| dc.description.abstract | Introduction: Globally about 25 to 35 million children under-five years of age have severe acute malnutrition (SAM) and 13 million of these live in sub-Saharan Africa; of these one million die every year. The prevalence of SAM in children less than 6 months ranges from 1 to 34%. In Uganda 1% of children less than 5 years have SAM; while the prevalence of SAM in infants less than6 months of age was 4.6% according in the 2016 Uganda Demographic and Health Survey. Infants less than 6 months diagnosed with SAM receive in patient care which includes therapeutic feeding. Therapeutic feeds have been noted to be complicated with refeeding syndromes which manifest with hypophosphatemia, often associated with heart failure, seizure, coma and heart failure; the major causes of morbidity and mortality in this age group. Although the refeeding syndrome has been studied among children with SAM above 6 months, the burden of refeeding hypophosphatemia in those below 6 months is not known. Objective: We set out to determine the prevalence, factors associated and short term outcomes of refeeding hypophosphatemia in infants less than 6 months of age admitted with severe acute malnutrition in Mulago Hospital. Methods:A prospective cohort study was used to enroll 76 infants below6 months of age with SAMin Acute Care Unit, Mulago Hospital. Eligible participants were consecutively enrolled until the sample size was achieved. Upon obtaining consent, the caretakers to these infants were interviewed and blood drawn for the estimation of serum phosphate levels at the point of admission and 48 hours after initiation of feeds. The prevalence of refeeding hypophosphatemia was derived using simple proportions. Factors associated with refeeding hypophosphatemia were subjected to bivariate analysis and those with a P value of 0.2 or less were then be subjected to multivariate analysis and a P value of 0.05 or less was considered statistically significant. Short term outcomes (resolution of edema, return of appetite, weight gain and mortality) were assessed over 2 weeks of followed up using survival analysis. Data was analyzed using STATA version 13.
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Results: A total of 76 infants with severe acute malnutrition were recruited. The prevalence of refeeding hypophosphatemia was 20% (15/76). Factors associated with increased risk of developing refeeding hypophosphatemia were: an age above 2 months [OR= 4.86, 95% CI (0.96- 24.67), p=0.047], being dehydrated [OR =5.28, 95% CI (1.88- 29.33), p=0.013] and being clinically anemic [OR =4.22, 95% CI (1.06-16.66), p=0.042] .In the analysis for short term outcomes, the infants who had oedema took a longer time for the oedema to resolve [OR+ 3.7,95% CI (1.59.14), p=0.005]
Conclusions and recommendation This studyshowedthat 1 in 5 infants under six months had refeeding hypophosphatemia; more often those above 2 months, those who present with paleness and dehydration at time of admission. Refeeding hypophosphatemia was associated with delayed resolution of oedema. This study supports need of phosphate level been done at admission then after initiation of feeds for children under 6months of age with SAM | en_US |
