http://www.inosr.net/inosr experimental sciences/ Banga etal
INOSRExperimentalSciences9(1):21 32,2022.
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ISSN:2705 1692
Factors Associated With Mortality among Children Under Five Years Admitted With Severe Acute Malnutrition (Sam) In the Nutritional Unit of Jinja Regional Referral Hospital.
Desire Ngudjolo Banga, Melvis Baren and Namale Vivian SsonkoDepartmentofMedicine,PaediatricsandChildHealthofKampalaInternationalUniversity Uganda
ABSTRACT
Mortality among children with severe acute malnutrition remains an immense health concern in the hospitals in Africa, but its attributes are not fully known various hospital settings. This study determined the factors associated with in hospital mortality among children under five years of age admitted with severe acute malnutrition at Jinja Regional Referral Hospital. This was a hospital based analytical descriptive prospective cohort study conducted at in the nutritional unit of Jinja Regional Referral Hospital. This study was performed from July to October 2019 with children under five years of age admitted with severe acute malnutrition and their caregivers from and their caregivers. A total of 338 children and their caretakers who met the criteria were consecutively enrolled into the study. Children were followed until discharge from the nutritional unit or until death. Data collected from questionnaires, WHO chart and culture media were entered into Microsoft Excel version 10 and imported into Stata 12 for data analysis. Descriptive statistics were used to each of the independent factors and were subjected to Chi square test followed by logistic regression analysis to assess its association incidence of mortality among children. Factors with p values ≤0.05 were considered as associates of mortality of mortality among children. Sex of the child, duration of admission, caregiver’s highest education level and caregiver’s average monthly income were found to be associated with mortality among children admitted with SAM at JRRH. In conclusion, it was found that the risk of death was less likely to occur among females and those children with a hospital stay of 72 hours and above.
Keywords: Factors,Mortality,ChildrenandSevereacutemalnutrition
INTRODUCTION
Childhood under nutrition is a major global health problem, contributing to childhood morbidity, mortality, impaired intellectual development, suboptimal adult work capacity, and increased risk of diseases, contributing to 50 60% of deaths in children. It affects all age groups, but is more frequent among infants and young children (4 6 years). It is estimated that 19 million preschool age children, mostly from the WHO African and SouthEast Asia Regions, are suffering from severe wasting [1] Nor, [2] reported thatmalnutritionisinfluencedbyparental education, child factors such as residence location, age, and gender, relationship between patient and providers, and the system of care. Since this was a hospital based cross sectional survey, exposure and outcome were measured at the same time,leading tolackof temporalsequence of exposure, preceding mortality of the under five and potential misclassification
of comorbidity status, if comorbidity has exacerbations and remissions. Those gaps were bridged in this current study by usingtheprospectivecohortstudydesign. In a retrospective cohort study carried out to determine the survival status and its associated factors among under five childrenadmittedwithcomplicatedSevere Acute Malnutrition in Ethiopia, from a total of 340 children, 30 were dying in the sub county and there was no difference in the incidence of deaths between sexes, the majority of death (63.3%) occurred in children younger than 12 months, there was the same magnitude (10%) for 13 24 and 23 36 months of age groups while 6.7% and 10% of death occurred among 37 48 and above 49 months of age respectively [3] The probability of survival by the end of 3rd, 6th, and the 9th day for children younger than 6 months was 95%, 88%, and 88%; for 6 to 23 months 94%, 92% and 89%; while
for children older than 24 months, the probability of survival was of 93% for the three respective days [3] Another study by [4] in Sudan revealed that of a total of 593 children with SAM, 35.4% were classified as low socioeconomic class, 22.9% classified as an average class and there were no sufficient data to classify the remaining.Theage ofthe childrenisa very important sociodemographic factor associated with mortality of under five due to SAM meanwhile sex of the children did not have influence on mortality. This study determined whether this was true though the possibility of a discrepancy could not be ruled out due to the difference in the study settings and the methodsofstatisticalanalysisused.
