Clinical Outcomes and Determinants of Recovery Rates of Pediatric Inpatients Treated for Severe Acute Malnutrition
DOI:
https://doi.org/10.6000/1929-4247.2015.04.04.4Keywords:
In-patient care, severe acute malnutrition, under-five children, recovery rate, fatality rate, medical complications, Tamale Teaching Hospital, Northern GhanaAbstract
Background: Though treatment of severe acute malnutrition cases in both the in-patient care and the out-patient care has been going on since 2011 at the Tamale Teaching Hospital, little is known about the clinical treatment outcomes and factors that may be associated with the recovery rate in the in-patient setting. This study investigated the clinical treatment outcomes and determinant factors likely to be associated with recovery rates at the Hospital.
Methods: We performed a retrospective chart review (RCR) of all pediatric patients aged (0-11 years of age) who were diagnosed of severe acute malnutrition between March 2011 and December 2013. Logistic regression modeling was used to determine the risk factors of severe malnutrition.
Results: Of the 630 cases that were reviewed, only 19.5 % recovered (having mid-upper-arm-circumference measure ≥125 mm, or oedema resolved, or gained 5g/kg/body weight for 2 consecutive days at the time of discharge), 1.7 % defaulted, and 65.2 % were referred to out-patient care units for continued treatment. The observed case fatality rate was 13.5 %. Marasmic cases had more chronic co-morbid conditions at admission compared to kwashiorkor patients (81.7% vs. 69.3%, p=0.01).
Conclusions: Case fatality rate in this population was quite high. Case referral to out-patient care unit was appropriately high. Malaria was the most common co-morbid condition diagnosed among the cases reviewed. Younger age, 15% or more increase in weight, and type of malnutrition were the main predictors of recovery from severe acute malnutrition in the in-patient care setting.
References
Gordon DM, Frenning S, Draper HR, Kokeb M. Prevalence and burden of diseases presenting to a general pediatrics ward in Gondar, Ethiopia. J Trop Pediatr 2013; 59: 350-7. http://dx.doi.org/10.1093/tropej/fmt031
Asres G, Eidelman AI. Nutritional assessment of Ethiopian Beta-Israel children: a cross-sectional survey. Breastfeed Med 2011; 6: 171-6. http://dx.doi.org/10.1089/bfm.2011.0016
Preidis GA, McCollum ED, Mwansambo C, Kazembe PN, Schutze GE, Kline MW. Pneumonia and malnutrition are highly predictive of mortality among African children hospitalized with human immunodeficiency virus infection or exposure in the era of antiretroviral therapy. J Pediatr 2011; 159: 484-9. http://dx.doi.org/10.1016/j.jpeds.2011.02.033
Marazzi MC, De Luca S, Palombi L, et al. Predictors of adverse outcomes in HIV-1 infected children receiving combination antiretroviral treatment: results from a DREAM Cohort in Sub-Saharan Africa. Pediatr Infect Dis J 2014; 33: 295-300. http://dx.doi.org/10.1097/INF.0b013e3182a0994b
Johnson AW, Osinusi K, Aderele WI, Gbadero DA, Olaleye OD, Adeyemi-Doro FA. Etiologic agents and outcome determinants of community-acquired pneumonia in urban children: a hospital-based study. J Natl Med Assoc 2008; 100: 370-85.
Muoneke VU, Ibekwe RC, Nebe-Agumadu HU, Ibe BC. Factors associated with mortality in under-five children with severe anemia in Ebonyi, Nigeria. Indian Pediatr 2012; 49: 119-23. http://dx.doi.org/10.1007/s13312-012-0026-4
Lagrone L, Cole S, Schondelmeyer A, Maleta K, Manary MJ. Locally produced ready-to-use supplementary food is an effective treatment of moderate acute malnutrition in an operational setting. Ann Trop Paediatr 2010; 30: 103-8. http://dx.doi.org/10.1179/146532810X12703901870651
Chang CY, Trehan I, Wang RJ, et al. Children successfully treated for moderate acute malnutrition remain at risk for malnutrition and death in the subsequent year after recovery. J Nutr 2013; 143: 215-20. http://dx.doi.org/10.3945/jn.112.168047
Amsalu S, Asnakew G. The outcome of severe malnutrition in northwest Ethiopia: retrospective analysis of admissions. Ethiop Med J 2006; 44: 151-7.
WHO: Guidelines: Updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization 2013.
