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Research article
Damalie Nalwanga
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1862-8109
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Background: Mortality among children under five years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under five years of age admitted to the NRH for routine care of SAM. Methods: This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14. Results: Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2 % (95% CI 19.9-30.4%) died. In-hospital mortality was 20.7% (95% CI 15.9-25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2-4.2), p=0.014), bacteraemia (AHR 9 (95% CI 3.4-23.0), p<0.001, and low glomerular filtration rate (GFR), AHR 3.2; (95% CI 1.7-6.3), p=0.001). Conclusions: A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have GFR below 60 mL/min/1.73m2 or are bacteraemic, are more likely to die. Further studies to explore the relationship between GFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.
Keywords
Severe Acute Malnutrition, Mortality, Children, Uganda
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CURRENT STATUS: Published
View the published article at BMC Pediatrics.
No community comments so far
Submission checks complete
On 17 Apr, 2020
Editorial decision: Accept
On 17 Apr, 2020
No comments provided
Submission checks complete
On 14 Apr, 2020
Editorial decision: Minor revision
On 14 Apr, 2020
No comments provided
Editorial decision: Major revision
On 24 Feb, 2020
Review #3 received
Received 21 Feb, 2020
Reviewer #3 agreed
On 17 Feb, 2020
Review #1 received
Received 31 Oct, 2019
Review #2 received
Received 31 Oct, 2019
Reviewer #2 agreed
On 25 Oct, 2019
Reviewer #1 agreed
On 24 Oct, 2019
Editor assigned
On 23 Oct, 2019
Reviewers invited
Invitations sent on 23 Oct, 2019
Submission checks complete
On 22 Oct, 2019
Editor invited
On 22 Oct, 2019
Version 1
Posted 01 Jul, 2019
No comments provided
Editorial decision: Major revision
On 25 Sep, 2019
Review #1 received
Received 11 Sep, 2019
Review #2 received
Received 03 Sep, 2019
Reviewer #2 agreed
On 20 Aug, 2019
Reviewer #1 agreed
On 26 Jul, 2019
Reviewers invited
Invitations sent on 23 Jul, 2019
Submission checks complete
On 25 Jun, 2019
Editor invited
On 25 Jun, 2019
Editor assigned
On 20 Jun, 2019
First submitted
On 13 Jun, 2019
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Pediatrics
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A new preprint design is coming!
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See the published version of this preprint at BMC Pediatrics.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Damalie Nalwanga
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1862-8109
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Pediatrics.
No community comments so far
Submission checks complete
On 17 Apr, 2020
Editorial decision: Accept
On 17 Apr, 2020
No comments provided
Submission checks complete
On 14 Apr, 2020
Editorial decision: Minor revision
On 14 Apr, 2020
No comments provided
Editorial decision: Major revision
On 24 Feb, 2020
Review #3 received
Received 21 Feb, 2020
Reviewer #3 agreed
On 17 Feb, 2020
Review #1 received
Received 31 Oct, 2019
Review #2 received
Received 31 Oct, 2019
Reviewer #2 agreed
On 25 Oct, 2019
Reviewer #1 agreed
On 24 Oct, 2019
Editor assigned
On 23 Oct, 2019
Reviewers invited
Invitations sent on 23 Oct, 2019
Submission checks complete
On 22 Oct, 2019
Editor invited
On 22 Oct, 2019
Version 1
Posted 01 Jul, 2019
No comments provided
Editorial decision: Major revision
On 25 Sep, 2019
Review #1 received
Received 11 Sep, 2019
Review #2 received
Received 03 Sep, 2019
Reviewer #2 agreed
On 20 Aug, 2019
Reviewer #1 agreed
On 26 Jul, 2019
Reviewers invited
Invitations sent on 23 Jul, 2019
Submission checks complete
On 25 Jun, 2019
Editor invited
On 25 Jun, 2019
Editor assigned
On 20 Jun, 2019
First submitted
On 13 Jun, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Pediatrics.
Background: Mortality among children under five years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under five years of age admitted to the NRH for routine care of SAM. Methods: This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14. Results: Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2 % (95% CI 19.9-30.4%) died. In-hospital mortality was 20.7% (95% CI 15.9-25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2-4.2), p=0.014), bacteraemia (AHR 9 (95% CI 3.4-23.0), p<0.001, and low glomerular filtration rate (GFR), AHR 3.2; (95% CI 1.7-6.3), p=0.001). Conclusions: A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have GFR below 60 mL/min/1.73m2 or are bacteraemic, are more likely to die. Further studies to explore the relationship between GFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.
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