implemented at community level to combat malnutrition such as provision of “Ready to Use therapeutic food” and prevention of mother to child transmission of HIV at health centre level. Strategies that enhance and expand growth monitoring interventions at community level to detect malnutrition early to reduce incidence of severe cases and mortality need to be strengthened.

Mortality and morbidity trends and predictors of mortality in under-five children with severe acute malnutrition in Hadiya zone, South Ethiopia: a four-year retrospective review of hospital-based records (2012–2015)

“…This is similar with some previous studies [6,12,13], but it is inconsistent with study conducted in Colombia [14]. The difference may be due to difference in causes of malnutrition and life styles in the regions.…”

“…The death rate after admission is higher. Study conducted in Zambia showed death rate after admission as 46% [6].…”

Determination of the frequency of growth retardation in pediatric out patients with growth retardation complaints

“…Retarded growth is a condition that directly affects morbidity and mortality in childhood (8,9). According to World Health Organization data, pneumonia, diarrhea, malaria, measles and AIDs represent the cause of death in more than half of children under 5, and inadequate nutrition is present in one in three of these patients (10).…”

Survival Status and Its Associated Factors among Under-Five Children Admitted with Complicated Severe Acute Malnutrition in Hospitals of Wolaita Zone, South Ethiopia: Retrospective Cohort Study

“…The study conducted in South Africa showed that Case-fatality rate for SAM cases is remaining high 40.1% [4]. Likewise, another finding from Zambia revealed mortality rate 51% Vs 35% from 2009-2013 [5]. Thus, there needs exist for improved adherence to the WHO guidelines and periodic clinical audits to reduce death from childhood malnutrition [6].…”