Biomarkers of post-discharge mortality among children with complicated severe acute malnutrition

Background: Children with severe acute malnutrition (SAM) having medical complications require immediate care at malnutrition treatment centers (MTC). Thus, it becomes important to assess the effect and treatment cost of such children in these facilities. Hence, the present study was done with these aims in two MTCs in Jharkhand, India.Methods: A retrospective record review was done of the children admitted to these two MTCs between 1st April 2017 and 31st March 2018. A predesigned proforma was used to collect child related information. The data collected was entered in Microsoft excel sheet and analysed.Results: Majority of the admitted children (90.6%) were in 6-23 months age group. 358 (51.5%) children were females. Only, 194 (27.9%) children admitted were SAM had any medical complication. 690 (99.3%) children were discharged of whom 499 (72.3%) were discharged after achieving the target weight. The average weight gain during their stay was 8.1±2.4 g/kg/day and average length of stay was 16.7±3.2 days. Post discharge follow up rates were found to be low and only 130 (18.8%) children completed all three follow ups. Average cost per SAM child treated was Rs. 18,599 (US$ 272) and per SAM child cured was Rs. 25,904 (US$ 379).Conclusions: MTCs are effective in managing medically complicated SAM children. However, improvements are necessary to ensure that more such children should be treated at facility level, complimented with a community based programme for managing uncomplicated SAM children to improve coverage and ensure continuum of care.

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Post-Discharge survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to Minia University Maternity and Children Hospital

10.21203/rs.2.13514/v1 ◽

2019 ◽

Author(s):

Eman Ghazawy ◽

Gihan Bebars ◽

Ehab Salah Eshak

Keyword(s):

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Treatment Programs ◽

Cumulative Probability ◽

Post Discharge ◽

Under Five ◽

Survival Status ◽

Probability Of Survival ◽

Malnourished Children ◽

Nutrition Rehabilitation

Abstract Background: Though effective treatment programs for severely malnourished children are available, but little is known about long-term outcomes and potential predictors of post-discharge mortality. The aim of this study was to assess the post-discharge survival status and predictors for post-discharge mortality in severely malnourished children admitted to Minia University Maternity and Children Hospital Methods: A retrospective cohort study which included 135 children under five years of age who were admitted to the nutrition rehabilitation ward with severe acute malnutrition (SAM) during the period from January to December 2018. Data were collected from the inpatients hospital records and children’s parents/guardians were interviewed using a detailed structured questionnaire that inquired about demographic and socioeconomic variables. Results: A total of 135 children were enrolled into the study. Death rate during hospitalization was 9.6%. The cumulative probability of survival beyond eight weeks and at least for 24 weeks after discharge was 89.3% with a cumulative probability of post-discharge mortality of 10.7% and all deaths occurred within eight weeks after discharge. The main predictors for post-discharge mortality were illiteracy of mothers and the presence of edema at admission; the multivariable HRs (95%CIs) were 7.10 (1.58-31.93; p=0.01) and 6.96 (0.84-357.85; p=0.07), respectively. Conclusions: Mothers’ education and edema at admission are independent predictors for post-discharge mortality in under-five children with SAM. The identification of predictors for post-discharge mortality is an important preliminary step for interventions aiming to reduce morbidity and mortality following discharge.

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Post discharge morbidities and mortalities among children with severe acute malnutrition who did not undergo nutrition rehabilitation

Advances in Pediatric Research ◽

10.12715/apr.2017.4.15 ◽

2017 ◽

Keyword(s):

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Post Discharge ◽

Nutrition Rehabilitation

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Survival and nutritional status of children with severe acute malnutrition, six months post-discharge from outpatient treatment in Jigawa state, Nigeria

PLoS ONE ◽

10.1371/journal.pone.0196971 ◽

2018 ◽

Vol 13 (6) ◽

pp. e0196971 ◽

Cited By ~ 3

Author(s):

Collins John ◽

Udochukwu Diala ◽

Ruth Adah ◽

Luret Lar ◽

Esther Awazzi Envuladu ◽

...

