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
Observational Study
. 2023 Sep;77(9):895-904.
doi: 10.1038/s41430-023-01320-9. Epub 2023 Aug 8.

Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia

Jonathan P Sturgeon  1   2 , Wadzanai Mufukari  3 , Joice Tome  3 , Cherlynn Dumbura  3 , Florence D Majo  3 , Deophine Ngosa  4 , Kanta Chandwe  4 , Chanda Kapoma  4 , Kuda Mutasa  3 , Kusum J Nathoo  5 , Claire D Bourke  3   6 , Robert Ntozini  3 , Mutsa Bwakura-Dangarembizi  3   5 , Beatrice Amadi  4 , Paul Kelly  4   6 , Andrew J Prendergast  3   6 ; HOPE-SAM study team
Collaborators, Affiliations
Observational Study

Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia

Jonathan P Sturgeon et al. Eur J Clin Nutr. 2023 Sep.

Abstract

Background/objectives: Malnutrition underlies 45% of deaths in children under-5 years annually. Children hospitalised with complicated severe acute malnutrition (SAM) have unacceptably high mortality. We aimed to identify variables from early hospital admission (baseline factors) independently associated with inpatient mortality in this cohort to identify those most at risk.

Subjects/methods: Observational study of 745 children aged 0-59 months admitted with complicated SAM at three hospitals in Zimbabwe/Zambia. Children underwent anthropometry and clinical assessment by a study physician within 72 h of enrolment, and caregivers provided sociodemographic data. Children were followed-up daily until discharge/death. A multivariable survival analysis identified the baseline factors independently associated with mortality.

Results: 70/745 (9.4%) children died in hospital. Age between 6-23 months [aHR 6.53, 95%CI 2.24-19.02], higher mid-upper arm circumference [aHR 0.73, 95%CI 0.59-0.89], presence of oedema [aHR 2.22, 95%CI 1.23-4.05], shock [aHR 8.18, 95%CI 3.79-17.65], sepsis [aHR 3.13, 95%CI 1.44-6.80], persistent diarrhoea [aHR 2.27, 95%CI 1.18-4.37], lack of a toilet at home [aHR 4.35, 95%CI 1.65-11.47], and recruitment at one Harare site [aHR 0.38, 95%CI 0.18-0.83] were all independently associated with inpatient mortality. Oedematous children had a significantly higher birthweight [2987 g vs 2757 g, p < 0.001] than those without oedema; higher birthweight was weakly associated with mortality [aHR 1.50 95%CI 0.97-2.31].

Conclusions: Children with oedema, low MUAC, baseline infections, shock and lack of home sanitation had a significantly increased risk of inpatient mortality following hospitalisation for complicated SAM. Children with high-risk features may require additional care. A better understanding of the pathophysiology of SAM is needed to identify adjunctive interventions.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Enrolment in HOPE-SAM study.
Flow diagram of children recruited in the HOPE-SAM study.
Fig. 2
Fig. 2. Kaplan-Meier curves for each of the seven significant categorical variables.
Hazard tables are included beneath each graph. Graphs showing survival by A age group, B site, C presence of oedema, D Shock, E Diarrhoea, F Sepsis and G access to a toilet.
See this image and copyright information in PMC

Comment in

References

    1. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–51. doi: 10.1016/s0140-6736(13)60937-x. - DOI - PubMed
    1. World Health Organization, Food and Agriculture Organization of the United Nations. Driving commitment for nutrition within the UN Decade of Action on Nutrition: policy brief. Geneva: World Health Organization; 2018 (WHO/NMH/NHD/17.11).
    1. Thaxton GE, Melby PC, Manary MJ, Preidis GA. New insights into the pathogenesis and treatment of malnutrition. Gastroenterol Clin. 2018;47:813–27. doi: 10.1016/j.gtc.2018.07.007. - DOI - PMC - PubMed
    1. Bwakura-Dangarembizi M, Amadi B, Bourke CD, Robertson RC, Mwapenya B, Chandwe K, et al. Health Outcomes, Pathogenesis and Epidemiology of Severe Acute Malnutrition (HOPE-SAM): rationale and methods of a longitudinal observational study. BMJ Open. 2019;9:e023077.. doi: 10.1136/bmjopen-2018-023077. - DOI - PMC - PubMed
    1. World Health Organization. Guideline: updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization; 2013. - PubMed

Publication types