Ngwalangwa Fatsani, Chirambo Chawanangwa Mahebere, Lindsjö Cecilia, Dube Queen, Langton Josephine, Baker Tim, Hildenwall Helena
Department of Paediatrics, College of Medicine, University of Malawi, P/Bag 360, Blantyre, Malawi.
MACHI Initiative, P.O Box 30012, Chichiri Blantyre, Malawi.
BMC Pediatr. 2020 Sep 4;20(1):423. doi: 10.1186/s12887-020-02305-4.
The presence of low or hypo glycaemia in children upon admission to hospital in low income countries is a marker for poor outcome. Fasting during illness may contribute to low blood glucose and caretakers' feeding practices during childhood illnesses may thus play a role in the development of low or hypo glycaemia. This study aims to describe the caretaker's feeding practices and association of fasting with low or hypo glycaemia in sick children in Malawi.
A mixed method approach was used combining quantitative cross-sectional data for children aged 0-17 years admitted to Queen Elizabeth Central Hospital (QECH), a tertiary hospital in Malawi, with qualitative focus group discussions conducted with caretakers of young children who were previously referred to QECH from the five health centres around QECH. Logistic regression was used to analyse the quantitative data and thematic content analysis was conducted for qualitative data analysis.
Data for 5131 children who were admitted through the hospital's Paediatric Accident and Emergency Department (A&E) were analysed whereof 2.1% presented with hypoglycaemia (< 2.5 mmol/l) and 6.6% with low glycaemia (≥2.5mmoll/l - < 5 mmol/l). Fasting for more than eight hours was associated with low glycaemia as well as hypoglycaemia with Adjusted Odds Ratios (AOR) of 2.9 (95% Confidence Interval (CI) of 2.3-3.7) and 4.6, (95% CI 3.0-7.0), respectively. Caretakers demonstrated awareness of the importance of feeding during childhood illness and reported intensified feeding attention to sick children but face feeding challenges when illness becomes severe causing them to seek care at a health facility.
Results suggests that caretakers understand the importance of feeding during illness and make efforts to intensify feeding a sick child but challenges occur when illness is severe leading to fasting. Fasting among children admitted to hospitals may serve as a marker of severe illness and determine those at risk of low and hypoglycaemia.
在低收入国家，儿童入院时出现低血糖或血糖过低是预后不良的一个标志。患病期间禁食可能导致血糖降低，因此照顾者在儿童患病期间的喂养方式可能在低血糖或血糖过低的发生中起作用。本研究旨在描述马拉维患病儿童照顾者的喂养方式以及禁食与低血糖或血糖过低之间的关联。
采用混合方法，将马拉维一家三级医院——伊丽莎白女王中央医院（QECH）收治的0至17岁儿童的定量横断面数据，与对先前从QECH周边五个健康中心转诊至QECH的幼儿照顾者进行的定性焦点小组讨论相结合。采用逻辑回归分析定量数据，并对定性数据分析进行主题内容分析。
分析了通过医院儿科急症科（A&E）收治的5131名儿童的数据，其中2.1%出现低血糖（<2.5 mmol/l），6.6%出现血糖过低（≥2.5 mmol/l - <5 mmol/l）。禁食超过八小时与血糖过低以及低血糖相关，调整后的优势比（AOR）分别为2.9（95%置信区间（CI）为2.3 - 3.7）和4.6（95%CI为3.0 - 7.0）。照顾者意识到儿童患病期间喂养的重要性，并报告对患病儿童加强了喂养关注，但在病情严重导致他们前往医疗机构就诊时面临喂养挑战。
结果表明，照顾者理解患病期间喂养的重要性，并努力加强对患病儿童的喂养，但在病情严重导致禁食时会出现挑战。入院儿童的禁食可能是重病的一个标志，并可确定那些有低血糖和血糖过低风险的儿童。
