School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia.
PLoS One. 2024 Aug 26;19(8):e0309122. doi: 10.1371/journal.pone.0309122. eCollection 2024.
Severe acute malnutrition (SAM) poses a significant threat to child health globally, particularly in low- and middle-income countries. Zambia, like many Sub-Saharan African nations, faces high rates of child malnutrition, with SAM contributing significantly to under-five mortality. Therefore, this study aimed to determine the prevalence and factors associated with SAM.
This retrospective cross-sectional study was conducted at Livingstone University Teaching Hospital in Zambia (LUTH). SAM was defined according to the World Health Organization (WHO) criteria as either weight-for-height less than -3 standard deviations, mid-upper arm circumference (MUAC) less than 115 mm, or presence of bilateral pitting edema in children between 6 months and 5 years old who were attended to between 2020 and 2022. Data abstraction from pediatric patient records was conducted between August 2023 and January 2024. The records without the age and outcome variable were excluded. A total of 429 participants between 6 months and 5 years old were included, with demographic, clinical, and hematological parameters analyzed. Univariable and multivariable logistic regression were employed to investigate factors associated with SAM.
Overall, 429 medical records were included in the study and the prevalence of SAM was 27.0% (n = 116). Age group 6-24 months (Adjusted Odds Ratio [AOR]: 11.60; 95% Confidence Interval [CI]: 3.34-40.89, p<0.001), living with HIV (AOR:3.90; 95% CI: 1.14-13.70, p = 0.034), Tuberculosis (TB) (AOR:22.30, 95% CI: 4.53, 110.3, p < 0.001), comorbidities (AOR: 2.50; 95% CI 1.13, 5.88, p = 0.024) and platelet count (AOR: 1.00; 95% CI 1.00, 1.00, p = 0.027) were positively associated with SAM.
This study found a high prevalence of SAM, exceeding the WHO target of reducing SAM to 5% by 2025. SAM was associated with younger age (6-24 months), HIV infection, TB, comorbidities and platelet count. Therefore, there is need to enhance strategies aimed at reducing SAM among young children, children living with HIV, TB and comorbidities, particularly by intensive treatment, continuing and strengthening nutrition services.
严重急性营养不良（SAM）对全球儿童健康构成重大威胁，尤其是在中低收入国家。赞比亚与许多撒哈拉以南非洲国家一样，面临着儿童营养不良率高的问题，SAM 是导致五岁以下儿童死亡的主要原因之一。因此，本研究旨在确定 SAM 的患病率和相关因素。
本研究为赞比亚利文斯顿大学教学医院（LUTH）的回顾性横断面研究。SAM 按照世界卫生组织（WHO）的标准定义为 6 至 59 个月儿童的身高体重指数低于 -3 个标准差、中上臂围（MUAC）小于 115 毫米，或 6 至 59 个月儿童存在双侧凹陷性水肿，且在 2020 年至 2022 年就诊。2023 年 8 月至 2024 年 1 月期间从儿科患者记录中提取数据。排除无年龄和结局变量的记录。共纳入 429 名 6 至 59 个月大的参与者，分析了人口统计学、临床和血液学参数。采用单变量和多变量逻辑回归分析与 SAM 相关的因素。
共有 429 份病历纳入研究，SAM 的患病率为 27.0%（n=116）。6-24 个月年龄组（调整优势比[OR]：11.60；95%置信区间[CI]：3.34-40.89，p<0.001）、HIV 感染（OR：3.90；95%CI：1.14-13.70，p=0.034）、结核病（TB）（OR：22.30，95%CI：4.53，110.3，p<0.001）、合并症（OR：2.50；95%CI 1.13，5.88，p=0.024）和血小板计数（OR：1.00；95%CI 1.00，1.00，p=0.027）与 SAM 呈正相关。
本研究发现 SAM 的患病率很高，超过了世卫组织到 2025 年将 SAM 减少到 5%的目标。SAM 与年龄较小（6-24 个月）、HIV 感染、TB、合并症和血小板计数有关。因此，需要加强旨在减少幼儿、HIV 感染儿童、TB 患者和合并症儿童 SAM 的策略，特别是通过强化治疗、持续和加强营养服务。