A study in Zambia found that the mortalitypatternwashigherinmalesthan females and the mortality at 24 hours, 48 hoursand 1 weekofadmission was93.2%, 88.7 and 29%, respectively [5]. Another study carried out in Ethiopia revealed that young age was one of the independent predictors of death among children with SAM [6] A study by [7] on association between feeding practices and under nutrition in areas of urban Allahabad established that delayed initiation of breast feeding, deprivation from colostrum, and improper complementary feeding, were significant risk factors for under nutrition among under fives, which could lead to mortality. Malnutrition is one of the most important underlying causes of child mortality in developing countries, particularly during the first 5 years of life the major causes for this are poverty, world conflicts, lack of education, natural disasters and poor access to health care [8]. Nutritional habit has also beeen shown to be a risk factor formortalityoftheunder fiveduetoSAM. This study assessed nuritional habit by asking the caretaker of the child during recruitmentinthestudy whetherthechild was exclusively breastfed, mixed breastfedorartificially breastfedand then the child was followed up while admitted in the nutritional unit. In a retrospective cohort study carried out to determine the survival status and its associated factors among under five children admitted with complicated severe acute malnutrition in hospitals of Wolaita Zone, South Ethiopia, it was found that from a total of 340 study subjects, there was no difference in theincidenceofdeaths betweentwosexes and the majority of deaths (63.3%)
occurred in children age less than 12 months, and the same magnitude of 10% for13 24and23 36monthsofagegroups, the remaining 6.7% and 10% of death occurred among 37 48 and above 49 months of age, respectively [3],the probability of survival by the end of 3rd, 6th, and the 9thday for age groups less than 6 months was 95%, 88%, and 88%; for 6 to 23 months 94%, 92% and 89%; and greater than 24 months was 93% for three respective days. They realized that the probability of survival was very low among young age groups than older ones [3]. However, these studies did not capture other important socio demographic characteristics like area of residence, whether urban, rural or semi urban, yet this could also be a risk factor for mortlaity due to SAM. The current study had bridged that gap by capturing information about the residence during the time of recruitment to the study. Furthermore, a five year retrospective review of hospital based records on mortalityandmorbiditypatternsinunder five children with Severe Acute Malnutrition in Zambia, found that the mortality pattern differed by sex in that it was higher in males than females (52% vs. 48%, P = 0.007). Also, mortality at 24 hours, 48 hours and 1 week of admission was 93.2%, 88.7 and 29%, respectively [5]. According to observations from mortality trends at the Children’s Hospital, in Accra, Ghana, 20032013, mortality in males (52.2%) was higher than in females (47.8%) and similar to other studies in Africa, but it differed from the study in Mali which reported significantly higher case fatality rates among girls [9]. There is a serious discrepancy in the different findings about sex of the children being a risk factor for mortality, as some studies revealed that sex was not associated with mortality,while other studies showed that sex was a risk factor, with the number of males who died being higher than the number of females who died, although other studies made clear the difference of mortality between sexes. There is still an existing confusion as to whether sex is a risk factor for mortality and the current study tried to address that. Socio economic factors are usually measured by determining education, income and occupation or a composite of these dimensions. The economic status of a household is an indicator of access to adequate food supplies, use of health services, availability of improved water
sources, and sanitation facilities, which are prime determinants of child nutritional status. Indicators showing levels of nutritional status in children are often regarded as representative of the health and general well being of society at large, while high levels of malnutrition in children under 2 years is prevalent in countries with low socio economic status [10]. In this study, various questions were used to assess the ecomic factors associated with mortality due to SAM. Optimal feeding practices are essential to meet the nutritional needs of children in the first years of life [11]. This report further concludes that optimal infant and young child feeding practices rank among the most effective interventions to improve child health, poor nutrition among infants and young children results primarily from inappropriate feeding practices, where the timing, quantity and quality of foods given to infants are often inadequate [11]. A study by Lauer et al., (2006) revealed that suboptimal breastfeeding was associated with infant mortality in limitedresource countries, 96% of children below 6 months with suboptimal breastfeeding died and 12% of deaths were reported after 6 months. Africa and Asia had the largest number of deaths and respiratory infections (AOR = 4.7, CI = 2.4 9.1), and diarrhea (AOR = 7.3, CI = 3.7 14.4) were the most causes of death [12]. Optimal breastfeeding practices, especially exclusive breastfeeding up to 6 months of age, has the single greatest potential impact on child survival, with the potential to prevent 1.4 million under 5 deaths in the developing world and 6% can be prevented by ensuring optimal complementary feeding [12]. The mother’s breast milk has antibodies that are passed to the baby to help in fighting infections and, therefore, children who are not exclusivelybreastfedfor6 months tend to have weak immunities, therefore sub optimally breastfed children with SAM are at high risk of dying from comorbidities such as acute diarrhea and pneumonia. The timing, quantity and quality of foods given to infants should be adequate so as to prevent SAM. A study by [13] on association between feeding practices and under nutrition in areas of urban Allahabad established that delayed initiation of breastfeeding, deprivation from colostrum, and improper complementary feeding are significant risk factors for undernutrition among
under fives, which can lead to mortality [13]. In Sudan, a study by [4, 14, 15, 16] revealedthatoutofatotalof593children with severe acute malnutrition, 10.7% were exclusively breastfed for the first 3 months and 33.40% were mixed fed, while others were bottlefed [4, 17,18,19]. These two studies reviewed, only concentrated on establishing association between nutritional habit/breast feeding and severe acute malnutrition, but did not show evidence whether nutritional habit was also a risk factor for mortality in severely malnourished children. The current study covered that loop hole by finding out whether there was a direct relationship between nutritional habit of thechildrenandmortalityduetoSAM.
