Predictors of mortality among hospitalized children with severe acute malnutrition: a prospective study from Uganda
Background We determined the predictors of mortality among children admitted with severe acute malnutrition (SAM). Methods This was a prospective study nested in a randomized trial among 6–59-month-old children admitted with SAM. Socio-demographic and medical history data were collected using questi...
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| Veröffentlicht in: | Pediatric research 2018-07, Vol.84 (1), p.92-98 |
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| creator | Nabukeera-Barungi, Nicolette Grenov, Benedikte Lanyero, Betty Namusoke, Hanifa Mupere, Ezekiel Christensen, Vibeke Brix Michaelsen, Kim F. Mølgaard, Christian Rytter, Maren Johanne Friis, Henrik |
| description | Background
We determined the predictors of mortality among children admitted with severe acute malnutrition (SAM).
Methods
This was a prospective study nested in a randomized trial among 6–59-month-old children admitted with SAM. Socio-demographic and medical history data were collected using questionnaires and clinical examination, anthropometry and laboratory tests were performed. They were monitored daily until discharge or death during hospitalization while receiving care according to national guidelines. Predictors of death were assessed using Cox regression.
Results
Of 400 children, 9.8% (
n
= 39) died during hospitalization. Predictors of mortality included diarrhoea at admission [hazard ratio [HR] 2.19, 95% confidence interval (CI): 1.06; 4.51], lack of appetite [HR 4.50, 95% CI: 1.76; 11.50], suspected sepsis [HR 2.23, 95% CI: 1.18; 4.24] and skin ulcers [HR 4.23, 95% CI: 1.26; 4.17]. Chest indrawing [HR 5.0, 95% CI: 1.53; 16.3], oxygen saturation below 94% [HR 3.92, 95% CI: 1.42; 10.83] and confirmed HIV infection [HR 3.62, 95% CI: 1.69; 7.77] also predicted higher mortality.
Conclusion
Infections were major contributors to mortality. This underscores the need for improved prevention and management of these infections among children with severe malnutrition. |
| doi_str_mv | 10.1038/s41390-018-0016-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2045268614</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2084900362</sourcerecordid><originalsourceid>FETCH-LOGICAL-c415t-5570f733b9369780f1e4f7090d5798daa6595199447ac7edca30a0eb9cc57c4c3</originalsourceid><addsrcrecordid>eNp1kV9rFDEUxYNY7Fr9AL5IwJe-jL2ZJJOJb1KsCgV9sM8hm9zZTZmZrEmmdvvpzbJVQehT4OZ3zv1zCHnD4D0D3l9kwbiGBljfALCuuX9GVkzyWhFCPScrAM4arnV_Sl7mfFsZIXvxgpy2WmnZglqR_D2hD67ElGkc6BRTsWMoe2qnOG_oNuZdOFQe0FO3DaNPONNfoWxpxjtMSK1bCtLJjvNSUighzh-opbtUhehKuEOay-L3dEhxojcbO3v7ipwMdsz4-vE9IzdXn35cfmmuv33-evnxunGCydJIqWBQnK8177TqYWAoBgUavFS699Z2Ukumdd3VOoXeWQ4WcK2dk8oJx8_I-dG3TvNzwVzMFLLDcbQzxiWbFoRsu75joqLv_kNv45LmOl2leqHrJbu2UuxIubpeTjiYXQqTTXvDwBwSMcdETE3EHBIx91Xz9tF5WU_o_yr-RFCB9gjk-jVvMP1r_bTrb_QPmEU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2084900362</pqid></control><display><type>article</type><title>Predictors of mortality among hospitalized children with severe acute malnutrition: a prospective study from Uganda</title><source>MEDLINE</source><source>SpringerLink Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Nabukeera-Barungi, Nicolette ; Grenov, Benedikte ; Lanyero, Betty ; Namusoke, Hanifa ; Mupere, Ezekiel ; Christensen, Vibeke Brix ; Michaelsen, Kim F. ; Mølgaard, Christian ; Rytter, Maren Johanne ; Friis, Henrik</creator><creatorcontrib>Nabukeera-Barungi, Nicolette ; Grenov, Benedikte ; Lanyero, Betty ; Namusoke, Hanifa ; Mupere, Ezekiel ; Christensen, Vibeke Brix ; Michaelsen, Kim F. ; Mølgaard, Christian ; Rytter, Maren Johanne ; Friis, Henrik</creatorcontrib><description>Background
We determined the predictors of mortality among children admitted with severe acute malnutrition (SAM).
