Mortality in severe protein-energy malnutrition at Nchelenge, Zambia

Gernaat, Hajo B.P.E.; Dechering, W. H. J. C.; Voorhoeve, H. W. A.

doi:10.1093/tropej/44.4.211

Cited by 30 publications

(24 citation statements)

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“…The high mortality rate as found in the present study accords with previous findings of high case fatality rate in hospitalized severely malnourished children in other African countries [6,12,19,20]. However, our findings show a much higher mortality rate than that reported in studies in Ethiopia [5] and Niger [18], but much lower than that reported in another Ugandan and other studies [12,21,22].…”

Section: Discussionsupporting

confidence: 88%

Treatment outcome among children under-five years hospitalized with severe acute malnutrition in St. Mary’s hospital Lacor, Northern Uganda

et al. 2016

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Background: Severe malnutrition contributes to more than 60 % of deaths in children in developing countries. The minimum international standard set for management of severe acute malnutrition is a cure rate of at least 75 % and death rate of less than 10 %, yet the outcome of severely malnourished children treated in most hospitals in developing countries remain poor. This study was conducted to determine the treatment outcomes among severely malnourished children admitted at St. Mary's hospital Lacor in Northern Uganda during a one year period in order to inform clinical decisions to maximize management of severely malnourished children. Methods: This was a retrospective study involving 251 severely malnourished children treated at St. Mary's hospital Lacor within a one year period in 2014. Patients' medical records in the facility therapeutic feeding unit were retrospectively reviewed using a check list to collect basic demographic, clinical, and treatment outcome data of the sampled study patients. The UNICEF treatment outcome categories were used, and further grouped into three summary categories: "successful (cured)", "died" and "potentially unsatisfactory". Data were entered, cleaned and analyzed using statistical package SPSS version 13. For categorical data, proportions with 95 % confidence intervals, odds ratio and Chi-square test to compare different groups were used. Multivariate analysis using logistic regression was used to analyze the association between treatment outcome and potential associated factors. P values less than 0.05 was considered for statistical significance. Results: The study consisted 251 patients and the treatment outcome was successful (cured) in 168 (66.9 %) and potentially unsatisfactory in 53 (21.2 %), while 30 (11.9 %) died. Hypothermia and HIV infection were the factors significantly associated with mortality among the severely malnourished children in the current study. Conclusions: The treatment cure rate of severely malnourished children admitted at St. Mary's hospital Lacor of 66.9 % is below the accepted standard of least 75 % cure rate. A high proportion of patients died (11.9 %) or defaulted (8.0 %). Hypothermia and HIV infection were the factors significantly associated with mortality. We recommend that in order to address the high default rate, home based care through the outpatient therapeutic care should be strengthened.

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Section: Discussionsupporting

confidence: 88%

Treatment outcome among children under-five years hospitalized with severe acute malnutrition in St. Mary’s hospital Lacor, Northern Uganda

et al. 2016

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“…The age group 6 to 24 months accounted for 92.5% of the total number of children admitted for PEM. In previous Nigerian and Zambian studies, an approximate 64% of admitted cases of PEM were less than two years [4,14] while Cartmell et al [13] documented a mean age of 21.7 months in the Maputo study. The reasons for the high number of cases of PEM among the age group 6 to 24 months could be due to a number of factors including low rate of exclusive breast feeding as documented in our review as well as poor weaning and feeding practices.…”

Section: Discussionmentioning

confidence: 99%

“…Sub-saharan Africa bears the brunt of PEM in the world. On the average, the PEM associated mortality in sub-Saharan Africa is between 25 and 35% [4,5]. In Nigeria, 22 to 40% of under-five mortality has been attributed to PEM [6].…”

Section: Introductionmentioning

confidence: 99%

Under-five Protein Energy Malnutrition Admitted at the University of In Nigeria Teaching Hospital, Enugu: a 10 year retrospective review

