Alemu Wagaye, Argaw Dirshaye, Adimasu Mebrate, Ewunie Temesgen Muche
Department of Epidemiology and Biostatistics, Collage of Medicine and Health Science, Dilla University, Ethiopia.
Department of Human Nutrition, Collage of Medicine and Health Science, Dilla University, Ethiopia.
Clin Nutr ESPEN. 2023 Feb;53:165-169. doi: 10.1016/j.clnesp.2022.12.014. Epub 2022 Dec 15.
BACKGROUND & AIMS: Severe acute malnutrition (SAM) is a public health problem in developing countries including Ethiopia, because of the high risk of death, most severely malnourished children are managed in hospitals. Hence, the aim of this study was to assess the predictors of mortality among severely malnourished children admitted in Gedeo zone hospitals, Southern Ethiopia.
Multicenter institution-based prospective follow-up study was conducted among 568 severely malnourished children with age <5 years in Gedeo zone hospitals from December 2018 to April 2020. Survival analysis with Cox proportional hazard model was conducted to determine factors associated with mortality rate. Variables with a p-value <0.05 in multivariate regression were considered statistically significant.
From a total of 568 children admitted with SAM; 54(9.5%), 306(53.9%), 179(31.5%) and 29(5.1%) died, recovered, transferred out and defaulted respectively. Over the study period, the rate of mortality was eight per 1000 person-days. Comorbidity after admission (Adjusted hazard ratio (AHR) = 2.96; 95% CI 1.35, 6.47), being HIV reactive (AHR = 1.31; 95% CI 1.12, 1.72), hospital stay for more than one week (AHR = 1.78; 95% CI 1.03, 3.12), no formal education of the mother (AHR 2.25; 95% CI 1.24, 4.08) and Nasogastric (NG) tube (AHR = 1.87; 95% CI: 1.562-2.37) given were the significant predictors of mortality.
Maternal/caregiver educational status, co-morbidity after admission, being HIV reactive, vaccination status, hospital stay for more than one week and NG tube given were found as significant determinant factors of mortality rate. Hence, the government of Ethiopia and stakeholders should implement strong interventions focusing on these predictors.
严重急性营养不良（SAM）是包括埃塞俄比亚在内的发展中国家面临的一个公共卫生问题，由于死亡风险高，大多数严重营养不良的儿童在医院接受治疗。因此，本研究的目的是评估埃塞俄比亚南部格德奥地区医院收治的严重营养不良儿童的死亡预测因素。
2018年12月至2020年4月，在格德奥地区医院对568名年龄小于5岁的严重营养不良儿童进行了多中心基于机构的前瞻性随访研究。采用Cox比例风险模型进行生存分析，以确定与死亡率相关的因素。多变量回归中p值<0.05的变量被认为具有统计学意义。
在总共568名因严重急性营养不良入院的儿童中，分别有54名（9.5%）死亡、306名（53.9%）康复、179名（31.5%）转出和29名（5.1%）失访。在研究期间，死亡率为每1000人日8例。入院后合并症（调整后风险比（AHR）=2.96；95%置信区间1.35，6.47）、HIV反应阳性（AHR=1.31；95%置信区间1.12，1.72）、住院时间超过一周（AHR=1.78；95%置信区间1.03，3.12）、母亲未接受正规教育（AHR 2.25；95%置信区间1.24，4.08）以及接受鼻胃管（NG）治疗（AHR=1.87；95%置信区间：1.562 - 2.37）是死亡的显著预测因素。
母亲/照顾者的教育状况、入院后合并症、HIV反应阳性、疫苗接种状况、住院时间超过一周以及接受鼻胃管治疗被发现是死亡率的重要决定因素。因此，埃塞俄比亚政府和利益相关者应针对这些预测因素实施强有力的干预措施。
