A Five-Year Retrospective Trend Assessment of Severe Acute Malnutrition and Clinical Outcomes in a Pediatric Referral Ward

International Journal of Medicine and Medical Sciences | Vol. 13, No. 7, July 2023 | pp. 49–56

DOI: 10.46882/2023/IJMMS/130049

Original Research Article

A Five-Year Retrospective Trend Assessment of Severe Acute Malnutrition and Clinical Outcomes in a Pediatric Referral Ward

Evelyn N. Kamau¹, Tunde O. Adebayo², Sarah M. Touré¹*

¹Department of Paediatrics and Child Health, School of Medicine, University of Nairobi, Nairobi, Kenya.

²Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Abstract:

Severe acute malnutrition (SAM) remains a major contributor to under-five child mortality in developing regions, requiring regular audits of clinical care protocols. This retrospective health facility study analyzed five-year trends (2018–2022) and specific predictors of treatment failure among SAM children admitted to a specialized inpatient stabilization center. De-identified medical charts of 650 children aged 6 to 59 months with SAM (defined by weight-for-height Z-score < -3 or presence of nutritional edema) were analyzed. Primary endpoints included cure rate, default rate, and in-hospital mortality rate, assessed according to World Health Organization (WHO) benchmarks. Over the five-year duration, the overall cure rate was 78.5% (510/650), the default rate was 9.2%, and the mortality rate was 12.3% (80/650). The annual trend showed that mortality peaked in 2020 at 15.4% during pandemic service disruptions. The primary direct clinical causes of inpatient death were severe septic shock (38.7%), acute gastroenteritis with severe dehydration (28.3%), and severe bronchopneumonia (18.8%). Cox proportional hazards regression modeling demonstrated that the presence of nutritional edema (kwashiorkor phenotype) (HR = 2.4, 95% CI = 1.3–4.8, p < 0.01), severe hypokalemia < 2.5 mmol/L (HR = 3.1, 95% CI = 1.6–6.2, p < 0.001), and concurrent HIV infection (HR = 2.1, p < 0.05) were independent predictors of inpatient mortality. Inpatient SAM mortality remains above the ideal WHO target (< 10%). Reducing mortality requires earlier detection at the community level, stricter adherence to fluid management guidelines, and aggressive empiric antibiotic treatment for septicemia.

Keywords: Severe Acute Malnutrition, Inpatient Mortality, Kwashiorkor, Sepsis, Dehydration, Pediatric Nutrition

Manuscript Timeline: Received: April 02, 2023; Revised: May 12, 2023; Accepted: June 05, 2023; Published: July 11, 2023.

Citation: Kamau EN, Adebayo TO, Touré SM. A Five-Year Retrospective Trend Assessment of Severe Acute Malnutrition and Clinical Outcomes in a Pediatric Referral Ward. International Journal of Medicine and Medical Sciences, 2023, 13(7): 49–56. DOI: 10.46882/2023/IJMMS/130049

Subscribe to read the full article: https://internationalscholarsjournals.org/subscribe-to-read