An institution-based study on risk factors associated with mortality in children under five years old with Severe Acute Malnutrition in Limpopo Province-South Africa, 2014-2018

  • Maternal and child health
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Background:
Mortality in children <5 with Severe Acute Malnutrition (SAM) reaches up to 30% in South Africa despite the im- plementation of the World Health Organization SAM management guidelines. We aimed to identify risk factors associated with mortality among children <5 hospitalized with SAM in Limpopo Province public hospitals from 2014 to 2018.
Methods:
We conducted a cross-sectional review of hospital records of children <5 who were admitted with SAM in five hos- pitals of Limpopo Province. We extracted socio-demographic and clinical history data from hospital records using a data capture sheet. We used univariable and multivariable logistic regression to identify risk factors associated with mortality.
Results:
We included 956 children with 480 (50.2%) males and 476 (49.8%) females. The median age was 13 months (range 2 to 59 months) with 73.8% (706/956) of the children aged between 7 and 24 months. Overall, 248 (25.9%) of 956 children with SAM died from 2014 to 2018. Diarrhoea and lower respiratory tract infections (LRTIs) were the most common complications with 610 (63.8%) and 405 (42.4%) cases respectively. Factors associated with mortality in- cluded history of herbal medication ingestion (adjusted Odds Ratio (aOR): 2.0, 95% Confidence Interval (CI): 1.2-3.4, p=0.007), diarrhoea (aOR: 1.9, 95% CI: 1.1-3.2, p=0.009), LRTIs (aOR: 1.6, 95% CI: 1-2.5, p=0.042), anemia (aOR: 4.3, 95% CI: 2.5-7.2, p<0.001), hypoglycemia (aOR: 12.7, 95% CI: 6.2-26.3, p<0.001) and human immunodeficiency virus (HIV) infection (aOR:1.8, 95% CI: 1.1-3.1, 0.016).
Conclusion
Herbal medication and health conditions such as diarrhoea, LRTIs, anemia, hypoglycemia and HIV infection were associated with increased mortality in children with SAM. These risk factors should be taken into consideration when managing children with SAM.

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