Undernourished children presenting to an urban emergency department of a tertiary hospital in Tanzania: a prospective descriptive study

Abstract

Background: Childhood undernutrition causes significant morbidity and mortality in low- and middle-income countries (LMICs). In Tanzania, the in-hospital prevalence of undernutrition in children under five years of age is approximated to be 30% with a case fatality rate of 8.8%. In Tanzania, the burden of undernourished children under five years of age presenting to emergency departments (EDs) and their outcomes are unknown. This study describes the clinical profiles and outcomes of this population presenting to the emergency department of Muhimbili National Hospital (ED-MNH), a large, urban hospital in Dar es Salaam, Tanzania. Methods This was a prospective descriptive study of children aged 1–59 months presenting to the ED-MNH over eight weeks in July and August 2016. Enrolment occurred through consecutive sampling. Children less than minus one standard deviation below World Health Organization mean values for Weight for Height/Length, Height for Age, or Weight for Age were recruited. Structured questionnaires were used to document primary outcomes of patient demographics and clinical presentations, and secondary outcomes of 24-h and 30-day mortality. Data was summarised using descriptive statistics and relative risks (RR). Results A total of 449 children were screened, of whom 34.1% (n = 153) met criteria for undernutrition and 95.4% (n = 146) of those children were enrolled. The majority of these children, 56.2% (n = 82), were male and the median age was 19 months (IQR 10–31 months). They presented most frequently with fever 24.7% (n = 36) and cough 24.0% (n = 35). Only 6.7% (n = 9) were diagnosed with acute undernutrition by ED-MNH physicians. Mortality at 24 h and 30 days were 2.9% (n = 4) and 12.3% (n = 18) respectively. A decreased level of consciousness with Glasgow Coma Scale below fifteen on arrival to the ED and tachycardia from initial vital signs were found to be associated with a statistically significant increased risk of death in undernourished children, with mortality rates of 16.1% (n = 23), and 24.6% (n = 35), respectively. Conclusions In an urban ED of a tertiary referral hospital in Tanzania, undernutrition remains under-recognized and is associated with a high rate of in-hospital mortality.

Profile of Children with Undernutrition Admitted in Two Secondary-Level Hospitals in Maputo City, Mozambique

“…Co-morbidities were common in our study population of undernourished children, with HIV (30.0%), diarrhea (20.0%), and anemia (12.5%) being the most frequent. This is in line with studies in hospitalized undernourished children in other African countries, such as South Africa and Tanzania [48,49]. These co-morbidities are well known to contribute to the development of undernutrition [48][49][50], not only separately but also together, as they are interrelated.…”

“…This is in line with studies in hospitalized undernourished children in other African countries, such as South Africa and Tanzania [48,49]. These co-morbidities are well known to contribute to the development of undernutrition [48][49][50], not only separately but also together, as they are interrelated. For instance, HIV infection can lead to diarrhea, and diarrhea is associated with anemia [8,[50][51][52][53][54].…”

Severe Acute Malnutrition among Unoperated Ethiopian Children with Congenital Heart Disease: A Wake-up Call to Reverse the Situation, A Retrospective Cross-Sectional Study

“…Underweight,stunting, and moderate and severe wasting were documented in 70(49.6%), 42(29.8%), 34(24.1%) and 16(11.1%) of the study subjects, respectively. Comparable results were reported from Uganda and Nigeria; undernutrition assessment in a tertiary hospital in Tanzania documented a similar pattern (18,19,32).A higher figure was reported from Iraq with underweight and wasting contributing to 32% and 65% of CHD (16). Nevertheless, this study only included infants as study subjects.…”