Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome
Severe acute malnutrition (SAM) accounts for two million deaths worldwide annually. In those hospitalised with SAM, concomitant infections and diarrhoea are frequent complications resulting in adverse outcome. We examined the clinical and laboratory features on admission and outcome of children with...
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| Veröffentlicht in: | PloS one 2012-06, Vol.7 (6), p.e38321-e38321 |
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| creator | Talbert, Alison Thuo, Nahashon Karisa, Japhet Chesaro, Charles Ohuma, Eric Ignas, James Berkley, James A Toromo, Christopher Atkinson, Sarah Maitland, Kathryn |
| description | Severe acute malnutrition (SAM) accounts for two million deaths worldwide annually. In those hospitalised with SAM, concomitant infections and diarrhoea are frequent complications resulting in adverse outcome. We examined the clinical and laboratory features on admission and outcome of children with SAM and diarrhoea at a Kenyan district hospital.
A 4-year prospective descriptive study involving 1,206 children aged 6 months to 12 years, hospitalized with SAM and managed in accordance with WHO guidelines. Data on clinical features, haematological, biochemical and microbiological findings for children with diarrhoea (≥ 3 watery stools/day) were systematically collected and analyzed to identify risk factors associated with poor outcome.
At admission 592 children (49%) had diarrhoea of which 122 (21%) died compared to 72/614 (12%) deaths in those without diarrhoea at admission (Χ(2) = 17.6 p |
| doi_str_mv | 10.1371/journal.pone.0038321 |
| format | Article |
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A 4-year prospective descriptive study involving 1,206 children aged 6 months to 12 years, hospitalized with SAM and managed in accordance with WHO guidelines. Data on clinical features, haematological, biochemical and microbiological findings for children with diarrhoea (≥ 3 watery stools/day) were systematically collected and analyzed to identify risk factors associated with poor outcome.
At admission 592 children (49%) had diarrhoea of which 122 (21%) died compared to 72/614 (12%) deaths in those without diarrhoea at admission (Χ(2) = 17.6 p<0.001). A further 187 (16%) children developed diarrhoea after 48 hours of admission and 33 died (18%). Any diarrhoea during admission resulted in a significantly higher mortality 161/852 (19%) than those uncomplicated by diarrhoea 33/351 (9%) (Χ(2) = 16.6 p<0.001). Features associated with a fatal outcome in children presenting with diarrhoea included bacteraemia, hyponatraemia, low mid-upper arm circumference <10 cm, hypoxia, hypokalaemia and oedema. Bacteraemia had the highest risk of death (adjusted OR 6.1; 95% C.I 2.3, 16.3 p<0.001); and complicated 24 (20%) of fatalities. Positive HIV antibody status was more frequent in cases with diarrhoea at admission (23%) than those without (15%, Χ(2) = 12.0 p = 0.001) but did not increase the risk of death in diarrhoea cases.
Children with SAM complicated by diarrhoea had a higher risk of death than those who did not have diarrhoea during their hospital stay. Further operational and clinical research is needed to reduce mortality in children with SAM in the given setting.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0038321</identifier><identifier>PMID: 22675542</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acute Disease ; Antigens ; Arm circumference ; Bacteremia ; Bacteria - isolation & purification ; Bacterial infections ; Biology ; Child ; Child, Preschool ; Children ; Chromatography ; Complications ; Death ; Diarrhea ; Diarrhea - blood ; Diarrhea - complications ; Diarrhea - microbiology ; Diarrhea - mortality ; Edema ; Fatalities ; Hematology ; HIV antibodies ; Hospitalization - statistics & numerical data ; Hospitals ; Humans ; Hyponatremia ; Hypoxia ; Infant ; Infection ; Infections ; Kaplan-Meier Estimate ; Kenya - epidemiology ; Logistic Models ; Malnutrition ; Malnutrition - blood ; Malnutrition - complications ; Malnutrition - microbiology ; Malnutrition - mortality ; Medical research ; Medicine ; Monte Carlo simulation ; Mortality ; Multivariate Analysis ; Native peoples ; Nutrition ; Permeability ; Plasma ; Population ; Prospective Studies ; Risk analysis ; Risk Factors ; Studies ; Treatment Outcome</subject><ispartof>PloS one, 2012-06, Vol.7 (6), p.e38321-e38321</ispartof><rights>COPYRIGHT 2012 Public Library of Science</rights><rights>2012 Talbert et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Talbert et al. 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-b43dac3f60038017a4839f8d4ad9f9c94ce9ec1898f986c1b3ef2b6293a3c7bb3</citedby><cites>FETCH-LOGICAL-c692t-b43dac3f60038017a4839f8d4ad9f9c94ce9ec1898f986c1b3ef2b6293a3c7bb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366921/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366921/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22675542$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Nizami, Qamaruddin</contributor><creatorcontrib>Talbert, Alison</creatorcontrib><creatorcontrib>Thuo, Nahashon</creatorcontrib><creatorcontrib>Karisa, Japhet</creatorcontrib><creatorcontrib>Chesaro, Charles</creatorcontrib><creatorcontrib>Ohuma, Eric</creatorcontrib><creatorcontrib>Ignas, James</creatorcontrib><creatorcontrib>Berkley, James A</creatorcontrib><creatorcontrib>Toromo, Christopher</creatorcontrib><creatorcontrib>Atkinson, Sarah</creatorcontrib><creatorcontrib>Maitland, Kathryn</creatorcontrib><title>Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Severe acute malnutrition (SAM) accounts for two million deaths worldwide annually. In those hospitalised with SAM, concomitant infections and diarrhoea are frequent complications resulting in adverse outcome. We examined the clinical and laboratory features on admission and outcome of children with SAM and diarrhoea at a Kenyan district hospital.
