Severe acute malnutrition in children admitted in an Intensive Therapeutic and Feeding Centre of South Kivu, Eastern Democratic Republic of Congo: Why do our patients die?

Kambale, Richard Mbusa; Ngaboyeka, Gaylord; Ntagazibwa, Joseph Ntagerwa; Bisimwa, Marie-Hélène Igega; Kasole, Lisa Yvette; Habiyambere, Viateur; Kubuya, Victor Buunda; Kasongo, Joseph Kasongowa; André, Emmanuel; Linden, Dimitri Van der

doi:10.1371/journal.pone.0236022

Cited by 12 publications

(12 citation statements)

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“…The predictive effect of breastfeeding on mortality among children with SAM has been reported in several sub-Saharan studies [29,24]. In a study done in Ethiopia, the ndings showed that hospitalized children with SAM who were breastfed were 59% less likely to die compared to non-breastfed children (AHR: 0.41 (95% CI: 0.29-2.37)) [24].…”

Section: Discussionmentioning

confidence: 82%

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

Pajogo,

Ndholvu,

Chamambala

et al. 2023

Preprint

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Introduction Severe acute malnutrition (SAM) is a leading cause of inpatient mortality in children in sub-Saharan Africa (SSA). In Malawi, there is limited data that explains why this is the case. Therefore, this study determined the time to death and its predictors among children under five years of age with SAM admitted at Mulanje District Hospital. Methods We conducted a retrospective cohort study by reviewing the medical charts of 454 randomly selected children under five years of age who were admitted to Mulanje District Hospital from January 2017 to February 2021. We collected data using data collection forms and analyzed the data with STATA version 16. Cox proportional hazard regression was used to identify predictors of mortality. A statistical significance was declared at a p-value < 0.05 Results A total of 7,685 children under five years of age were admitted to Mulanje District Hospital between January 2017 and February 2021. We enrolled and analyzed 454 cases, of which 227 were SAM children and the other 227 belonged to non-SAM children. The overall death rate was 14.8%. For SAM children, the death rate was 8.4%, compared to 21.2% for non-SAM children. The median time to death was 5 days (IQR: 2–8) for SAM and 1 day (IQR: 1–2) for non-SAM children. Among SAM children, shock (AHR: 15.3; CI: 2.08–113.42) and not having received amoxicillin (AHR: 4.15; CI: 1.24–13.90) were significant predictors of death. Among non-SAM children, shock (AHR: 2.33; CI: 1.18–4.6), diarrhoea (AHR: 2.07; CI: 1.00–2.30), oxygen therapy (AHR: 3.17; CI: 1.66–6.05), and not having received amoxicillin (AHR: 20.78; CI: 2.81–153.67) were significant predictors of death. Conclusion Clinical and nursing interventions should be more focused on predictors of mortality to address the high incidence of deaths among children under five years of age.

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Section: Discussionmentioning

confidence: 82%

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

Pajogo,

Ndholvu,

Chamambala

et al. 2023

Preprint

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“…The observed level of achievement of weight gain among children with complicated SAM is in line with reports from studies conducted in Ethiopian towns of Aksum, 18 Mekelle, 19 Woldia 20 and Gedeo. 21 Studies in India, 22 Bangladesh 15 , and Democratic Republic of Congo 14 also reported comparable levels of achievement of weight gain among children with complicated SAM. In contrast, higher proportion of treated patients achieved adequate weight gain in this study when compared with other studies conducted in the Dadaab refugee camp of Kenya 23 and Jimma university referral hospital of Ethiopia.…”

Section: Discussionmentioning

confidence: 88%

“…8 Studies on the adequacy of weight gain and associated factors among admitted children with complicated SAM were mainly conducted in non-refugee settings and outside of Africa, primarily in Asian countries. [14][15][16] According to a study in Bangladesh, admitted children with complicated SAM achieved a mean weight gain of 10.6 g/kg per day. 15 In India, 57.4% of the total 300 children did not gain final target weight despite giving adequate diet.…”

