Prognostic factors in children with severe acute malnutrition at a tertiary hospital in Cape Town, South Africa

dc.contributor.advisorNel, Etienneen_ZA
dc.contributor.advisorCooke, Melissa Louiseen_ZA
dc.contributor.authorSwanson, Lenise C.en_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.en_ZA
dc.descriptionThesis (MMed)--Stellenbosch University, 2014.en_ZA
dc.description.abstractENGLISH 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.en_ZA
dc.format.extent33 pagesen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen
dc.subjectSevere acute malnutrition -- South Africa -- Cape Townen_ZA
dc.subjectMalnutrition in children -- Prognosisen_ZA
dc.titlePrognostic factors in children with severe acute malnutrition at a tertiary hospital in Cape Town, South Africaen_ZA
dc.rights.holderStellenbosch Universityen

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