Methods
This was a prospective study nested in a randomized trial among 6–59-month-old children admitted with SAM. Socio-demographic and medical history data were collected using questionnaires and clinical examination, anthropometry and laboratory tests were performed. They were monitored daily until discharge or death during hospitalization while receiving care according to national guidelines. Predictors of death were assessed using Cox regression.
Results
Of 400 children, 9.8% (
n
= 39) died during hospitalization. Predictors of mortality included diarrhoea at admission [hazard ratio [HR] 2.19, 95% confidence interval (CI): 1.06; 4.51], lack of appetite [HR 4.50, 95% CI: 1.76; 11.50], suspected sepsis [HR 2.23, 95% CI: 1.18; 4.24] and skin ulcers [HR 4.23, 95% CI: 1.26; 4.17]. Chest indrawing [HR 5.0, 95% CI: 1.53; 16.3], oxygen saturation below 94% [HR 3.92, 95% CI: 1.42; 10.83] and confirmed HIV infection [HR 3.62, 95% CI: 1.69; 7.77] also predicted higher mortality.
Conclusion
Infections were major contributors to mortality. This underscores the need for improved prevention and management of these infections among children with severe malnutrition.</description><identifier>ISSN: 0031-3998</identifier><identifier>EISSN: 1530-0447</identifier><identifier>DOI: 10.1038/s41390-018-0016-x</identifier><identifier>PMID: 29795207</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>Anthropometry ; Bifidobacterium animalis ; Child ; Child, Hospitalized ; Child, Preschool ; Clinical Research Article ; Diarrhea - complications ; Female ; HIV Infections - complications ; Hospitalization - statistics & numerical data ; Humans ; Infant ; Lactobacillus rhamnosus ; Male ; Malnutrition ; Medicine ; Medicine & Public Health ; Mortality ; Pediatric Surgery ; Pediatrics ; Prevalence ; Probiotics - therapeutic use ; Proportional Hazards Models ; Prospective Studies ; Sepsis - complications ; Severe Acute Malnutrition - complications ; Severe Acute Malnutrition - mortality ; Skin Ulcer - complications ; Surveys and Questionnaires ; Uganda - epidemiology</subject><ispartof>Pediatric research, 2018-07, Vol.84 (1), p.92-98</ispartof><rights>International Pediatric Research Foundation, Inc 2018</rights><rights>Copyright Nature Publishing Group Jul 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-5570f733b9369780f1e4f7090d5798daa6595199447ac7edca30a0eb9cc57c4c3</citedby><cites>FETCH-LOGICAL-c415t-5570f733b9369780f1e4f7090d5798daa6595199447ac7edca30a0eb9cc57c4c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/s41390-018-0016-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/s41390-018-0016-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29795207$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nabukeera-Barungi, Nicolette</creatorcontrib><creatorcontrib>Grenov, Benedikte</creatorcontrib><creatorcontrib>Lanyero, Betty</creatorcontrib><creatorcontrib>Namusoke, Hanifa</creatorcontrib><creatorcontrib>Mupere, Ezekiel</creatorcontrib><creatorcontrib>Christensen, Vibeke Brix</creatorcontrib><creatorcontrib>Michaelsen, Kim F.</creatorcontrib><creatorcontrib>Mølgaard, Christian</creatorcontrib><creatorcontrib>Rytter, Maren Johanne</creatorcontrib><creatorcontrib>Friis, Henrik</creatorcontrib><title>Predictors of mortality among hospitalized children with severe acute malnutrition: a prospective study from Uganda</title><title>Pediatric research</title><addtitle>Pediatr Res</addtitle><addtitle>Pediatr Res</addtitle><description>Background
We determined the predictors of mortality among children admitted with severe acute malnutrition (SAM).
Methods
This was a prospective study nested in a randomized trial among 6–59-month-old children admitted with SAM. Socio-demographic and medical history data were collected using questionnaires and clinical examination, anthropometry and laboratory tests were performed. They were monitored daily until discharge or death during hospitalization while receiving care according to national guidelines. Predictors of death were assessed using Cox regression.