Section: Introductionmentioning

confidence: 99%

Achievement of adequate weight gain among infants and children with complicated severe acute malnutrition receiving treatment in therapeutic feeding centers of South Sudanese refugee camps in Ethiopia

et al. 2023

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Objectives: This study aimed to assess achievement of adequate weight gain and identify its associated factors among infants and children with complicated severe acute malnutrition admitted in Kule and Tierkidi refugee camps in Gambella, Southwest Ethiopia. Methods: Records of 332 infants and children with complicated severe acute malnutrition were selected by systematic random sampling. Weight gain was calculated for all participants. Patients who achieved weight gain of >5 g/kg/day were regarded as achieving adequate weight gain. Sociodemographic characteristics, season of admission, patients’ anthropometry at admission, source of admission, clinical conditions at admission, types of medications used, length of stay at the centers, and the centers of the treatment were considered as covariates. The adjusted odds ratio and its 95% confidence interval were used to identify factors associated with adequate average weight gain in the multivariable logistic regression. Results: In total, 72% of the treated patients achieved adequate weight gain. Treatment at Tierkidi center Adjusted Odds Ratio = 5.9, 95% Confidence Interval: (2.0,16.9), treatment with amoxicillin–clavulanate Adjusted Odds Ratio = 4.1, 95% Confidence Interval: (1.7, 10.0), WFH z-score < −3 Adjusted Odds Ratio = 4.1, 95% Confidence Interval: (1.9, 9.0) and length of stay of ⩽7 days Adjusted Odds Ratio = 2.5, 95% Confidence Interval: (1.4, 4.4) were significantly associated with achievement of adequate weight gain. Conclusion: Seven in ten of treated patients achieved adequate weight gain. However, significant proportion of patients still failed to achieve recommended weight gain in refugee camps. Anthropometric indices, type of antibiotics used for treatment, short length of stay, and the treatment center were associated with achievement of adequate weight gain. We recommend that the local antibiotic sensitivity pattern be studied in order to recommend an appropriate treatment regimen for infants and children. Children requiring longer duration have to be given due focus. Inter-center variations have to be narrowed by strengthening follow-up and supervisory supports.

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“…This is indicative of the frequent association between malnutrition and HIV in sub-Saharan African countries. The HIV rate among malnourished children is 23% in Malawi [ 49 ], while a study conducted in the Pediatric ward of the Provincial Hospital of South Kivu shows that HIV is the main infectious cause of death among children hospitalized for malnutrition [ 50 ]. However, the two HIV-positive cases in the exposed group did not have thinness or edema.…”

Section: Discussionmentioning

confidence: 99%

Nutritional and health status of a cohort of school-age children born to mothers treated for severe acute malnutrition in their childhood in The Democratic Republic of Congo

et al. 2022

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Background Malnutrition is a public health problem, but outside the theoretical framework, little is known about the concrete intergenerational effects of malnutrition. Objective The objective of this study is to compare the nutritional status and health indicators of school children born to mothers who were treated for severe acute malnutrition (SAM). Methodology The study took place in Miti-Murhesa health zone in the Democratic Republic of Congo. This is a cohort study assessing the nutritional and health status of school children born to mothers who had been treated for SAM, based on WHZ or edema, in Lwiro hospital between 1988–2002 compared to children born to mothers who were not exposed to SAM. Stunting and thinness were evaluated by Height for Age Z-score (HAZ) and Body Mass Index by Age criteria (BMIAZ) respectively. On admission, blood samples were taken to assess anemia, HIV serology, hemogram and others biological indicators. Stool’s examinations were conducted by using Olympus optical microscope. Parametric and non-parametric tests were applied to compare the different variables in two groups. Results We identified 106 children aged 5–16 years (103 exposed and 58 unexposed) and we received 83.5% and 91.4% children respectively for anthropometric parameters. The mean of age was 7.9 ± 2.4 year in exposed group and 7.4 ± 2.1 year in unexposed group (p = 0.26). The prevalence of stunting was 68.3% in the exposed group and 67.3% in the unexposed group (p = 0.90). The prevalence of thinness was 12.8% in the exposed group and 9.6% in the unexposed group (p = 0.57). The biological profile (glycemia, urea, creatinine and hemogram) and the prevalence of intestinal parasites were similar in the two groups. Conclusion In this sample, in a malnutrition-endemic area, there was no statistically significant difference in nutrition and health indicators between school children born to mothers exposed to SAM and their community controls.

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Severe acute malnutrition in children admitted in an Intensive Therapeutic and Feeding Centre of South Kivu, Eastern Democratic Republic of Congo: Why do our patients die?

Cited by 12 publications

References 40 publications

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

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

Achievement of adequate weight gain among infants and children with complicated severe acute malnutrition receiving treatment in therapeutic feeding centers of South Sudanese refugee camps in Ethiopia

Nutritional and health status of a cohort of school-age children born to mothers treated for severe acute malnutrition in their childhood in The Democratic Republic of Congo

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