Aim of the Study
To assess the factors associated with in hospital mortality among children under five years of age admitted with severe acute malnutrition at Jinja Regional ReferralHospital.
Specific objective
1. To establish the factors associated with in hospital mortality among children under five years of age admitted with SAM in the nutritional unit of Jinja Regional ReferralHospital.
Research question
1. What are the factors associated with in hospital mortality among children under five years of age admitted with SAM in the nutritional unit of Jinja Regional ReferralHospital?
Significance of the study
Malnutrition plays a major role in the premature mortality of millions of children in developing countries [14] Those it does not kill, it renders them vulnerable to infection and disease, ruining the lives of hundreds of millions [15] An understanding of factors associated with mortality in children under 5 years with SAM will contribute towards finding relevant solutions aimed at reducing child mortality in Jinja region. The study will make a contribution to future research by adding on the existing literature on in hospital mortality of children with severe acute malnutrition in Jinja region. The study will also provide information about the burden of severe acute malnutrition at Jinja Regional Referral Hospital which will contribute towards enabling the administration to institute proper planning for the
nutritional unit which will help to reduce mortalityamongchildrenunder5years.
Scope of the study
Geographical scope
The study was conducted at Jinja Regional Referral Hospital (JRRH), Kampala International University Teaching Hospital (KIU TH) satellite hospital. JRRH is located in Southeastern Uganda, approximately 87 kilometers east of Kampala, the capital city of Uganda. The hospital is located in the center of Jinja Municipality with coordinates of Jinja hospital as: 00 25 52 N, 33 12 18E (Latitude; 0.4310; Longitude 33.2050). Jinja district sits along the northern shores of Lake Victoria, near the source of the White Nile and has an average elevation of 1,204 meters above sea level. It is bordered by Kamuli district to the north, Luuka district to the east, Buvuma district to the south, and Buikwe district to the north west. An estimated 65.8 sq.km of the district’s total land area (767.8 sq.km) is covered by water. The main economic activity in Jinja District is agriculture,engagingthemajority(85%)of the district population. Administratively, the district is constituted by 12 sub counties including three town councils, three divisions under Jinja municipality and six rural sub counties with a total of 53 parishes and wards and 386 villages. According to the 2014 census data, Jinja RRH serves a population of 471,242 in Jinja district, and the hospital also serves Bugiri, Kamuli, Iganga, Mayuge,
Study design
Namutumba, Kaliro, Buyende, Luuka, Namiyongo and Jinja district. The nutritional unit of JRRH where this study was conducted is located in pediatric ward, around 1 km from the main hospital.
Content scope
This study encompassed mortality among children under five years of age admitted with severe acute malnutrition in the nutritional unit of Jinja Regional Referral Hospital The study was limited to determination of in hospital mortality, comorbidities and factors associated with mortality among children under five years of age admitted with SAM in the nutritional unit of Jinja Regional Referral Hospital. The factors to be considered included demographic and biological characteristics of caretakers and children that are associated with mortality due to malnutrition for example; age, sex, residence, relationship to the child, education, and average monthly income. Additionally, the medical history of the child was taken coupled with physical examinations laboratory investigations to diagnose the comorbidities associated withmortality.
