Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
School of Public Health & Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
PLoS One. 2021 Feb 2;16(2):e0246267. doi: 10.1371/journal.pone.0246267. eCollection 2021.
Moderate to severe acute malnutrition (SAM/MAM) and severe anaemia are important and associated co-morbidities in children aged less than five years. Independently, these two morbidities are responsible for high risk of in-hospital and post-discharge deaths and hospital readmissions. The primary objective of this study is to investigate the risk of death among severely anaemic children with moderate to severe acute malnutrition compared to children with severe anaemia alone.
This was a retrospective analysis of data collected from a large prospective study that was investigating severe anaemia in children aged less than 5 years old. The study was conducted at Queen Elizabeth Central Hospital in Blantyre and Chikhwawa district hospital in southern Malawi. Children aged less than five years old; with severe anaemia were screened and enrolled. Each child was followed up for eighteen months at one, three, six, twelve and eighteen months after enrolment. Data were analysed using STATA 15.
Between July 2002 and July 2004, 382 severely anaemic children were enrolled in the main study. A total of 52 children were excluded due to missing anthropometric data. Out of the 330 included, 53 children were moderately to severely malnourished and 277 were not. At the end of the 18-month follow period, 28.3% of children with MAM/SAM died compared to 13% of children without MAM/SAM (RR 2.1, CI 0.9-4.2, p = 0.03). Similarly, children with moderate to severe malnutrition reported a significantly higher number of malaria infection cases (33.9%) compared to children with severe anaemia alone (27.9%, p = 0.02). However, the number of hospitalizations and recurrence of severe anaemia was similar and not statistically significant between the two groups (RR 0.8 (0.4-1.4), p = 0.6 and RR 1.1 (0.3-2.8), p = 0.8).
Among children with severe anaemia, those who also had moderate to severe malnutrition had a twofold higher risk of dying compared to those who did not. It is therefore crucial to investigate acute malnutrition among severely anaemic children, as this might be treatable factor associated with high mortality.
5 岁以下儿童中，中重度急性营养不良（SAM/MAM）和严重贫血是重要且相关的合并症。这两种疾病本身就会导致住院和出院后死亡以及再次住院的风险增加。本研究的主要目的是调查患有中重度急性营养不良的严重贫血儿童与单纯患有严重贫血儿童相比的死亡风险。
这是对一项大型前瞻性研究数据的回顾性分析，该研究旨在调查 5 岁以下儿童严重贫血。研究在马拉维布兰太尔的伊丽莎白女王中央医院和南部奇克瓦瓦区医院进行。筛选并招募了年龄小于 5 岁、患有严重贫血的儿童。在登记后 1、3、6、12 和 18 个月，对每个孩子进行了为期 18 个月的随访。使用 STATA 15 进行数据分析。
2002 年 7 月至 2004 年 7 月期间，共有 382 名严重贫血儿童纳入主要研究。由于缺乏人体测量数据，共有 52 名儿童被排除在外。在纳入的 330 名儿童中，53 名儿童患有中重度营养不良，277 名儿童没有营养不良。在 18 个月的随访期结束时，患有 MAM/SAM 的儿童中有 28.3%死亡，而没有 MAM/SAM 的儿童中有 13%死亡（RR 2.1，CI 0.9-4.2，p = 0.03）。同样，患有中重度营养不良的儿童报告的疟疾感染病例明显多于单纯患有严重贫血的儿童（33.9%比 27.9%，p = 0.02）。然而，两组之间的住院次数和严重贫血复发次数相似，且无统计学意义（RR 0.8（0.4-1.4），p = 0.6 和 RR 1.1（0.3-2.8），p = 0.8）。
在患有严重贫血的儿童中，同时患有中重度急性营养不良的儿童死亡风险是没有营养不良的儿童的两倍。因此，对严重贫血儿童进行急性营养不良调查至关重要，因为这可能是与高死亡率相关的可治疗因素。