A 4-year prospective descriptive study involving 1,206 children aged 6 months to 12 years, hospitalized with SAM and managed in accordance with WHO guidelines. Data on clinical features, haematological, biochemical and microbiological findings for children with diarrhoea (≥ 3 watery stools/day) were systematically collected and analyzed to identify risk factors associated with poor outcome.
At admission 592 children (49%) had diarrhoea of which 122 (21%) died compared to 72/614 (12%) deaths in those without diarrhoea at admission (Χ(2) = 17.6 p<0.001). A further 187 (16%) children developed diarrhoea after 48 hours of admission and 33 died (18%). Any diarrhoea during admission resulted in a significantly higher mortality 161/852 (19%) than those uncomplicated by diarrhoea 33/351 (9%) (Χ(2) = 16.6 p<0.001). Features associated with a fatal outcome in children presenting with diarrhoea included bacteraemia, hyponatraemia, low mid-upper arm circumference <10 cm, hypoxia, hypokalaemia and oedema. Bacteraemia had the highest risk of death (adjusted OR 6.1; 95% C.I 2.3, 16.3 p<0.001); and complicated 24 (20%) of fatalities. Positive HIV antibody status was more frequent in cases with diarrhoea at admission (23%) than those without (15%, Χ(2) = 12.0 p = 0.001) but did not increase the risk of death in diarrhoea cases.
Children with SAM complicated by diarrhoea had a higher risk of death than those who did not have diarrhoea during their hospital stay. Further operational and clinical research is needed to reduce mortality in children with SAM in the given setting.</description><subject>Acute Disease</subject><subject>Antigens</subject><subject>Arm circumference</subject><subject>Bacteremia</subject><subject>Bacteria - isolation & purification</subject><subject>Bacterial infections</subject><subject>Biology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Chromatography</subject><subject>Complications</subject><subject>Death</subject><subject>Diarrhea</subject><subject>Diarrhea - blood</subject><subject>Diarrhea - complications</subject><subject>Diarrhea - microbiology</subject><subject>Diarrhea - mortality</subject><subject>Edema</subject><subject>Fatalities</subject><subject>Hematology</subject><subject>HIV antibodies</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hyponatremia</subject><subject>Hypoxia</subject><subject>Infant</subject><subject>Infection</subject><subject>Infections</subject><subject>Kaplan-Meier Estimate</subject><subject>Kenya - epidemiology</subject><subject>Logistic Models</subject><subject>Malnutrition</subject><subject>Malnutrition - blood</subject><subject>Malnutrition - complications</subject><subject>Malnutrition - microbiology</subject><subject>Malnutrition - mortality</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Monte Carlo simulation</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Native peoples</subject><subject>Nutrition</subject><subject>Permeability</subject><subject>Plasma</subject><subject>Population</subject><subject>Prospective Studies</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Studies</subject><subject>Treatment 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complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome</title><author>Talbert, Alison ; Thuo, Nahashon ; Karisa, Japhet ; Chesaro, Charles ; Ohuma, Eric ; Ignas, James ; Berkley, James A ; Toromo, Christopher ; Atkinson, Sarah ; Maitland, Kathryn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-b43dac3f60038017a4839f8d4ad9f9c94ce9ec1898f986c1b3ef2b6293a3c7bb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Acute Disease</topic><topic>Antigens</topic><topic>Arm circumference</topic><topic>Bacteremia</topic><topic>Bacteria - isolation & purification</topic><topic>Bacterial infections</topic><topic>Biology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Chromatography</topic><topic>Complications</topic><topic>Death</topic><topic>Diarrhea</topic><topic>Diarrhea - 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acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2012-06-04</date><risdate>2012</risdate><volume>7</volume><issue>6</issue><spage>e38321</spage><epage>e38321</epage><pages>e38321-e38321</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Severe acute malnutrition (SAM) accounts for two million deaths worldwide annually. In those hospitalised with SAM, concomitant infections and diarrhoea are frequent complications resulting in adverse outcome. We examined the clinical and laboratory features on admission and outcome of children with SAM and diarrhoea at a Kenyan district hospital.