Time scope
The time scope for data collection was three months covering the period of July to October 2019. The participants were followed up fromadmissionto the timeof discharge.
METHODOLOGY
This was an analytical descriptive prospective cohort study to determine the proportion of mortality, demographic, biological, socioeconomic factors and Comorbidities associated with mortality among children below 5 years admitted with severe acute malnutrition in the nutritional unit of Jinja Regional Referral Hospital.
Study site
The study was conducted at Jinja RRH. Jinja RRH is located in South eastern Uganda, approximately 87 kilometers East of Kampala, the capital of Uganda. The coordinates of Jinja hospital are; 00 25 52 N, 33 12 18E (Latitude; 0.4310; Longitude 33.2050). Jinja district sits along the northern shores of Lake Victoria, near the source of the White Nile and has an average elevation of 1,204 meters above sea level. It is bordered by Kamuli district to the north, Luuka district to the east, Buvuma district to the south, and Buikwe
district to the north west. It is a designated internship hospital where medical graduate internship centre and has several consultant staff and specialists in medical and surgical disciplines. Jinja RRH, also provides comprehensive HIV/AIDS services. It is also a KIU Satellite Teaching Hospital aimed at training undergraduates and postgraduate students including postgraduate in Pediatrics. The nutritional unit is in pediatric ward, around 1 km fromthemainhospital, ithas 32bedsand 3 trained nurses assigned for the ward. Patients are categorized into moderate acute malnutrition, severe acute malnutrition, and edematous and non edematous malnutrition with a minimum of60admissionspermonth.
Study population
The study included all children under five years of age admitted with SAM in the nutritional unit of Jinja Regional Referral Hospitalandtheircaregivers.Accordingto
the 2014 census data, Jinja RRH serves a population of 471,242 in Jinja district,and the hospital also serves Bugiri, Kamuli, Iganga, Mayuge, Namutumba, Kaliro, Buyende, Luuka, Namiyongo and Jinja district.
Selection criteria
Inclusion criteria
All children under five years of age admittedwithsevereacutemalnutritionin the nutritional unit of Jinja Regional Referral Hospital and their caregivers who consentedwereincludedinthisstudy.
Exclusion criteria
Those who were referred for further management were excluded from this study. Also, children with pre existing congenital malformations, and cerebral palsywereexcludedfromthisstudy.
Sample size estimation
Sample size calculation was done using a formula for estimating a population proportion[16].
n = Zα/2 2 *p*(1 p) / MOE2 , And
Zα/2 is the critical value of the Normal distribution at α/2 (e.g. for a confidence level of 95%, α is 0.05 and the critical valueis1.96), MOE is the margin of error, estimated at 0.05
P is the estimated proportion of children withSAMthatdiedinhospital=0.33based on a study done in Kenya that reported 33%[17].
n= 1.962 x 0.33 (1 0.33) /0.052 = 339.7 = 340 children with Severe Acute Malnutrition.
Estimating the sample size for the socio demographic, biological and economic factors associated with mortality among children under five years of age with severe acute malnutrition in the nutritionalunitcare.
Using the modified Daniel’s formula n = Zα/2 2 *1 /R*P (1 P)/ d2 Where n=desiredsamplesize
Z= value corresponding to 95% confidence interval=1.96
R= Odds ratio for the SAM mortality according to the socio demographic factors associated with mortality in children under five years of age with SAM that died in hospital based on a study done in Uganda (Mulago) that reported an OR=1infemales[18]
P= proportion of mortality among females under five years admitted with SAM based ontheabovestudywas0.25.
d=degree of error to be accepted which is 5%.
n= 1.962 *1 /1*0.25 (1 0.25)/ 0.052 =147 children under five years of age admitted withSAM.
Estimating the sample size for the co morbidities associated with mortality of children under five years of age admitted withSAMinthenutritionalunitcare. Using the same modified Daniel’s formula n = Zα/2 2 *1 /R*P (1 P)/ d2 Where n=desiredsamplesize Z= value corresponding to 95% confidence interval=1.96
R= Odds ratio for children with SAM mortality according to the associated co morbidities based on a study done in Mulago that reported an OR=3.62 of childrenwithHIVthatdiedofSAM[19]
P= proportion of mortality among HIV patients with SAM in the nutritional unit basedontheabovestudywas0.34 d= degree of error to be accepted which is 5% n =1.962 *1/3.62*0.34 (1 0.34)/ 0.052 =95 children under five years of age admitted withSAM.
