Original ArticleDiarrhea, Dehydration, and the Associated Mortality in Children with Complicated Severe Acute Malnutrition: A Prospective Cohort Study in Uganda
Section snippets
Methods
The study was a prospective cohort study nested in a randomized, controlled intervention trial assessing the effect of probiotics on diarrhea in 400 children with cSAM.20 The study was conducted at Mwanamugimu Nutrition Unit, Mulago National Referral Hospital, Kampala, Uganda, between March 2014 and September 2015. Children aged 6-59 months with cSAM were eligible for the study. SAM was defined as weight-for-height z-score (WHZ) of less than −3 or a mid-upper arm circumference (MUAC) of less
Results
Of 400 children enrolled, the median age was 15.0 months (IQR, 11.2-19.2 months) and 58% were boys. Two-thirds (66%) had edematous malnutrition, 11% (n = 43) were confirmed to have HIV, and 61% (n = 244) were reported by caregivers to have diarrhea at the time of admission. The median duration of diarrhea present at admission was 7 days (IQR 4-21 days) and 43% of the 244 children (n = 103) presenting with diarrhea reported persistent diarrhea with 14 or more days of diarrhea before admission.
Discussion
In our study, days with diarrhea during hospitalization were strongly correlated with mortality. The OR for mortality was 1.4 for each additional day of diarrhea during hospitalization. As reported elsewhere from this study, children admitted with diarrhea had a 2.2-fold higher hazard ratio of dying compared with children admitted without diarrhea.19 In Kenya, Talbert et al found a higher mortality in children with SAM admitted with or having any diarrhea during the hospitalization period
Data Statement
Data sharing statement available at www.jpeds.com.
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2023, Biochimica et Biophysica Acta - Molecular Basis of DiseaseCitation Excerpt :Severely malnourished children face high mortality rates when admitted to hospital for treatment of acute, mostly infectious, illnesses (e.g. 23–46 % in African hospitals) [11–14]. These children often show signs of hepatic dysfunction (e.g. hypoglycaemia, bile acid dysregulation) and intestinal dysfunction (e.g. diarrhea, increased intestinal permeability), both of which have negative impacts on their survival [15–18]. Children with severe malnutrition are extremely vulnerable and simple re-feeding protocols do not produce acceptable levels of recovery, thus the development of co-therapies are urgently needed.
Funded by University of Copenhagen, Chr. Hansen A/S, Denmark and Innovation Fund Denmark.
The authors declare no conflicts of interest.