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. 2022 Apr;18(2):e13302.
doi: 10.1111/mcn.13302. Epub 2021 Dec 22.

Recovery of children following hospitalisation for complicated severe acute malnutrition

Mutsa Bwakura-Dangarembizi  1   2   3 , Cherlynn Dumbura  2 , Beatrice Amadi  4 , Bernard Chasekwa  2 , Deophine Ngosa  4 , Florence D Majo  2 , Jonathan P Sturgeon  2   5 , Kanta Chandwe  4 , Chanda Kapoma  4 , Claire D Bourke  2   5 , Ruairi C Robertson  2   5 , Kusum J Nathoo  1 , Robert Ntozini  2 , Shane A Norris  3 , Paul Kelly  4   5 , Andrew J Prendergast  2   5
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Recovery of children following hospitalisation for complicated severe acute malnutrition

Mutsa Bwakura-Dangarembizi et al. Matern Child Nutr. 2022 Apr.

Abstract

Nutritional recovery and hospital readmission following inpatient management of complicated severe acute malnutrition (SAM) are poorly characterised. We aimed to ascertain patterns and factors associated with hospital readmission, nutritional recovery and morbidity, in children discharged from hospital following management of complicated SAM in Zambia and Zimbabwe over 52-weeks posthospitalization. Multivariable Fine-Gray subdistribution hazard models, with death and loss to follow-up as competing risks, were used to identify factors associated with hospital readmission; negative binomial regression to assess time to hospitalisation and ordinal logistic regression to model factors associated with nutritional recovery. A total of 649 children (53% male, median age 18.2 months) were discharged to continue community nutritional rehabilitation. All-cause hospital readmission was 15.4% (95% CI 12.7, 18.6) over 52 weeks. Independent risk factors for time to readmission were cerebral palsy (adjusted subhazard ratio (aSHR): 2.96, 95% CI 1.56, 5.61) and nonoedematous SAM (aSHR: 1.64, 95%CI 1.03, 2.64). Unit increases in height-for-age Z-score (HAZ) (aSHR: 0.82, 95% CI 0.71, 0.95) and enrolment in Zambia (aSHR: 0.52, 95% CI 0.28, 0.97) were associated with reduced subhazard of time to readmission. Young age, SAM at discharge, nonoedematous SAM and cerebral palsy were associated with poor nutritional recovery throughout follow-up. Collectively, nonoedematous SAM, ongoing SAM at discharge, cerebral palsy and low HAZ are independent risk factors for readmission and poor nutritional recovery following complicated SAM. Children with these high-risk features should be prioritised for additional convalescent care to improve long-term outcomes.

Keywords: HIV; morbidity; nutritional recovery; readmission; severe acute malnutrition.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Cumulative incidence readmission among children discharged from hospital after treatment for complicated SAM. Curves showing cumulative incidence of readmission (death and loss to follow up as competing risks) postdischarge and log rank test p value. (a) overall cumulative incidence of readmission; (b) cumulative incidence of readmission by child HIV status; (c) cumulative incidence of readmission among children with oedematous versus nonoedematous SAM at the time of initial hospitalisation; (d) cumulative incidence of readmission in children with cerebral palsy versus those without cerebral palsy. Univariable subhazard ratios and log rank test p values were used to compare the differences in time to readmission between groups. Adjusted subhazard ratios are shown in Table 2
Figure 2
Figure 2
Patterns of nutritional recovery among children discharged from hospital after treatment for complicated severe acute malnutrition (SAM). Sankey diagram showing the pattern of nutritional recovery between hospital discharge and 52 weeks postdischarge. Nutritional status was assessed at every study visit and classified as SAM, moderate acute malnutrition (MAM) or adequately nourished (AN). The purple colour represents SAM, yellow MAM, and green AN. Children who withdrew consent were classified as (WC) and those who missed visits but turned up later were classified as missed
Figure 3
Figure 3
Mean weight for height Z‐score (WHZ) and mid‐upper arm circumference (MUAC) trend over the follow‐up time. Graphs showing mean change in WHZ and MUAC over the period of follow up for the following variables; sex, age, baseline oedema, severe acute malnutrition at discharge, cerebral palsy and stunting
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