Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique

Abstract

Objective: To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years. Design: Retrospective study of hospital-based data systematically collected from January 2001 to December 2010. Setting: Rural Mozambican district hospital. Subjects: All children aged ,5 years admitted with severe malnutrition. Results: During the 10-year long study surveillance, 274 813 children belonging to Manhiça's Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6 % (17 188/274 813) with severe malnutrition. Of these, only 15 % (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7 % (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum communitybased incidence rate was 15 cases per 1000 child-years at risk and children aged 12-23 months had the highest incidence. Conclusions: Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.

Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique

“…The association between mortality and these factors has not been properly described in the literature, but it is likely that edema is associated with kwashiorkor (protein-deficient malnutrition) and oral candidiasis is a proxy of HIV coinfection, highly endemic in the Manhiça area 22 and highly prevalent among malnourished patients. 13 Regarding hyperglycemia, we found a prevalence of 1.7%, and a significantly higher associated CFR (12.1%, P < 0.001) when compared with normoglycemia. Other studies in similar settings have shown similar 7 or higher 8,44 prevalence rates.…”

“…11,13,41 In malnourished patients, glucose homeostasis 41 can be compromised in several ways, including a lack of exogenous nutritional intake, decreased absorption of disaccharides because of intestinal villous atrophy, increased oxidative stress, or glucose uptake compromised by intestinal bacteria. In our series, 62% of all hypoglycemic children were malnourished, with 19.4% being severely malnourished.…”

“…[11][12][13][14][15] Hypoglycemia has been extensively reported to have important influence on the outcome of very ill patients, both children and adults. 1,16,17 In Africa, its prevalence among pediatric admissions has been estimated to range between 1.8% and 7.3%.…”

Incidence of Tuberculosis Among Young Children in Rural Mozambique

“…In 2011, the <5yr mortality rate was 70/1000 live births. Severe malnutrition is common with an estimated IR of 35/1000 person-years among children from 1-2yr 15 .…”

Making nutrition work for development

“…Research findings from several regions of the world are included; i.e. Africa: Senegal (3) , Uganda (4,5) , Mozambique (6,7) , Mali (8) , Sudan (9) , Kenya (10)(11)(12)(13) and South Sudan (14) ; Asia: Philippines, Malaysia and Indonesia (15) , India (16)(17)(18) , Pakistan (19) and Sri Lanka (20) ; the Caribbean: Trinidad and Tobago (21) ; and Latin America: Colombia (22) . This research reflects the wide range of nutritional issues that low-and middle-income countries face, i.e.…”