A 4-year prospective descriptive study involving 1,206 children aged 6 months to 12 years, hospitalized with SAM and managed in accordance with WHO guidelines. Data on clinical features, haematological, biochemical and microbiological findings for children with diarrhoea (≥ 3 watery stools/day) were systematically collected and analyzed to identify risk factors associated with poor outcome.
At admission 592 children (49%) had diarrhoea of which 122 (21%) died compared to 72/614 (12%) deaths in those without diarrhoea at admission (Χ(2) = 17.6 p<0.001). A further 187 (16%) children developed diarrhoea after 48 hours of admission and 33 died (18%). Any diarrhoea during admission resulted in a significantly higher mortality 161/852 (19%) than those uncomplicated by diarrhoea 33/351 (9%) (Χ(2) = 16.6 p<0.001). Features associated with a fatal outcome in children presenting with diarrhoea included bacteraemia, hyponatraemia, low mid-upper arm circumference <10 cm, hypoxia, hypokalaemia and oedema. Bacteraemia had the highest risk of death (adjusted OR 6.1; 95% C.I 2.3, 16.3 p<0.001); and complicated 24 (20%) of fatalities. Positive HIV antibody status was more frequent in cases with diarrhoea at admission (23%) than those without (15%, Χ(2) = 12.0 p = 0.001) but did not increase the risk of death in diarrhoea cases.
Children with SAM complicated by diarrhoea had a higher risk of death than those who did not have diarrhoea during their hospital stay. Further operational and clinical research is needed to reduce mortality in children with SAM in the given setting.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>22675542</pmid><doi>10.1371/journal.pone.0038321</doi><tpages>e38321</tpages><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_1325003210 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acute Disease Antigens Arm circumference Bacteremia Bacteria - isolation & purification Bacterial infections Biology Child Child, Preschool Children Chromatography Complications Death Diarrhea Diarrhea - blood Diarrhea - complications Diarrhea - microbiology Diarrhea - mortality Edema Fatalities Hematology HIV antibodies Hospitalization - statistics & numerical data Hospitals Humans Hyponatremia Hypoxia Infant Infection Infections Kaplan-Meier Estimate Kenya - epidemiology Logistic Models Malnutrition Malnutrition - blood Malnutrition - complications Malnutrition - microbiology Malnutrition - mortality Medical research Medicine Monte Carlo simulation Mortality Multivariate Analysis Native peoples Nutrition Permeability Plasma Population Prospective Studies Risk analysis Risk Factors Studies Treatment Outcome |
| title | Diarrhoea complicating severe acute malnutrition in Kenyan children: a prospective descriptive study of risk factors and outcome |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-01T14%3A56%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Diarrhoea%20complicating%20severe%20acute%20malnutrition%20in%20Kenyan%20children:%20a%20prospective%20descriptive%20study%20of%20risk%20factors%20and%20outcome&rft.jtitle=PloS%20one&rft.au=Talbert,%20Alison&rft.date=2012-06-04&rft.volume=7&rft.issue=6&rft.spage=e38321&rft.epage=e38321&rft.pages=e38321-e38321&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0038321&rft_dat=%3Cgale_plos_%3EA477116627%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1325003210&rft_id=info:pmid/22675542&rft_galeid=A477116627&rft_doaj_id=oai_doaj_org_article_f4c19f6c7df9472d88808720882e754f&rfr_iscdi=true |