Amsalu Solomon, Asnakew Gashaw
Department of Pediatrics, Gondar University, P.O. Box 196, Gondar.
Ethiop Med J. 2006 Apr;44(2):151-7.
To assess the clinical profile and treatment outcome of children with severe malnutrition.
A retrospective study of 335 children with severe malnutrition was conducted in Gondar University hospital over a period of four years; September 1997 - August 2000.
There were 175 (52.2%) males and 160 (47.8%) females with severe malnutrition. Children below the age of 24 months constituted for 60.3% of all the admissions. Marasmus was the most common type of malnutrition, present in 174 (52.0%) of the patients. Kwashiorkor and marasmic kwashiorkor were seen in 78 (23.3%) and 83 (24.7%) of the patients respectively. The overall case fatality rate was 61 (18.4%) while 30 (9.1%) abandoned treatment. Two hundred forty (72.5%) of the patients were discharged improved. The case fatality rates for the different types of malnutrition were 28.4% for marasmic kwashiorkor, 16.9% for kwashiorkor and 14.5% for marasmus. A statistically significant risk of death was observed in those with history of bottle feeding (OR 4.5, P-value < 0.01), diarrhea with severe dehydration (OR 3.05, P-value < 0.01), altered level of consciousness (OR 7.08, P-value < 0.001), total serum protein of 5 g/dl and less (OR 3.45, P-value < 0.05) and patients having marasmic kwashiorkor (OR 2.55, P-value < 0.01).
This study shows a high mortality rate of severe malnutrition despite hospitalization. The findings confirm the need for intensive management of severe malnutrition.
评估重度营养不良患儿的临床特征及治疗效果。
对贡德尔大学医院在1997年9月至2000年8月这四年间收治的335例重度营养不良患儿进行回顾性研究。
重度营养不良患儿中，男性175例（52.2%），女性160例（47.8%）。24个月龄以下儿童占所有入院患儿的60.3%。消瘦是最常见的营养不良类型，174例（52.0%）患者存在该情况。分别有78例（23.3%）和83例（24.7%）患者出现夸希奥科病和消瘦型夸希奥科病。总体病死率为61例（18.4%），30例（9.1%）放弃治疗。240例（72.5%）患者出院时病情好转。不同类型营养不良的病死率分别为：消瘦型夸希奥科病28.4%，夸希奥科病16.9%，消瘦14.5%。有奶瓶喂养史者（比值比4.5，P值<0.01）、伴有重度脱水的腹泻患者（比值比3.05，P值<0.01）、意识水平改变者（比值比7.08，P值<0.001）、总血清蛋白低于5g/dl者（比值比3.45，P值<0.05）以及患有消瘦型夸希奥科病的患者（比值比2.55，P值<0.01），观察到有统计学意义的死亡风险。
本研究表明，尽管住院治疗，重度营养不良的死亡率仍很高。研究结果证实了对重度营养不良进行强化管理的必要性。