Results
Of 400 children, 9.8% (
n
= 39) died during hospitalization. Predictors of mortality included diarrhoea at admission [hazard ratio [HR] 2.19, 95% confidence interval (CI): 1.06; 4.51], lack of appetite [HR 4.50, 95% CI: 1.76; 11.50], suspected sepsis [HR 2.23, 95% CI: 1.18; 4.24] and skin ulcers [HR 4.23, 95% CI: 1.26; 4.17]. Chest indrawing [HR 5.0, 95% CI: 1.53; 16.3], oxygen saturation below 94% [HR 3.92, 95% CI: 1.42; 10.83] and confirmed HIV infection [HR 3.62, 95% CI: 1.69; 7.77] also predicted higher mortality.
Conclusion
Infections were major contributors to mortality. This underscores the need for improved prevention and management of these infections among children with severe malnutrition.</description><subject>Anthropometry</subject><subject>Bifidobacterium animalis</subject><subject>Child</subject><subject>Child, Hospitalized</subject><subject>Child, Preschool</subject><subject>Clinical Research Article</subject><subject>Diarrhea - complications</subject><subject>Female</subject><subject>HIV Infections - complications</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Infant</subject><subject>Lactobacillus rhamnosus</subject><subject>Male</subject><subject>Malnutrition</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Prevalence</subject><subject>Probiotics - therapeutic use</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Sepsis - complications</subject><subject>Severe Acute Malnutrition - complications</subject><subject>Severe Acute Malnutrition - mortality</subject><subject>Skin Ulcer - complications</subject><subject>Surveys and Questionnaires</subject><subject>Uganda - epidemiology</subject><issn>0031-3998</issn><issn>1530-0447</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kV9rFDEUxYNY7Fr9AL5IwJe-jL2ZJJOJb1KsCgV9sM8hm9zZTZmZrEmmdvvpzbJVQehT4OZ3zv1zCHnD4D0D3l9kwbiGBljfALCuuX9GVkzyWhFCPScrAM4arnV_Sl7mfFsZIXvxgpy2WmnZglqR_D2hD67ElGkc6BRTsWMoe2qnOG_oNuZdOFQe0FO3DaNPONNfoWxpxjtMSK1bCtLJjvNSUighzh-opbtUhehKuEOay-L3dEhxojcbO3v7ipwMdsz4-vE9IzdXn35cfmmuv33-evnxunGCydJIqWBQnK8177TqYWAoBgUavFS699Z2Ukumdd3VOoXeWQ4WcK2dk8oJx8_I-dG3TvNzwVzMFLLDcbQzxiWbFoRsu75joqLv_kNv45LmOl2leqHrJbu2UuxIubpeTjiYXQqTTXvDwBwSMcdETE3EHBIx91Xz9tF5WU_o_yr-RFCB9gjk-jVvMP1r_bTrb_QPmEU</recordid><startdate>20180701</startdate><enddate>20180701</enddate><creator>Nabukeera-Barungi, Nicolette</creator><creator>Grenov, Benedikte</creator><creator>Lanyero, Betty</creator><creator>Namusoke, Hanifa</creator><creator>Mupere, Ezekiel</creator><creator>Christensen, Vibeke Brix</creator><creator>Michaelsen, Kim F.</creator><creator>Mølgaard, Christian</creator><creator>Rytter, Maren Johanne</creator><creator>Friis, Henrik</creator><general>Nature Publishing Group US</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20180701</creationdate><title>Predictors of mortality among hospitalized children with severe acute malnutrition: a prospective study from Uganda</title><author>Nabukeera-Barungi, Nicolette ; Grenov, Benedikte ; Lanyero, Betty ; Namusoke, Hanifa ; Mupere, Ezekiel ; Christensen, Vibeke Brix ; Michaelsen, Kim F. ; Mølgaard, Christian ; Rytter, Maren Johanne ; Friis, Henrik</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-5570f733b9369780f1e4f7090d5798daa6595199447ac7edca30a0eb9cc57c4c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Anthropometry</topic><topic>Bifidobacterium animalis</topic><topic>Child</topic><topic>Child, Hospitalized</topic><topic>Child, Preschool</topic><topic>Clinical Research Article</topic><topic>Diarrhea - complications</topic><topic>Female</topic><topic>HIV Infections - complications</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Infant</topic><topic>Lactobacillus rhamnosus</topic><topic>Male</topic><topic>Malnutrition</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Prevalence</topic><topic>Probiotics - therapeutic use</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Sepsis - complications</topic><topic>Severe Acute Malnutrition - complications</topic><topic>Severe Acute Malnutrition - mortality</topic><topic>Skin Ulcer - complications</topic><topic>Surveys and Questionnaires</topic><topic>Uganda - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nabukeera-Barungi, Nicolette</creatorcontrib><creatorcontrib>Grenov, Benedikte</creatorcontrib><creatorcontrib>Lanyero, Betty</creatorcontrib><creatorcontrib>Namusoke, Hanifa</creatorcontrib><creatorcontrib>Mupere, Ezekiel</creatorcontrib><creatorcontrib>Christensen, Vibeke Brix</creatorcontrib><creatorcontrib>Michaelsen, Kim F.