The overall sample size is 340 children under five years of age admitted with SAM.
Sampling technique
All children under five years of age admitted with SAM in the nutritional unit of Jinja Regional Referral hospital, who met our inclusion criteria were consecutivelyenrolled intothestudy until when the required sample size has been attained.
Data collection tools
The following tools will be used to collect data: questionnaires, tape measure, thermometer, pediatric size stethoscope, stadiometer, infantometer, WHO chart, vacutainers, gloves, and syringes, culture medium.
Study procedures
Screening
for eligibility
Screening and inclusion were performed upon admission of the child in the paediatric ward as long as they met inclusion criteria. The principal investigator explained the purpose and the process of the study to the patient and/or guardian and a written consent wasobtained.
Demographic information and biological information Information regarding the place of residence, sex, age and date of birth and
relationshipofthechildwiththecaretaker were collected by the principal investigator using the data collection tool. Complaints of diarrhea, vomiting, loss of appetite, fever, cough and others were alsorecordedinthedatacollectiontoolas well as the child’s immunization history, nutrition history, HIV status, occupation of the caretaker. All information obtained was entered in the data collection tool. The emergency cases were managed first; information from them was collected later
Clinical examination
Children underwent general examination with special emphasis on temperature, presence of visible wasting, presence of edema, dehydration, eye signs of vitamin A deficiency and pallor, respiratory distress, tachypnea, some dehydration was distinguished from septic shock according to the WHO protocol. Systemic examination was done with special emphasis on the respiratory, cardiovascular system where pulse rate, capillary refill time, temperature gradient in the limbs were assessed and the central nervous system where the level of consciousness was noted. Pulse rate and oxygen saturation were taken using a pulse oximeter. Findings on clinical exam were entered in the data collection tool by the principal investigator; they helped to diagnose some comorbidities. All the patients were followed up from admission to the discharge with the clinical care pathwayform(AppendixV).
Sample collection and laboratory procedures
Blood sample was collected during insertion of IV cannula for measurement of full blood count, blood glucose, blood slide for malaria and HIV test and culture. Prior to drawing of blood, the area will be swabbed with cotton dipped in ethyl alcohol 70% and iodine to prevent contamination. Three to four milliliters of blood were drawn for blood culture, determination of blood glucose, full blood count,HIV testandbloodslideformalaria and serum electrolytes. The blood sample for culture was taken and analyzed using AutomatedBloodCultureSystem(BACTEC) in the main hospital laboratory of JRRH. These laboratory investigations were done on admission except serum electrolytes that wasdone duringtransitionphase. For the HIV test, pre and post test counseling were done. A first Determine® HIV rapid test was performed and confirmed with a
2nd rapid test StatPak®. In case of discordance, a Unigold® test will be done. Children under 18 months with positive rapid tests will be referred for DNA PCR test in the HIV clinic in the Jinja RRH. Blood samples will be taken off only once atadmission.
Full blood count was analyzed using Sysmex® Automated Hematology Analyser at Jinja RRH. Blood glucose was measured using Freestyle optium glucometer by the principal investigator at admission. Thick blood smears for malaria parasites was done using Field stains A&B and examined by a Laboratory technician using the microscope in the pediatric ward laboratory. Early morning gastric aspirate was collected in a sterile for gene expert atadmission.Thesample was taken to the pediatric ward laboratory of JRRH for analysisatadmission.
Patient management
Children with severe acute malnutrition were treated according to updated WHO guidelines. Prescription of treatments for the participants was done by doctors and clinical officers who were availed with guidelines on treating children with SAM. The role of the principal investigator was limited on recommendations. All children were routinely treated with IV Ampicillin and IV Gentamycin that was modified according to the blood culture and sensitivity results. They were also routinely started on a feeding program with F75 formula feeds. Caretakers took the responsibility for the feeding of the children under the supervision of the hospital Nutritionist. Children with diarrhea were routinely given Zinc tablets in addition to the routine deworming tablet that was given to all the enrolled patients. Those with some dehydration were given ReSoMal solution while those with septic shock were given IV half strength Darrow’s and 5% Dextrose solution. All patients were followed up fromadmissiontothedischargeaccording totheWHOprotocol.
