Median time to death and factors associated with post-discharge mortality in children under 5 years admitted with severe acute malnutrition at Mulago Hospital: A retrospective cohort study

Abstract

Introduction: Globally, nearly 13.6 million children under five were severely wasted in 2021. In Uganda, up to 4% of under-fives are wasted, with 1% of these with severe wasting. Despite being treatable, up to 45% of all deaths in under-fives are related to malnutrition. Most deaths are in low and middle-income countries. Immunological disruptions in Severe Acute Malnutrition (SAM) render these children at a high risk of death from common childhood illnesses during admission and after discharge. Data on factors associated with post-discharge death is very scarce. Objective: Identify the median time to death and factors associated with post-discharge mortality in children under 5 years admitted with Severe Acute Malnutrition at Mulago Hospital, as well as medical events preceding these deaths. Methods: This was a retrospective cohort study using data collected in a multicentric study aiming to develop a TB diagnostic score in children admitted with SAM. Data was summarized as proportions, median, tables and graphs, and analysis was done using STATA 17. Cox proportional hazards regression was used to identify factors associated with post-discharge mortality. Results: Overall, 38 (11.3%) children died in the study, with 11 (3.3%) dying post-discharge. The median time to death was 38 days (IQR 17,51). Factors associated with post-discharge mortality included TB disease (aHR 6.155, 95%CI 1.378, 27.506) and lengthier admission (aHR 1.290, 95% CI 1.083, 1.535). Age, HIV, ongoing SAM, anaemia and oedema were confounders of TB. A majority (64%) of children died at home with the cause of death unestablished. Conclusion: Children with lengthier admission and TB require keener outpatient therapeutic (OTC) follow-up from clinicians, particularly in the first two months. The Ministry of Health also needs to consider integrating TB treatment services into the OTC services.