</creatorcontrib><creatorcontrib>Mølgaard, Christian</creatorcontrib><creatorcontrib>Rytter, Maren Johanne</creatorcontrib><creatorcontrib>Friis, Henrik</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nabukeera-Barungi, Nicolette</au><au>Grenov, Benedikte</au><au>Lanyero, Betty</au><au>Namusoke, Hanifa</au><au>Mupere, Ezekiel</au><au>Christensen, Vibeke Brix</au><au>Michaelsen, Kim F.</au><au>Mølgaard, Christian</au><au>Rytter, Maren Johanne</au><au>Friis, Henrik</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of mortality among hospitalized children with severe acute malnutrition: a prospective study from Uganda</atitle><jtitle>Pediatric research</jtitle><stitle>Pediatr Res</stitle><addtitle>Pediatr Res</addtitle><date>2018-07-01</date><risdate>2018</risdate><volume>84</volume><issue>1</issue><spage>92</spage><epage>98</epage><pages>92-98</pages><issn>0031-3998</issn><eissn>1530-0447</eissn><abstract>Background
We determined the predictors of mortality among children admitted with severe acute malnutrition (SAM).
Methods
This was a prospective study nested in a randomized trial among 6–59-month-old children admitted with SAM. Socio-demographic and medical history data were collected using questionnaires and clinical examination, anthropometry and laboratory tests were performed. They were monitored daily until discharge or death during hospitalization while receiving care according to national guidelines. Predictors of death were assessed using Cox regression.
Results
Of 400 children, 9.8% (
n
= 39) died during hospitalization. Predictors of mortality included diarrhoea at admission [hazard ratio [HR] 2.19, 95% confidence interval (CI): 1.06; 4.51], lack of appetite [HR 4.50, 95% CI: 1.76; 11.50], suspected sepsis [HR 2.23, 95% CI: 1.18; 4.24] and skin ulcers [HR 4.23, 95% CI: 1.26; 4.17]. Chest indrawing [HR 5.0, 95% CI: 1.53; 16.3], oxygen saturation below 94% [HR 3.92, 95% CI: 1.42; 10.83] and confirmed HIV infection [HR 3.62, 95% CI: 1.69; 7.77] also predicted higher mortality.
Conclusion
Infections were major contributors to mortality. This underscores the need for improved prevention and management of these infections among children with severe malnutrition.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>29795207</pmid><doi>10.1038/s41390-018-0016-x</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Pediatric research, 2018-07, Vol.84 (1), p.92-98 |
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| source | MEDLINE; SpringerLink Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Anthropometry Bifidobacterium animalis Child Child, Hospitalized Child, Preschool Clinical Research Article Diarrhea - complications Female HIV Infections - complications Hospitalization - statistics & numerical data Humans Infant Lactobacillus rhamnosus Male Malnutrition Medicine Medicine & Public Health Mortality Pediatric Surgery Pediatrics Prevalence Probiotics - therapeutic use Proportional Hazards Models Prospective Studies Sepsis - complications Severe Acute Malnutrition - complications Severe Acute Malnutrition - mortality Skin Ulcer - complications Surveys and Questionnaires Uganda - epidemiology |
| title | Predictors of mortality among hospitalized children with severe acute malnutrition: a prospective study from Uganda |
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