Prognostic factors in children with severe acute malnutrition at a tertiary hospital in Cape Town, South Africa
Thesis (MMed)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Severe acute malnutrition (SAM) remains a common problem worldwide and causes many childhood deaths. The World Health Organisation (WHO) aims for a case-fatality rate of <5% and has an established protocol to optimally manage patients. AIMS AND METHODS: We aimed to identify prognostic factors affecting the outcome of children under the age of 5 years admitted with severe acute malnutrition with oedema. This was a retrospective descriptive study over 2 years at a tertiary hospital in Cape Town, South Africa, documenting demographic details, co-morbidity including HIV exposure or infection, referral pattern, laboratory results, complications and clinical outcome. RESULTS: There were 59 patients with a median age of 12 months of whom 33 (56%) were male. Thirty-two children (54%) already had documented growth faltering and 9 of these 32 children (28.1%) died. There were 24 patients (40.6%) transferred from other hospitals, and they did significantly worse than children referred from community clinics (mortality rate 58.3% vs. 5.7%) (p<0.01). Fourteen children (23.7%) were HIV positive with a mortality rate of 42.8%. The overall mortality was 28.9%, with 81% of deaths occurring within the first 72 hours. Liver impairment (p<0.05), very low serum phosphate (p<0.01), and positive blood cultures (p<0.02) were all significantly associated with an increased risk of dying. CONCLUSION: Our mortality rate for SAM is high. Children with SAM need to be carefully assessed and managed, particularly during the first 72 hours, when mortality is highest, with additional vigilance in those who have poor prognostic factors. Growth faltering should be identified early and appropriately acted upon.