Prevalence and factors associated with oral candidiasis in severely malnourished children admitted to mwanamugimu nutritional unit, mulago hospital.

Abstract

BACKGROUND: Malnutrition, the most common cause of immunodeficiency worldwide is responsible for 5.3 million deaths under 5 years old. It remains the most important risk factor for the burden of disease in developing countries. Oral candidiasis is common in immunosuppressive states especially individuals infected with HIV/AIDS and severe acute malnutrition. Despite evidence that oral candidiasis prolongs hospital stay and predisposes to bacterial infection in the severely malnourished child there is a deaths of information concerning the association between oral candidiasis and malnutrition. OBJECTIVE: To describe the prevalence of, and study the factors associated with the oral candidacies infection among children, 2-59 months. Who were severely malnourished and admitted to MNU. METHOD: This was a cross sectional study of one hundred and sixty two severely malnourished children, 2-59 months. Presence of oral candidiasis and other clinical and laboratory characteristics were admitted at enrolment. Factors associated with the development of oral candidiasis were elicited. RESULTS: One hundred and sixty two patients with severe acute malnutrition were recruited, and of these, 52 (32.1% (C1 24.9%-39.9%)} had oral candidiasis. We found that having a history of fever for less than one month {OR 2.54(1.07-6.04), P=0.035}, a history of fever for more than one month {OR 4.74(1.48-15.18), P=0.009}, history of antibiotic use {OR 5.66(1.98-16.16) P=0.000}, ottorhea {OR 3.54(1.40-8.99), p=0.044), having signs of dehydration, {OR 2.57 (1.12-5.91) P=0.044} were independently associated with oral candidiasis. Severe CD4+ immunosuppression, {OR 3.01(1.26-7.17), P=0.009}, though significant on univariate analysis was not independently significant. Almost half, n=74 (45.7%), of respondents reported a previous history of oral candidiasis, with 28 (37.8%) of these reporting oral candidiasis more than once. CONCLUSIONS: With a prevalence of 32.1% oral candidiasis remains an important disease entity in children with severe acute malnutrition. The factors independently associated with oral candidiasis among children aged 2-59 months admitted with severe acute malnutrition to mwanamugimu nutritional unit include a prior history of antibiotic use within the last 3 weeks, prior history of oral candidiasis, signs of dehydration and otorrhea. Previous history of oral antibiotic use among children aged 2-59 months admitted with severe acute malnutrition to mwanamugimu nutritional unit is more likely to be associated with oral candidiasis compared to CD4+ immunosuppression suggesting a more prominent role of local, rather than systematic, immunity in the development of oral candidiasis in this population. Recurrent oral candidiasis is common. RECOMMENDATIONS: Given the high incidence of oral candidiasis and its strong association with prior use of antibiotics in severely malnourished children, there is need to regulate the rampant use of oral antibiotics among severely malnourished children. Studies to find out other factors concerning high recurrent rates including antifungal drug sensitivity are needed.