Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 12;8(1):63.
doi: 10.1186/s40795-022-00559-y.

Changing mortality amongst hospitalised children with Severe Acute Malnutrition in KwaZulu-Natal, South Africa, 2009 - 2018

S Ndlovu  1 , C David-Govender  2 , P Tinarwo  3 , K L Naidoo  4   5
Affiliations

Changing mortality amongst hospitalised children with Severe Acute Malnutrition in KwaZulu-Natal, South Africa, 2009 - 2018

S Ndlovu et al. BMC Nutr. .

Abstract

Background: The under-five mortality rates of children in South Africa (SA) remain high despite successful HIV prevention and treatment programs. The in-hospital mortality of children with severe acute malnutrition remains a key obstacle. This study identifies and describes changes in the mortality of under-five children with severe acute malnutrition (SAM) following the implementation of HIV and malnutrition prevention and treatment programmes.

Methods: This was a retrospective review of in-hospital mortality records and databases. The study was based at a large referral hospital in KwaZulu-Natal (KZN), where HIV and malnutrition rates are high, and SAM children are managed with standard WHO guidelines. Records of children under five years old who died from 2009 to 2018 were analysed.

Results: Of the 698 under-five children who died in this period, 285 (40, 8% of all under-5 deaths) were classified as having SAM. The number of HIV-infected SAM deaths dropped significantly, especially those below six months of age, mirroring the expansion of HIV treatment and prevention programmes. Despite this and a significant drop in the proportion of SAM admissions identified, there was no change in SAM case fatality rates over the ten years. Septicaemia remained the most common cause of death in children with SAM.

Conclusions: Despite significant decreases in HIV-related malnutrition deaths over ten years, the lack of change in SAM case fatality rates is a concern at this referral hospital. Standardised WHO inpatient management protocols, may require review, especially where underlying medical conditions may contribute to SAM deaths in HIV-negative children.

Keywords: HIV; Paediatrics; Severe acute malnutrition; Under-5 mortality.

PubMed Disclaimer

Conflict of interest statement

The author(s) declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article.

Figures

Fig. 1
Fig. 1
Change in percentage under-five deaths from 2009–2018
Fig. 2
Fig. 2
Changes in the proportion of SAM admissions as a percentage of all under-five admissions
Fig. 3
Fig. 3
Trend analysis of the proportion of SAM under-five deaths as a percentage of all under-five deaths and as a percentage of SAM admissions
Fig. 4
Fig. 4
Changes in HIV exposure percentage in SAM deaths
Fig. 5
Fig. 5
Changes in HIV-exposed and infected children with SAM who died. (2009–2018)
Fig. 6
Fig. 6
Comparing the relationship of age and HIV status with SAM nutritional status
Fig. 7
Fig. 7
Change in the top three causes of death from 2009 until 2018 in all children who died
See this image and copyright information in PMC

References

    1. UNICEF-WHO-The World Bank: Joint child malnutrition estimates — levels and trends – 2021 edition. https://data.unicef.org/resources/jme-report-2021/ (Accessed 14 Feb 2022)
    1. Yaya S, Bishwajit G, Okonofua F, et al. Under five mortality patterns and associated maternal risk factors in sub-Saharan Africa: A multi-country analysis. PLoS ONE. 2018;13(10):e0205977. doi: 10.1371/journal.pone.0205977. - DOI - PMC - PubMed
    1. Doherty T, Kroon M, Rhoda N, et al. ending preventable child deaths in South Africa: What role can ward-based outreach teams play? S Afr Med J. 2016;106(7):672–674. doi: 10.7196/samj.2016.v106i7.10790. - DOI - PubMed
    1. World Health Organization (WHO)/United Nations Children’s Fund (UNICEF). WHO Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. https://apps.who.int/iris/bitstream/handle/10665/44129/9789241598163_eng... (Accessed 14 Feb 2022) - PubMed
    1. Ashworth A, Chopra M, McCoy D, et al. WHO guidelines for management of severe malnutrition in rural South African hospitals: effect on case fatality and the influence of operational factors. Lancet. 2004;363(9415):1110–1115. doi: 10.1016/s0140-6736(04)15894-7. - DOI - PubMed

LinkOut - more resources