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      Predictors of mortality among under-five children with severe acute malnutrition, Northwest Ethiopia: an institution based retrospective cohort study

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          Abstract

          Background

          Globally, approximately 19 million children under 5 years are suffering from Severe Acute Malnutrition (SAM). It is a major cause of morbidity and mortality in low-income countries including Ethiopia. However, little is known regarding predictors of mortality among these children in Ethiopia. The current study aimed to assess the potential predictors of mortality among under-five children with SAM admitted to a stabilization center.

          Method

          A retrospective cohort study was conducted in 527 under-five children who were admitted for SAM at the University of Gondar comprehensive specialized hospital from 2014 to 2016. Data were collected from a randomly selected chart after getting ethical clearance. Data were cleaned, coded and entered to Epi-info (version 7) and analyzed using STATA (version14). The outcome was computed by using tables and graphs. A multivariable cox proportional hazards model was fitted to identify predictors of mortality.

          Result

          Overall, the median follow-up period was 10 days with interquartile range (Q1, Q3: 8, 17). At the end of the follow-up, the mortality rate was 66(12.52%). Anemia (AHR(Adjusted Hazard Ratio): 2.3, 95% CI: 1.2, 4.5), Shock (AHR: 7.9, 95% CI: 3.7, 16.7), no intake of antibiotics (AHR: 2.3 95% CI: 1.2, 4.4), IV-Fluid (AHR: 3.2, 95% CI: 1.7, 5.8), no intake of F75 (AHR: 6.6,95% CI: 2.9, 14.7) and no intake of F100 (AHR: 3, 95% CI: 1.6, 5.4) were independent predictors of mortality.

          Conclusion

          The survival status of under-five children with SAM was lower than the national standard protocol. Altered general conditions such as shock, anemia, not adhering to medical and nutritional therapies were identified as predictors of mortality among SAM children. Health education on early medical seeking behavior and adherence on the routine regimens may improve this gap in child survival.

          Electronic supplementary material

          The online version of this article (10.1186/s13690-018-0309-x) contains supplementary material, which is available to authorized users.

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          Antibiotics as part of the management of severe acute malnutrition.

          H Goldbach, Jian Wang, Indi Trehan … (2013)
          Severe acute malnutrition contributes to 1 million deaths among children annually. Adding routine antibiotic agents to nutritional therapy may increase recovery rates and decrease mortality among children with severe acute malnutrition treated in the community. In this randomized, double-blind, placebo-controlled trial, we randomly assigned Malawian children, 6 to 59 months of age, with severe acute malnutrition to receive amoxicillin, cefdinir, or placebo for 7 days in addition to ready-to-use therapeutic food for the outpatient treatment of uncomplicated severe acute malnutrition. The primary outcomes were the rate of nutritional recovery and the mortality rate. A total of 2767 children with severe acute malnutrition were enrolled. In the amoxicillin, cefdinir, and placebo groups, 88.7%, 90.9%, and 85.1% of the children recovered, respectively (relative risk of treatment failure with placebo vs. amoxicillin, 1.32; 95% confidence interval [CI], 1.04 to 1.68; relative risk with placebo vs. cefdinir, 1.64; 95% CI, 1.27 to 2.11). The mortality rates for the three groups were 4.8%, 4.1%, and 7.4%, respectively (relative risk of death with placebo vs. amoxicillin, 1.55; 95% CI, 1.07 to 2.24; relative risk with placebo vs. cefdinir, 1.80; 95% CI, 1.22 to 2.64). Among children who recovered, the rate of weight gain was increased among those who received antibiotics. No interaction between type of severe acute malnutrition and intervention group was observed for either the rate of nutritional recovery or the mortality rate. The addition of antibiotics to therapeutic regimens for uncomplicated severe acute malnutrition was associated with a significant improvement in recovery and mortality rates. (Funded by the Hickey Family Foundation and others; ClinicalTrials.gov number, NCT01000298.).
          Article 0 comments Cited 114 times – based on 0 reviews     Review now
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            Prevalence of malnutrition in pediatric hospital patients.

            Jessie M. Hulst, Koen Joosten (2008)
            Hospital protein-energy malnutrition and its adverse consequences were already described back in 1980. The purpose of this review is to describe the current prevalence of malnutrition in hospitalized children and to describe current risk groups. Different definitions have been used to describe malnutrition. According to WHO criteria, the SD score with a cutoff of less than -2 should be used to define malnutrition and to compare prevalence data. Using the SD score for weight for height or equivalent criteria, the prevalence of acute malnutrition over the last 10 years in hospitalized children in Germany, France, the UK and the USA varied between 6.1 and 14%, whereas in Turkey up to 32% of patients with malnutrition were reported. Acute malnutrition is still highly prevalent in children with an underlying disease; however, the prevalence rate seems lower in children with cystic fibrosis and malignancies. The prevalence of acute malnutrition of children admitted to hospital is still considerably high, but there is a scarcity of data concerning the nutritional status during hospital admission. Screening tools to identify children at risk of developing malnutrition might be helpful.
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              Magnitude and Factors Associated with Malnutrition in Children 6-59 Months of Age in Pastoral Community of Dollo Ado District, Somali Region, Ethiopia

              Berhan Demissie (2013)
              Article 0 comments Cited 60 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Fasil Wagnew: fasilw.n@gmail.com
                Debrework Tesgera: debre2012@gmail.com
                Mengistu Mekonnen: mesyfikir21@gmail.com
                Amanuel Alemu Abajobir: amanuel.abajobir@uqconnect.edu.au
                Journal
                Journal ID (nlm-ta): Arch Public Health
                Journal ID (iso-abbrev): Arch Public Health
                Title: Archives of Public Health
                Publisher: BioMed Central (London )
                ISSN (Print): 0778-7367
                ISSN (Electronic): 2049-3258
                Publication date (Electronic): 27 September 2018
                Publication date PMC-release: 27 September 2018
                Publication date Collection: 2018
                Volume: 76
                Electronic Location Identifier: 64
                Affiliations
                [1 ]GRID grid.449044.9, College of Health Sciences, , Debre Markos University, ; Debre Markos, Ethiopia
                [2 ]ISNI 0000 0000 8539 4635, GRID grid.59547.3a, College of Health Sciences, , University of Gondar, ; Gondar, Ethiopia
                [3 ]ISNI 0000 0000 9320 7537, GRID grid.1003.2, Faculty of Medicine, , The University of Queensland, ; Brisbane, Australia
                Article
                Publisher ID: 309
                DOI: 10.1186/s13690-018-0309-x
                PMC ID: 6158814
                PubMed ID: 30275951
                SO-VID: b5559e41-37aa-4cda-9f15-6b752b22ecaa
                Copyright © © The Author(s). 2018
                License:

                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.

                History
                Date received : 2 November 2017
                Date accepted : 28 August 2018
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Public health
                Keywords: mortality,severe acute malnutrition,ethiopia
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: mortality, severe acute malnutrition, ethiopia

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