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埃塞俄比亚北部提格雷地区综合医院收治的重度急性营养不良儿童的生存状况及死亡预测因素:一项回顾性队列研究

Survival status and predictors of mortality among children with severe acute malnutrition admitted to general hospitals of Tigray, North Ethiopia: a retrospective cohort study.

作者信息

Guesh Gebremicael, Degu Getu, Abay Mebrahtu, Beyene Berhe, Brhane Ermyas, Brhane Kalayu

机构信息

JSI, P.O. Box: 13898, Addis Ababa, Ethiopia.

Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.

出版信息

BMC Res Notes. 2018 Nov 26;11(1):832. doi: 10.1186/s13104-018-3937-x.

DOI:10.1186/s13104-018-3937-x
PMID:30477540
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6257969/
Abstract

OBJECTIVE

Despite the presence standard protocol for management of severe acute malnutrition case-fatality rates in African hospitals remain unacceptably high. The case in Ethiopia is not different from others. Therefore, this study was aimed to assess survival status and predictors of mortality among children with severe acute malnutrition admitted to stabilization centers of general hospitals in Tigray region, northern Ethiopia. A 24 months retrospective longitudinal study was conducted among 569 randomly selected medical records of children admitted to stabilizing centers. Both bi-variable and multivariable Cox regression analysis was conducted to identify predictors of mortality. Association was summarized using AHR, and statistical significances were declared at 95% CI and P-value < 0.05.

RESULTS

During follow up, 456 [82%] of children had got cured, 37 [6.65%] were absconded and 21 [3.8%] were died. The overall mean survival time was 41.93 [95% CI 40.17-43.68] days. Impaired conscious level [AHR = 6.69, 95% CI 2.43-19.93], development of comorbidity after admission [AHR 12.71, 95% CI 2.79-57.94] and being urban in residence [AHR = 2.73, 95% CI 1.12-6.64] were predictors of mortality. Therefore, interventions to reduce further mortality should focus in children having impaired consciousness level and who developed comorbidity after admission.

摘要

目的

尽管存在管理严重急性营养不良的标准方案,但非洲医院的病例死亡率仍然高得令人无法接受。埃塞俄比亚的情况与其他国家并无不同。因此,本研究旨在评估埃塞俄比亚北部提格雷地区综合医院稳定中心收治的严重急性营养不良儿童的生存状况及死亡预测因素。对随机抽取的569例入住稳定中心儿童的病历进行了为期24个月的回顾性纵向研究。采用双变量和多变量Cox回归分析来确定死亡预测因素。使用风险比(AHR)总结关联,并在95%置信区间和P值<0.05时声明具有统计学意义。

结果

在随访期间,456名[82%]儿童治愈,37名[6.65%]儿童逃走,21名[3.8%]儿童死亡。总体平均生存时间为41.93天[95%置信区间40.17 - 43.68]。意识水平受损[AHR = 6.69,95%置信区间2.43 - 19.93]、入院后出现合并症[AHR 12.71,95%置信区间2.79 - 57.94]以及居住在城市[AHR = 2.73,95%置信区间1.12 - 6.64]是死亡的预测因素。因此,为进一步降低死亡率而采取的干预措施应侧重于意识水平受损以及入院后出现合并症的儿童。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/77d2/6257969/07a4f94ececb/13104_2018_3937_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/77d2/6257969/07a4f94ececb/13104_2018_3937_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/77d2/6257969/07a4f94ececb/13104_2018_3937_Fig1_HTML.jpg

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