Keyword(s):

Nutritional Status ◽

Outpatient Treatment ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Post Discharge ◽

Nutritional Status Of Children

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Post-Discharge survival status and predictors of mortality among severely malnourished children <5 years of age admitted to Minia University Maternity and Children Hospital

10.21203/rs.2.13514/v2 ◽

2020 ◽

Author(s):

Eman Ghazawy ◽

Gihan Bebars ◽

Ehab Salah Eshak

Keyword(s):

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Treatment Programs ◽

Cumulative Probability ◽

Post Discharge ◽

Under Five ◽

Survival Status ◽

Probability Of Survival ◽

Malnourished Children ◽

Nutrition Rehabilitation

Abstract Background: Though effective treatment programs for severely malnourished children are available, little is known about long-term outcomes and potential predictors of post-discharge mortality. The aim of this study was to assess the post-discharge survival status and predictors for post-discharge mortality in severely malnourished children admitted to Minia University Maternity and Children HospitalMethods: A retrospective cohort study which included 135 children under five years of age who were admitted to the nutrition rehabilitation ward with severe acute malnutrition (SAM) during the period from January to December 2018. Data were collected from the inpatient’s hospital records and the children’s parents/guardians were interviewed using a detailed structured questionnaire that inquired about demographic and socioeconomic variables. The Cox proportional hazard model was used to assess the factors associated with the SAM’s post-discharge mortality.Results: A total of 135 children were enrolled into the study. Death rate during hospitalization was 9.6%. The cumulative probability of survival beyond eight weeks and at least for 24 weeks after discharge was 89.3% with a cumulative probability of post-discharge mortality of 10.7% and all deaths occurred within eight weeks after discharge. The main predictor for the SAM’s post-discharge mortality was illiteracy of mothers; the multivariable HR (95%CI) was 7.10 (1.58-31.93; p=0.01).Conclusions: Mothers’ education and edema at admission are independent predictors for post-discharge mortality in under-five children with SAM. The identification of predictors for post-discharge mortality is an important preliminary step for interventions aiming to reduce morbidity and mortality following discharge.

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Recovery and relapse from severe acute malnutrition after treatment: a prospective, observational cohort trial in Pakistan

Public Health Nutrition ◽

10.1017/s1368980018000745 ◽

2018 ◽

Vol 21 (12) ◽

pp. 2193-2199

Author(s):

Nancy M Dale ◽

Laila Salim ◽

Lindsey Lenters ◽

Salim Sadruddin ◽

Mark Myatt ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Community Treatment ◽

Acute Malnutrition ◽

Post Discharge ◽

Middle Income ◽

Discharge Outcomes ◽

Observational Cohort ◽

Save The Children ◽

Moderate Acute Malnutrition ◽

Lost To Follow Up

AbstractObjectiveMillions of children suffer from severe acute malnutrition (SAM) in low- and middle- income countries. Much is known about the effectiveness of community treatment programmes (CMAM) but little is known about post-discharge outcomes after successful treatment. The present study aimed to evaluate post-discharge outcomes of children cured of SAM.DesignProspective, observational cohort study. Children with SAM who were discharged as cured were followed monthly for 6 months or until they experienced relapse to SAM. ‘Cure’ was defined as a child achieving a mid-upper arm circumference (MUAC) of ≥115 mm with ≥15 % weight gain after loss of oedema. Relapse was defined as a child with MUAC<115 mm and/or oedema at any monthly visit.SettingSave the Children CMAM programme in Swabi, Pakistan, from January 2012 to December 2014.SubjectsChildren aged 6–59 months (n117) discharged as cured from the CMAM programme were eligible for the study and followed for 6 months.ResultsOne hundred children (92·6 %) remained free of SAM, eight (7·4 %) relapsed to SAM, nine (8·3 %) were lost to follow-up and none died. Most relapses occurred within 3 months of discharge (mean time to relapse 73·4 (sd36·2) d). At enrolment, 90 % had moderate acute malnutrition (MAM) and 10 % were not malnourished. By the end of 6 months, 35 % persisted with MAM and the remaining were not malnourished.ConclusionsIn rural Pakistan, fewer than 10 % of children cured of SAM relapsed. The first 3 months is the most vulnerable time.

