Oumer Abdu, Mesfin Leul, Tesfahun Esubalew, Ale Ahmed
Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia.
Department of Public Health, College of Medicine and Health Science, Debre Birhan, University, Debre Birhan, Ethiopia.
Int J Gen Med. 2021 Nov 24;14:8763-8773. doi: 10.2147/IJGM.S337348. eCollection 2021.
Severe acute malnutrition (SAM) is still the leading cause of global child morbidity and mortality, with a greater burden in sub-Saharan Africa. A facility-based treatment of SAM demands critical care for improved outcomes and survival of children. However, there is a need to understand predictors for time to death among SAM children for effective interventions.
To assess the predictors of death from complicated severe acute malnutrition among admitted children treated in East Ethiopia.
A 31-month retrospective cohort study was conducted among a total of 665 under-five children admitted with complicated SAM in Dilchora hospital, eastern Ethiopia. The data was extracted from the patient register and medical charts using the kobo tool. The life table, survival, and hazard curves were plotted. Kaplan-Meier with Log rank tests was used to estimate and compare the mean survival time. The bivariable and multivariable Cox proportional hazards models were used to identify predictors of time to death. Crude and adjusted hazard ratios with 95% confidence intervals and p-values were reported.
A total of 665 full medical charts were reviewed with a total of 60 (9%; 95% CI: 6.8-11.2%) deaths were observed, where most of the deaths occurred during the first two weeks of admission, while 74 (11%) and 449 (68%) were cured and recovered (stabilized and transferred to outpatient), respectively. Admitted children having good appetite (AHR=0.15; 95% CI: 0.64-0.33), pneumonia (AHR=2.46, 95% CI: 1.436, 4.22), diarrhea (AHR=2.16, 95% CI: 1.16, 4.06), tuberculosis (AHR=2.86, 95% CI: 1.08, 7.63) and having a nasogastric tube inserted (AHR=2.33, 95% CI: 1.15, 4.72) were significant predictors of time to death among SAM children.
There is unacceptably high under-five mortality due to SAM, which is predicted by co-morbidities (pneumonia, diarrhea, and tuberculosis), with medical complications and nasogastric tubes.
重度急性营养不良（SAM）仍是全球儿童发病和死亡的主要原因，在撒哈拉以南非洲地区负担更重。基于医疗机构的SAM治疗需要重症护理以改善儿童的治疗效果和生存率。然而，需要了解SAM儿童死亡时间的预测因素以便进行有效的干预。
评估在埃塞俄比亚东部接受治疗的住院儿童中，复杂重度急性营养不良导致死亡的预测因素。
对埃塞俄比亚东部迪尔乔拉医院收治的665名患有复杂SAM的五岁以下儿童进行了为期31个月的回顾性队列研究。使用kobo工具从患者登记册和病历中提取数据。绘制了生命表、生存曲线和风险曲线。采用Kaplan-Meier法和对数秩检验来估计和比较平均生存时间。使用双变量和多变量Cox比例风险模型来确定死亡时间的预测因素。报告了粗风险比和调整后的风险比以及95%置信区间和p值。
共审查了665份完整的病历，观察到60例（9%；95%CI：6.8-11.2%）死亡，其中大多数死亡发生在入院的前两周，而分别有74例（11%）和449例（68%）治愈并康复（病情稳定并转至门诊）。食欲良好的住院儿童（AHR=0.15；95%CI：0.64-0.33）、肺炎（AHR=2.46，95%CI：1.436，4.22）、腹泻（AHR=2.16，95%CI：1.16，4.06）、结核病（AHR=2.86，95%CI：1.08，7.63）以及插入鼻胃管（AHR=2.33，95%CI：1.15，4.72）是SAM儿童死亡时间的重要预测因素。
由于SAM导致的五岁以下儿童死亡率高得令人无法接受，其预测因素包括合并症（肺炎、腹泻和结核病）、医疗并发症和鼻胃管。