SPHERE project team: The SPHERE Humanitarian Charter and Minimum Standards in Disaster Response. In 2nd draft. Geneva: The SPHERE Project 2003.
Collins S, Sadler K. The outpatient treatment of severe malnutrition during humanitarian relief programmes. Lancet 2002; 360: 1824-30. http://dx.doi.org/10.1016/S0140-6736(02)11770-3
Minkah B. Pro-Inflammatory Cytokines as Markers for the Diagnosis of Protein Energy Malnutrition Kwame Nkrumah University of Science &Technology, Department of Molecular Medicine, School of Medical Sciences 2010.
UNICEF, GSS, MOH. Ghana Multiple Indicator Cluster Survey 2010 (MICS) – Monitoring the situation of children, women and men. Accra-Ghana: GSS/MOH/UNICEF 2011.
GSS, GHS, ICF Macro. Ghana Demographic and Health Survey 2008. Accra-Ghana: Ghana Statistical Service, Ghana Health Service, ICF Macro 2009.
Hotz C, Peerson JM, Brown KH. Suggested lower cutoffs of serum zinc concentrations for assessing zinc status: reanalysis of the second National Health and Nutrition Examination Survey data (1976–1980). Am J Clin Nutr 2003; 78: 756-64.
Castillo-Duran C, Rodriguez A, Venegas G. Zinc Supplementation and growth of infants born small for gestational age. J Pediatr 1995; 127: 206-11. http://dx.doi.org/10.1016/S0022-3476(95)70296-2
Ripa S, Ripa R. Zinc and the growth hormone system. Minerva Med 1996; 87: 25-31.
Ninh NX, Thissen JP, Collette L, Gerard G, Khoi HH, Ketelsl-egers JM. Zinc supplementation increases growth and circul-ating insulin like growth factor I (IGFI) in growth-retarded Vietnamese children. Am J Clin Nutr 1996; 63: 514-9.
Friis H, Ndhlouvu P, Mduluza T, et al. The impact of Zinc supplementation on growth and body composition: a randomised controlled trial among rural Zimbabwean School children. Eur J Clin Nutr 1997; 51: 38-45. http://dx.doi.org/10.1038/sj.ejcn.1600358
Fraker PJ, Jardieu P, Cook J. Zinc deficiency and immune function. Arch Dermatol 1987; 123: 1699-701. http://dx.doi.org/10.1001/archderm.1987.01660360152028
Sempertegui F, Estrella B, Correa E, et al. Effects of short term Zinc supplementation on cellular immunity, respiratory symptoms and growth of malnourished Ecuadorian children. Eur J Clin Nutr 1996; 50: 42-6.
Neves JR, Bertho AL, Veloso VG, Nascimento DV, Mello DL, Morgado MG. Improvement of the lymphoproliferative immune response and apoptosis inhibition, upon in vitro treatment with Zinc, of peripheral blood mononuclear cells (PBMC) from HIV +ve individuals. Clin Exp Immunol 1998; 111: 264-8. http://dx.doi.org/10.1046/j.1365-2249.1998.00495.x
WHO: Management of severe malnutrition: a manual for physicians and other senior health workers. Geneva: WHO 1999.
UNICEF. Management of Severe Acute Malnutrition in children: Programme and supply components of scaling-up an integrated approach New York: USA: UNICEF 2008.
Collins S, Dent N, Binns P, Bahwere P, Sadler K, Hallam A. Management of severe acute malnutrition in children. Lancet 2006; 368: 1992-2000. http://dx.doi.org/10.1016/S0140-6736(06)69443-9
Fuchs G, Ahmed T, Araya M, Baker S, Croft N, Weaver L. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Malnutrition: Working Group Report of the Second World Congress of Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2004; 39: S670-7.
Lapidus N, Minetti A, Djibo A, et al. Mortality risk among children admitted in a Large -Scale Nutritional Program in Niger, 2006. PLoS One 2009; 4: 13-50. http://dx.doi.org/10.1371/journal.pone.0004313
Ahmed AU, Ahmed TU, Uddin S, Chowdhury HA, Rahman MH, Hossain I. Outcome of standardized case management of under-5 children with severe acute malnutrition in three hospitals of Dhaka City in Bangladesh. Bangladesh J Child Health 2013; 37: 5-13. http://dx.doi.org/10.3329/bjch.v37i1.15345
Scrimshaw N, Taylor C, Gordon J (Eds.). Interactions of nutrition and infection. Geneva, Switzerland: World Health Organization 1968.
WHO: Guideline: Updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization 2013.
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