Mortality among children under five years admitted for routine care of severe acute malnutrition: A prospective study from Kampala, Uganda

Abstract

Background: Mortality among children admitted to the malnutrition unit at Mulago Hospital, Kampala, Uganda has reduced according to a recent randomised control trial. Anecdotal reports from the unit, however, report high mortality among SAM patients in routine care. HIV infection, a major risk factor for mortality among patients with SAM, has reduced due to effective prevention and treatment strategies. Furthermore, the World Health Organization (WHO) has revised the treatment guidelines, which have been adopted in Uganda. The mortality among children with SAM in routine care has not been recently elucidated. This study sought to determine the mortality and associated factors among children under five years of age admitted to Mulago hospital for routine care of SAM. Methodology: A prospective cohort study was conducted among 270 severely malnourished children admitted to Mulago Hospital. They were followed up for two weeks. Data was entered into Epidata V.3.1 and analyzed using Stata version 14.1. Mortality was calculated and cox regression models were used to determine factors associated with time to mortality. Results: Of the 266 participants whose outcomes were known, 67/266 (25.2 %, 95% CI 19.9-30.4%) died. In-hospital mortality was 56/270 (20.7%, 95% CI 15.9-25.6%). The prevalence of HIV infection was 12.2% (33/270). The factors associated with reduced time to mortality were positive HIV status (AHR 2.2, 95% CI; 1.2-4.2, p=0.014), bacteraemia (AHR 9; 95% CI 3.4-23, p=<0.001, and low GFR (AHR 3.2; 95% CI 1.7-6.3, p=0.001). Conclusions: Mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have GFR below 60 mL/min/1.73m2 or bacteraemia, are more likely to die. Further studies to explore the relationship between GFR and mortality among children with SAM as well as efficacious antibiotics among these children are required.