Nutritional status and short term outcome among children presenting with surgical conditions to Mulago Hospital, Kampala

Abstract

Background: The acute stress due to surgical conditions results in varying degrees of hyper-catabolism and hypermetabolism manifesting as PEM. This, together with pre-existing PEM adversely affects the morbidity and mortality of patients with surgical disease. Children are at the biggest risk of complications because they are the most affected by pre-existing PEM as well as having the highest rate of hypermetabolism due to surgical disease. This malnutrition prolongs wound healing, prolongs length of hospital stay, increases cost of care and ultimately increases morbidity and mortality. Objectives: This study aimed to describe and document the nutritional status and short-term outcome of children presenting with surgical conditions at Mulago hospital. Methods: Two hundred and thirty six (236) children aged less than twelve (12) years, presenting to Mulago hospital for management were recruited into this study. The children’s demographic data and symptom history were taken; nutritional assessment done and the cases were followed till discharge, abscondment, and death or until 21 days. Patients were classified into non-malnourished and malnourished groups. Short-term outcomes were documented as discharged, dead, 2nd surgery and length of stay. These outcomes were compared between malnourished and non-malnourished groups as well as other confounding factors. Results: A total of 236 patients were studied. Of these 30.4 %( n=72) of the patients were acutely malnourished with an alarming 23.2% (n=55) having severe acute malnutrition. Nutritional status affected patient outcome (death, discharge, 2nd surgery) significantly (p-value = 0.0116, p-value = 0.000) but not length of stay. Burn injured patients noted the highest rate of worsening of nutritional status during the period of follow up. Conclusion: This study shows that there is significant association between nutritional status and short-term outcome among children presenting with surgical conditions to Mulago hospital. Aggressive nutritional screening should be employed and therapeutic and supplementary nutrition undertaken.