Ngirabega J-d-D, Munyanshongore C, Donnen P, Dramaix M
Ministry of health, Ruli Hospital, Kigali, Rwanda.
Rev Epidemiol Sante Publique. 2011 Oct;59(5):313-8. doi: 10.1016/j.respe.2011.05.002. Epub 2011 Sep 1.
Recent estimates of the role of malnutrition on childhood mortality have led to a call for action by decision makers in the fight against child malnutrition. Further evaluation is needed to assess the burden of malnutrition in terms of morbidity and mortality, as well as to assess the impact of various interventions. The objective of this study is to determine the effect of malnutrition on mortality in a pediatric service of a rural hospital in Rwanda.
A prospective cohort study included children aged 6-59 months coming from the catchment area of the hospital and admitted to the pediatric ward between January 2008 and June 2009. Anthropometric, clinical and biological data were gathered at the time of admission. The effect of malnutrition at the time of admission on mortality during hospitalization was analyzed by using logistic regression.
At the time of admission, the prevalences of wasting, underweight and stunting among children was 14.2%, 37.5% and 57.3% respectively. Fifty-six children died during hospitalization. The period mortality rate was 6.9%. After adjustment for age, sex, malaria thick smear and breathing with chest retractions, death was associated with underweight and stunting with adjusted odds rations of 4.6 (IC95% 2.5-8.4) and 4.0 (IC95% 2.0-8.2) respectively.
The study confirmed the influence of malnutrition on child mortality in pediatrics wards. These results can be of great help for improving the awareness of the community decision-makers in the fight to prevent malnutrition.
近期关于营养不良对儿童死亡率影响的评估促使决策者呼吁采取行动抗击儿童营养不良问题。需要进一步评估营养不良在发病率和死亡率方面的负担，以及各种干预措施的影响。本研究的目的是确定营养不良对卢旺达一家农村医院儿科服务中儿童死亡率的影响。
一项前瞻性队列研究纳入了来自该医院服务区域、于2008年1月至2009年6月期间入住儿科病房的6至59个月大的儿童。入院时收集人体测量、临床和生物学数据。采用逻辑回归分析入院时营养不良对住院期间死亡率的影响。
入院时，儿童消瘦、体重不足和发育迟缓的患病率分别为14.2%、37.5%和57.3%。56名儿童在住院期间死亡。期间死亡率为6.9%。在对年龄、性别、疟原虫厚涂片检查结果和伴有胸壁凹陷的呼吸情况进行调整后，死亡与体重不足和发育迟缓相关，调整后的优势比分别为4.6（95%置信区间2.5 - 8.4）和4.0（95%置信区间2.0 - 8.2）。
该研究证实了营养不良对儿科病房儿童死亡率的影响。这些结果对于提高社区决策者在预防营养不良斗争中的认识可能会有很大帮助。