Data management
Hard copy questionnaires were kept in lockablesafes.Datawascheckedmanually by the principle investigator to verify the completeness of information. Where missing information was found, the principle investigator cross checked to find out whether the information was indeed missing from the field. The data was entered and cleaned using EPI info version 7 and was exported to STATA 12.0 for further analysis. The data was kept in
a password protected computer to avoid unauthorized persons from accessing it. The data was made accessible to authorizedpersonslikethebiostatistician, research supervisors, hospital administrators and any other authorized person. Descriptive statistics like frequencies, percentages and means was calculated.
Data analysis
Characteristics of study participants: Socio demographic were summarized descriptively as frequencies, percentages (categoricalvariables).
Objective 1: Keeping strata constant, socio demographic, economic and biological factors associated with in hospital mortality were assessed using Generalized Linear Model to obtain relative risk of mortality. Both Bivariate andmultivariateanalysiswerecarriedout.
Crude and adjusted Relative Risk (RR), their corresponding 95% CI and p values were reported. Data presentation was donebyusingtables.
Ethical considerations
Forthestudytobeethical,thefollowing wasconsidered.
Institutional consent
Approval was sought from the Research and Ethics Committee of Kampala International University and also by the hospitaladministrationofJinjaRRHwhere theresearchwascarriedout.
Privacy and confidentiality
All questionnaires did not have provisions for participant’s names, and participants will be interviewed separately from other clients to maintain privacy and confidentiality.
Informed consent
Written consent was obtained from the parents or caretakers of the participants. For parent or caretaker who does not know how to read and write, the consent form was translated in local language (Lusoga) and we identified a witness who had to explain the consent form to him/her after which the parent/caretaker gave consent using his/her thumbprint. Mothers who were emancipated minors gave their consent after being clearly informed about the risks and benefits of the study by the principal investigator. Pre andposttestcounsellingforHIVwere performed separately by the Research nurse. Written consent for HIV testing was obtainedonaspecificform.Therefusalof HIV test by the parent/caretaker did not stop the participant from getting care. Informed consent was sought from the attendant of the participants after clearly explaining the purpose of the study. Participation wasvoluntaryandparentsor guardians were free to refuse to participate or withdraw from the study without any penalties.
PRESENTATIONANDINTERPRETATIONOFTHERESULTS
Study profile of study participants
Overall, 340 participants under 5 years of age with severe acute malnutrition were consecutively enrolled in the study in the nutritional unit of Jinja Regional Referral Hospital after an informed consent of their caregivers from July to September
2019. Of the 340 participants, 2 participants were excluded from the study because of refusal to consent. A total of 338 participants were followed up from admission to discharge. A total of 49 participants died and 289 participants survived.
Figure 1: Study profile of study participants
Socio demographic characteristics of children under five years of age admitted with SAM in the nutritional unit of Jinja Regional Referral Hospital Table 1 shows that of the 338 children underfiveyearsofagestudied,majority
were males,208(61.5%) aged 13 24 months with a mean age of 18.months (SD = 10.7). Most of children had complete immunization status, 177 (52.4%) presented with fever 229(67.8%) and cough 204(60.4%). Most of the children hadcompletedimmunization,177(52.4%). Majority of the children were not exclusively breastfed up to 6 months, 229 (67.7%). Almost all the children had a hospital stay/duration of admission of at least72hours.
