Moges Tamirat, Haidar Jemal
Zewditu Memorial Hospital, Ethiopia.
East Afr J Public Health. 2009 Aug;6(2):162-7.
To describe the clinical profile and outcomes of severely malnourished cases admitted at Zewditu Memorial hospital, Ethiopia.
A retrospective descriptive data analysis of severely malnourished cases admitted to Zewditu Memorial Hospital from April 2005 to September 2008 was made. A total of 164 cases were enrolled and analyzed for various socio-demographic factors, comorbidities and outcomes. Both bivariate and multivariate models were performed to determine the outcome of the management by explanatory variables. Pearson's chi-square test of independence was used to test the existence of significant association of risk factors with the outcome. A p-value of less than 0.05 denoted significance in differences.
The predominant age group suffered from marasmus was the infants (75.4%) while kwashiorkor was prevalent during the second and third year and the difference noted was statistically significant. The mean age for marasmus, kwash and marasmickwash incidence was 16.9, 25.9 and 27.3 months respectively. The proportion of underweight was higher after the age of 60 months. Death occurred in 21.3% of the cases suggesting that mortality rate was higher than the acceptable range (21.3% vs. < 20.0%). Presence of diarrhoea (AOR=3.5, 95%CI=1.2 to 10.2), ocdema (AOR=0.2, 97%CI=0.1 to 0.9), stunting (AOR=3.3, 97%CI=1.2 to 8.2) and short mean duration of hospital stay (AOR=4.4 95%CI=2.0 to 10.1) were predictors of death outcome.
The observed case fatality rate is unacceptably high and the risk factors for death are identified. In the face of many shortcomings in the hospital setting, managing uncomplicated cases of severe acute malnutrition is not encouraging when compared with the promising results of community based therapeutic care. We recommend the staffs to be trained and retained.
描述埃塞俄比亚泽韦迪图纪念医院收治的重度营养不良病例的临床特征及治疗结果。
对2005年4月至2008年9月在泽韦迪图纪念医院收治的重度营养不良病例进行回顾性描述性数据分析。共纳入164例病例，分析各种社会人口学因素、合并症及治疗结果。采用双变量和多变量模型，以解释变量确定治疗结果。使用Pearson卡方独立性检验来检验危险因素与治疗结果之间是否存在显著关联。p值小于0.05表示差异具有统计学意义。
患消瘦症的主要年龄组是婴儿（75.4%），而夸希奥科病在第二年和第三年较为普遍，差异具有统计学意义。消瘦症、夸希奥科病和消瘦型夸希奥科病发病的平均年龄分别为16.9个月、25.9个月和27.3个月。60个月龄后体重不足的比例更高。21.3%的病例死亡，表明死亡率高于可接受范围（21.3%对<20.0%）。腹泻（比值比=3.5，95%置信区间=1.2至10.2）、水肿（比值比=0.2，97%置信区间=0.1至0.9）、发育迟缓（比值比=3.3，97%置信区间=1.2至8.2）和住院平均时间短（比值比=4.4，95%置信区间=2.0至10.1）是死亡结果的预测因素。
观察到的病死率高得令人无法接受，且已确定死亡的危险因素。鉴于医院环境存在诸多不足，与基于社区的治疗性照护取得的良好结果相比，处理单纯性重度急性营养不良病例的情况并不乐观。我们建议对工作人员进行培训并予以留用。
