Predictors of in-hospital mortality among under-five children with severe acute malnutrition in South-Western Uganda

被引:10
作者
Nduhukire, Timothy [1 ]
Atwine, Daniel [2 ]
Rachel, Luwaga [3 ]
Byonanebye, Joseph E. [4 ]
机构
[1] Kabale Univ, Dept Pediat & Child Hlth, Kabale, Uganda
[2] SOAR Res Fdn, Mbarara, Uganda
[3] Bishop Stuart Univ, Dept Nursing, Mbarara, Uganda
[4] Marquette Univ, Dept Biomed Sci, Milwaukee, WI 53233 USA
来源
PLOS ONE | 2020年 / 15卷 / 06期
关键词
MALNOURISHED CHILDREN; MANAGEMENT; GUIDELINES; ALBUMIN; RISK;
D O I
10.1371/journal.pone.0234343
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background Severe acute malnutrition (SAM) affects about 13 million under-five children (U5), with an estimated one million dying every year. In this study we aimed at determining the in hospital mortality and its associated factors among U5s admitted with SAM. Methods This was a prospective cohort study of children 6 months to 5 years with SAM admitted at Mbarara Regional Referral Hospital (MRRH) between June and August 2015. Care-takers were interviewed to collect socio-demographic and clinical information. Children under-went physical examination and had blood drawn for HIV, serum glucose, malaria, full blood count, culture and serum electrolytes investigation. Children were managed according to WHO treatment guidelines for SAM. All participants were followed up for a maximum period of 30 days. The proportion of U5 deaths within the first 48 hours and during the entire admission period was calculated. Using Poisson regression analysis, predictors of in-hospital mortality were analyzed with STATA/IC 11.0. Results We enrolled 122 children, median age of 15 months [IQR:11-24], 58.2% males, 90% immunized, 81% ill for more than 2 weeks before admission, 71% from lower health facilities and majority with unknown HIV status(76%). Overall, 13 (10.7%) children died in hospital. Seven (5.7%) died within the first 48 hours. Intravenous (IV) fluid administration significantly predicted in-hospital mortality (adjusted IRR: 7.2, 95%CI: 2.14-24.08,p = 0.001). Conclusion The in-hospital mortality in U5s with SAM was lower than that previously reported in central Uganda. Intravenous fluid administration significantly predicted overall in-hospital mortality. While Administration of intravenous fluids is still the main stay of managing severely malnourished children with shock, more research needs to be conducted in order to review the parameters presently used to assess children for shock with a view of diagnosing and managing shock in these children when it is still early. Adequate guidance on use of IV fluids in management of severely malnourished children should be prioritized during continuous medical education for healthcare workers and in the treatment guidelines.
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页数:15
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共 38 条
  • [1] Phase II trial of isotonic fluid resuscitation in Kenyan children with severe malnutrition and hypovolaemia
    Akech, Samuel O.
    Karisa, Japhet
    Nakamya, Phellister
    Boga, Mwanamvua
    Maitland, Kathryn
    [J]. BMC PEDIATRICS, 2010, 10
  • [2] Safety of Rapid Intravenous Rehydration and Comparative Efficacy of 3 Oral Rehydration Solutions in the Treatment of Severely Malnourished Children With Dehydrating Cholera
    Alam, Nur H.
    Islam, Sufia
    Sattar, Samima
    Monira, Shirajum
    Desjeux, Jehan-Francois
    [J]. JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 2009, 48 (03) : 318 - 327
  • [3] [Anonymous], 2010, WORLD HLTH STAT 2010
  • [4] [Anonymous], 2003, GUIDELINES INPATIENT
  • [5] [Anonymous], 2019, BRAIN STIMUL MAR
  • [6] [Anonymous], 2015, BMJ, V2015, ph1887
  • [7] [Anonymous], 1999, Management of severe malnutrition: a manual for physicians and other senior Health workers
  • [8] WHO guidelines for management of severe malnutrition in rural South African hospitals: effect on case fatality and the influence of operational factors
    Ashworth, A
    Chopra, M
    McCoy, D
    Sanders, D
    Jackson, D
    Karaolis, N
    Sogaula, N
    Schofield, C
    [J]. LANCET, 2004, 363 (9415) : 1110 - 1115
  • [9] Risk factors in hospital deaths in severely malnourished children in Kampala, Uganda
    Bachou H.
    Tumwine J.K.
    Mwadime R.K.N.
    Tylleskär T.
    [J]. BMC Pediatrics, 6 (1)
  • [10] BIOLOGICAL RISK-FACTORS FOR FATAL PROTEIN-ENERGY MALNUTRITION IN HOSPITALIZED CHILDREN IN ZAIRE
    BRASSEUR, D
    HENNART, P
    DRAMAIX, M
    BAHWERE, P
    DONNEN, P
    TONGLET, R
    DEVREKER, T
    DUCHATEAU, J
    [J]. JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 1994, 18 (02) : 220 - 224