Factors associated with mortality among children below 5 years admitted with Severe Acute Malnutrition in the nutritional unit of JRRH: Table 2 shows that the sex of the child and their duration of admission (hospital stay) were the independent factors associated with mortality among children under five years admitted at JRRH. Precisely, in the bivariate model, sex of the child, duration of admission, caregiver’s highest education level and caregiver’s average monthly income were found to be associated with mortality among children admitted with SAM at
JRRH (p ≤ 0.05) and were then entered into the multivariate model. Specifically, in the multivariate model it was found that risk of death was 0.39 time less in males than females (aRR = 0.39, 95%CI: 0.17 0.87, p = 0.02) Also, the risk of death among children below 5 years admitted with Severe Acute Malnutrition in the nutritional unit was associated with hospital stay in which duration of admission for 72 hours and above (aRR = 0.04,95%CI:0.000.40,p=0.01)compared to those children that spent less than 24 hoursinhospital
Table 2: Factors associated with mortality among children below 5 years admitted with Severe Acute Malnutrition in the nutritional unit of JRRH
Factor Mortality cRR(95%CI) P aRR(95%CI) P Yes, n=49 No, n=289
Sex of child
Males 39(18.75) 169(81.25) 1.0 Females 10(7.69) 120(92.31) 0.4(0.170.75) 0.01 0.39(0.17 0.87) 0.02
Age of child in months
≤12 14(13.08) 93(86.92) 1.0 13 24 26(14.53) 153(85.47) 1.1(0.562.27) 0.73 >24 9(17.31) 43(82.69) 1.3(3.553.46) 0.48
Immunisation Status
Complete 25(14.12) 152(85.88) 1.0 No/Incomplete 24(14.91) 137(85.09) 1.0(0.581.95) 0.84
Duration of admission
<24hours 4(80.00) 1(20.00) 1.0 24 71hours 10(83.33) 2(16.67) 1.2(0.08 17.97) 0.87 1.73(0.11 27.20) 0.70 72hours+ 35(10.90) 286(89.10) 0.04(0.00 0.28) 0.01 0.04(0.00 0.40) 0.01
Exclusive breastfeeding
Yes 14(12.84) 95(87.16) 1.0 No 35(15.28) 95(87.16) 1.2(0.622.38) 0.55
Caregiver’s Relationship to child
Mother 36(15.19) 201(84.81) 1.0 Father 4(14.29) 24(85.71) 0.9(0.302.84) 0.90 Grandparent 7(12.73) 48(87.27) 0.8(0.341.94) 0.64 Others 2(11.11) 16(88.89) 0.6(0.153.16) 0.64
Age of caregiver in years
<20years 2(8.00) 23(92.00) 1.0 20 29years 30(18.18) 81(.82) 2.5(0.57.11.43) 0.22 30 49years 14(11.57) 107(88.43) 1.5(0.317.07) 0.61 50+years 3(11.11) 24(88.89) 1.4(0.219.40) 0.71
Residence
Urban 5(7.81) 59(92.19) 1.0 Rural 44(16.06) 230(83.94) 2.3(0.855.94) 0.10
Highest education level
Noformal 15(18.99) 64(81.01) 1.0 Primary 29(15.43) 159(84.57) 0.8(0.391.54) 0.48 1.12(0.49 2.57) 0.79 Secondary+ 5(7.04) 66(92.96) 0.3(0.110.94) 0.04 0.38(0.10 1.41) 0.15
Occupation
Peasant 8(14.29) 48(85.71) 1.0 Business 35(17.07) 170(82.93) 1.2(0.532.83) 0.62 Civil servant/formal 6(7.79) 71(92.21) 0.5(0.161.55) 0.24
Average monthly income of caregiver (Ugx)
<100,000Ushs 43(16.6) 216(83.4) 1.0 100,000+Ushs 6(7.59) 73(92.41) 0.4(0.161.00) 0.05 0.62(0.23 1.65) 0.34
cRR = crude Relative Risk, aRR = crude Relative Risk, CI = Confidence Interval, P value is significant at 0.05
DISCUSSION
Theobjectiveofthestudywastoestablish the socio demographic factors associated with in hospital mortality among children underfive years of age admitted with SAM
in the nutritional unit of Jinja Regional Referral Hospital In this study, it was found out that the risk of death was less likely to occur among females and those
children with a hospital stay of 72 hours and above. Similarly, from mortality trends at the Children’s Hospital, in Accra, Ghana, 20032013, mortality in males (52.2%) was higher than in females (47.8%) and similar to other studies in Africa, but it differed from the study in Mali which reported significantly higher case fatality
ratesamonggirls [9] This similarity could be expalined by the genetic disparities between males and females. More so, in Zambia it was found that the mortality pattern was higher in males than females and the mortality at 24 hours, 48 hours and 1 week of admission was 93.2%, 88.7 and29%,respectively[5]
CONCLUSION
The sex of the child and their duration of admission (hospital stay) were the factors associated with with mortality among children below 5 years admitted with
Severe Acute Malnutrition in the nutritional unit of Jinja Regional Referral Hospital.
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