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      Survival status and predictors of mortality among children with severe acute malnutrition admitted to general hospitals of Tigray, North Ethiopia: a retrospective cohort study

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          Abstract

          Objective

          Despite the presence standard protocol for management of severe acute malnutrition case-fatality rates in African hospitals remain unacceptably high. The case in Ethiopia is not different from others. Therefore, this study was aimed to assess survival status and predictors of mortality among children with severe acute malnutrition admitted to stabilization centers of general hospitals in Tigray region, northern Ethiopia. A 24 months retrospective longitudinal study was conducted among 569 randomly selected medical records of children admitted to stabilizing centers. Both bi-variable and multivariable Cox regression analysis was conducted to identify predictors of mortality. Association was summarized using AHR, and statistical significances were declared at 95% CI and P-value < 0.05.

          Results

          During follow up, 456 [82%] of children had got cured, 37 [6.65%] were absconded and 21 [3.8%] were died. The overall mean survival time was 41.93 [95% CI 40.17–43.68] days. Impaired conscious level [AHR = 6.69, 95% CI 2.43–19.93], development of comorbidity after admission [AHR 12.71, 95% CI 2.79–57.94] and being urban in residence [AHR = 2.73, 95% CI 1.12–6.64] were predictors of mortality. Therefore, interventions to reduce further mortality should focus in children having impaired consciousness level and who developed comorbidity after admission.

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          The online version of this article (10.1186/s13104-018-3937-x) contains supplementary material, which is available to authorized users.

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          Most cited references 14

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          Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles.

          Previous analyses derived the relative risk (RR) of dying as a result of low weight-for-age and calculated the proportion of child deaths worldwide attributable to underweight. The objectives were to examine whether the risk of dying because of underweight varies by cause of death and to estimate the fraction of deaths by cause attributable to underweight. Data were obtained from investigators of 10 cohort studies with both weight-for-age category ( -1 SD) and cause of death information. All 10 studies contributed information on weight-for-age and risk of diarrhea, pneumonia, and all-cause mortality; however, only 6 studies contributed information on deaths because of measles, and only 3 studies contributed information on deaths because of malaria or fever. With use of weighted random effects models, we related the log mortality rate by cause and anthropometric status in each study to derive cause-specific RRs of dying because of undernutrition. Prevalences of each weight-for-age category were obtained from analyses of 310 national nutrition surveys. With use of the RR and prevalence information, we then calculated the fraction of deaths by cause attributable to undernutrition. The RR of mortality because of low weight-for-age was elevated for each cause of death and for all-cause mortality. Overall, 52.5% of all deaths in young children were attributable to undernutrition, varying from 44.8% for deaths because of measles to 60.7% for deaths because of diarrhea. A significant proportion of deaths in young children worldwide is attributable to low weight-for-age, and efforts to reduce malnutrition should be a policy priority.
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            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)

            Background Severe 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. Methods It 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. Results Overall (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). Conclusions We 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.
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              Seasonal variation in the prevalence of acute undernutrition among children under five years of age in east rural Ethiopia: a longitudinal study

              Background Malnutrition is a deficiency state of both macro and micronutrients (under - nutrition) and their over consumption (over- nutrition) causing measurable adverse effects on human body structure and function, resulting in specific physical and clinical outcomes. Little has been known about the seasonal variation in the magnitude of acute child under-nutrition and its determinants in low and middle-income countries making difficult the choice of a better nutrition intervention. The objective of this study was to determine the prevalence of acute under-nutrition and its associated factors on children aged 6 to 36 months in east rural Ethiopia in wet and dry seasons. Methods A longitudinal study was conducted on children aged 6 to 36 months and their mothers (mother–child pairs) from July/August 2010/2011 to January/ February 2011/2012 in east rural Ethiopia. Data were collected from 2,132 mother–child pairs using a pretested structured questionnaire and the UNICEF recommended anthropometric measuring instruments after standardization. The Odds Ratio with 95% confidence interval was estimated to identify the predictors of acute child under nutrition (wasting) using a conditional fixed- effects logistic regression. Results The prevalence of acute child under-nutrition was 7.4%; 95% CI: (6.3%, 8.5%) in wet and 11. 2%; 95% CI: (9.8%, 12.5%) in dry seasons. Child wasting was more common among children of poor households who had no cooperative bank saving accounts [AOR (95% CI) = 8.2. (1.8, 37.6)], and access to health facilities [AOR (95% CI) = 2.2 (1.4, 3.6)]. Conclusion Acute child under-nutrition was relatively higher in the dry season. Although season was not significantly associated with child under - nutrition, poverty and poor access to health services were important predictors of wasting in the study setting. Thus, effective community–based nutrition interventions that require a multi - disciplinary approach should be scaled up to curb childhood under-nutrition.
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                Author and article information

                Contributors
                gebremicael.gm@gmail.com
                adgetu123@yahoo.com
                gmebrahtuabay@gmail.com
                berhebeyene2005@gmail.com
                ermiyasbr@gmail.com
                kalayu2002@gmail.com
                Journal
                BMC Res Notes
                BMC Res Notes
                BMC Research Notes
                BioMed Central (London )
                1756-0500
                26 November 2018
                26 November 2018
                2018
                : 11
                Affiliations
                [1 ]JSI, P.O. Box: 13898, Addis Ababa, Ethiopia
                [2 ]ISNI 0000 0000 8539 4635, GRID grid.59547.3a, Department of Epidemiology and Biostatistics, Institute of Public Health, , University of Gondar, ; P.O. Box: 196, Gondar, Ethiopia
                [3 ]GRID grid.448640.a, School of Public Health, College of Health Science, , Aksum University, ; P.O. Box: 298, Aksum, Ethiopia
                [4 ]ISNI 0000 0004 0455 7818, GRID grid.464565.0, Department Public Health, College of Health Science, , Debre Berhan University, ; P.O. Box: 445, Debre Berhan, Ethiopia
                Article
                3937
                10.1186/s13104-018-3937-x
                6257969
                30477540
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Research Note
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                © The Author(s) 2018

                Medicine

                survival status, severe acute malnutrition, mortality, tigray region

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