Ubesie

Ibeziako

Ndiokwelu

et al. 2012

Nutr J

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ObjectiveTo determine the prevalence, risk factors, co-morbidities and case fatality rates of Protein Energy Malnutrition (PEM) admissions at the paediatric ward of the University of Nigeria Teaching Hospital Enugu, South-east Nigeria over a 10 year period.DesignA retrospective study using case Notes, admission and mortality registers retrieved from the Hospital’s Medical Records Department.SubjectsAll children aged 0 to 59 months admitted into the hospital on account of PEM between 1996 and 2005.ResultsA total of 212 children with PEM were admitted during the period under review comprising of 127 (59.9%) males and 85(40.1%) females. The most common age groups with PEM were 6 to 12 months (55.7%) and 13 to 24 months (36.8%). Marasmus (34.9%) was the most common form of PEM noted in this review. Diarrhea and malaria were the most common associated co-morbidities. Majority (64.9%) of the patients were from the lower socio-economic class. The overall case fatality rate was 40.1% which was slightly higher among males (50.9%). Mortality in those with marasmic-kwashiokor and in the unclassified group was 53.3% and 54.5% respectively.ConclusionMost of the admissions and case fatality were noted in those aged 6 to 24 months which coincides with the weaning period. Marasmic-kwashiokor is associated with higher case fatality rate than other forms of PEM. We suggest strengthening of the infant feeding practices by promoting exclusive breastfeeding for the first six months of life, followed by appropriate weaning with continued breast feeding. Under-five children should be screened for PEM at the community level for early diagnosis and prompt management as a way of reducing the high mortality associated with admitted severe cases.

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“…25 In this study, the proportion of severely malnourished, HIV-1-infected children and their mortality rate were similar to reports from elsewhere in the region. 21,[25][26][27] The increase in children admitted with HIV infection probably reflects improved care in the community, including better accessibility to admission. This might be partly owing to the new paediatric infectious disease clinic in Mulago Hospital which identifies a greater number of HIV-infected children and refers them for admission when seriously ill.…”

Section: Discussionmentioning

confidence: 99%

Reduction of unnecessary transfusion and intravenous fluids in severely malnourished children is not enough to reduce mortality

Bachou

Tumwine²,

Mwadime³

et al. 2008

Annals of Tropical Paediatrics

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Aim: To test whether standardising the use of blood transfusions and intravenous (IV) infusions could reduce fatality in severely malnourished children admitted to Mulago Hospital, Kampala. Methods: Improved adherence to the WHO protocol for blood transfusion and IV fluids was effected in patients with severe malnutrition by continuous medical education. A 'before and after' design was used to study 450 severely malnourished children (weight-for-height ,23 Z-score or presence of oedema) under 60 months of age. A total of 220 pre-and 230 post-'improved practice' patients were enrolled consecutively during the periods September to November 2003 and September to December 2004, respectively. Patients were followed up until discharge or death. The Kaplan-Meier survival curve and the Cox regression hazard model were used for univariate and multivariate analyses, respectively. Results: Overall case fatality was 23.6% (52/220) in the pre-period and 24.8% (57/230) in the post-period (p50.78). Most of the deaths occurred in the 1st week of admission (73%, 38/52 in the pre-period and 61%, 35/57 in the post-period) and were of children who had received blood transfusion or IV infusion or both in the pre-period. Mortality in children transfused and/or infused was significantly reduced in the post-period (82%, 31/38 in the preperiod vs 23%, 8/35 in the post-period, p50.008). In the post-period, there was a significant reduction in the number of inappropriate blood transfusions (18%, 34/194 vs 3.5%, 8/230, p50.01) and IV fluid infusions (27%, 52/194 vs 9%, 20/230, p,0.001). Survival improved in children who received blood transfusions in the post-period [hazards ratio (HR) 0.22, 95% CI 0.30-1.67 vs HR 4.80, 95% CI 1.71-13.51], as did that of children who received IV infusions (HR 2.10, 95% CI 0.84-5.23 vs HR 3.91, 95% CI 1.10-14.04). Conclusion: Management according to the WHO protocol for severe malnutrition can reduce the need for blood and IV infusions. However, further studies are required to verify whether full implementation of the WHO protocol reduces the high case fatality in sub-Saharan hospitals.

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Mortality in severe protein-energy malnutrition at Nchelenge, Zambia

Cited by 30 publications

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Treatment outcome among children under-five years hospitalized with severe acute malnutrition in St. Mary’s hospital Lacor, Northern Uganda

Treatment outcome among children under-five years hospitalized with severe acute malnutrition in St. Mary’s hospital Lacor, Northern Uganda

Under-five Protein Energy Malnutrition Admitted at the University of In Nigeria Teaching Hospital, Enugu: a 10 year retrospective review

Reduction of unnecessary transfusion and intravenous fluids in severely malnourished children is not enough to reduce mortality

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