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A feasibility study using mid-upper arm circumference as the sole anthropometric criterion for admission and discharge in the outpatient treatment for severe acute malnutrition

BMC Nutrition ◽

10.1186/s40795-021-00448-w ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Souna Garba ◽

Halidou Salou ◽

Fabienne Nackers ◽

Amadou Ayouba ◽

Montse Escruela ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

World Health ◽

Operational Experience ◽

Post Discharge ◽

Upper Arm ◽

Standard Program ◽

Arm Circumference ◽

Increased Risk ◽

Mid Upper Arm Circumference

Abstract Background The World Health Organization recommends the use of a weight-for-height Z-score (WHZ) and/or mid-upper arm circumference (MUAC) as anthropometric criteria for the admission and discharge of young children for the community-based management of severe acute malnutrition. However, using MUAC as a single anthropometric criterion for admission and discharge in therapeutic nutritional programs may offer operational advantages to simplify admission processes at therapeutic nutritional centers and improve program coverage. Methods This pragmatic, non-randomized, intervention study compared a standard outpatient nutritional program (n = 824) for the treatment of uncomplicated severe acute malnutrition using WHZ < − 3 and/or MUAC< 115 mm and/or bipedal edema for admission and discharge to a program (n = 1019) using MUAC as the sole anthropometric criterion for admission (MUAC< 120 mm) and discharge (MUAC ≥125 mm at two consecutive visits) in the Tahoua Region of Niger. Results Compared to the standard program, the MUAC-only program discharged more children as recovered (70.1% vs. 51.6%; aOR 2.31, 95%CI 1.79–2.98) and fewer children as non-respondent or defaulters, based on respective program definitions. The risk of non-response was high in both programs. Three months post-discharge, children who were discharged after recovery in the MUAC-only program had lower WHZ and MUAC measures. Sixty-three children ineligible for the MUAC-only program but eligible for a standard program (MUAC ≥120 mm and WHZ < -3) were followed for twelve weeks and the anthropometric status of 69.8% of these children did not deteriorate (i.e. MUAC ≥120 mm) despite not immediately receiving treatment in the MUAC-only program. Conclusions The results from this study share the first operational experience of using MUAC as sole anthropometric criterion for admission and discharge in Niger and overall support the consideration for MUAC-only programming: the MUAC-only model of care was associated with a higher recovery and a lower defaulter rate than the standard program with very few children found to be excluded from treatment with an admission criterion of MUAC < 120 mm. Further consideration of the appropriate MUAC-based discharge criterion as it relates to an increased risk of non-response and adverse post-discharge outcomes would be prudent.

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A cohort analysis of survival and outcomes in severely anaemic children with moderate to severe acute malnutrition in Malawi

PLoS ONE ◽

10.1371/journal.pone.0246267 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246267

Author(s):

Thandile Nkosi-Gondwe ◽

Job Calis ◽

Michael Boele van Hensbroek ◽

Imelda Bates ◽

Björn Blomberg ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Cohort Analysis ◽

Hospital Readmissions ◽

Severe Anaemia ◽

Primary Objective ◽

Acute Malnutrition ◽

Severe Malnutrition ◽

Post Discharge ◽

Risk Of Death ◽

Queen Elizabeth Central Hospital

Introduction Moderate to severe acute malnutrition (SAM/MAM) and severe anaemia are important and associated co-morbidities in children aged less than five years. Independently, these two morbidities are responsible for high risk of in-hospital and post-discharge deaths and hospital readmissions. The primary objective of this study is to investigate the risk of death among severely anaemic children with moderate to severe acute malnutrition compared to children with severe anaemia alone. Methods This was a retrospective analysis of data collected from a large prospective study that was investigating severe anaemia in children aged less than 5 years old. The study was conducted at Queen Elizabeth Central Hospital in Blantyre and Chikhwawa district hospital in southern Malawi. Children aged less than five years old; with severe anaemia were screened and enrolled. Each child was followed up for eighteen months at one, three, six, twelve and eighteen months after enrolment. Data were analysed using STATA 15. Results Between July 2002 and July 2004, 382 severely anaemic children were enrolled in the main study. A total of 52 children were excluded due to missing anthropometric data. Out of the 330 included, 53 children were moderately to severely malnourished and 277 were not. At the end of the 18-month follow period, 28.3% of children with MAM/SAM died compared to 13% of children without MAM/SAM (RR 2.1, CI 0.9–4.2, p = 0.03). Similarly, children with moderate to severe malnutrition reported a significantly higher number of malaria infection cases (33.9%) compared to children with severe anaemia alone (27.9%, p = 0.02). However, the number of hospitalizations and recurrence of severe anaemia was similar and not statistically significant between the two groups (RR 0.8 (0.4–1.4), p = 0.6 and RR 1.1 (0.3–2.8), p = 0.8). Conclusion Among children with severe anaemia, those who also had moderate to severe malnutrition had a twofold higher risk of dying compared to those who did not. It is therefore crucial to investigate acute malnutrition among severely anaemic children, as this might be treatable factor associated with high mortality.

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