Treatment outcomes and determinants of mortality in children aged 0-59 months diagnosed with complicated severe acute malnutrition in two referral hospitals in Ghana

ABSTRACT

Background: Complicated severe acute malnutrition (SAM) poses an enormous threat to the survival of children. However, the relationship between admission characteristics and recovery, weight gain and the risk of mortality in children with complicated SAM is limited in Ghana, especially those <6 months old. This study aimed at investigating the treatment outcomes and determinants of mortality in children aged 0–59 months with complicated SAM. Methods: A review of records of children, 0–59 months treated for complicated SAM between January 2013 and June 2017 in two hospitals in Ghana was conducted. Results: Discharge, death and abscond rates were 77.7%, 17.7% and 3.8%, respectively. Median time to death was 5.0 days (IQR: 2.0; 9.0), with infants <6 months dying earlier (1.5 days; 95% CI: 0.7; 3.2, p = 0.001) compared to the 6–59 month group (5.9 days). Shock, convulsion, oedema and HIV-positive status were associated with 7.1 (95% CI: 2.7; 20.5, p < 0.001), 4.2 (95% CI: 1.6; 10.7, p < 0.001), 2.5 (95% CI: 1.2; 5.5, p = 0.02) and 3.1 (95% CI: 1.3; 7.2, p = 0.03) increased odds of death. Conclusion: The high death rate beyond the internationally accepted minimum observed in this study necessitates further research into effective care delivery, appropriate interventions and implementation to reduce SAM deaths in hospitals.

KEYWORDS:

• Children
• infants
• severe acute malnutrition
• medical complications
• treatment outcomes
• mortality

Acknowledgments

We would like to thank Mrs Freda Intiful of the Department of Nutrition and Dietetics, University of Ghana, for her assistance in coordinating the implementation of this project. We also appreciate the contribution of all staff members of the various hospitals who assisted in the research.

Author’s contributions

Dr Martani Lombard and Dr Robin Claire Dolman conceptualised the study. Dr Cristian Ricci supervised the development of the data capturing tool, data management and data analysis. Hannah Asare assisted in development of database, data collection and capturing. Prof Etienne Nel supervised the clinical correctness and interpretation of data and results. Janet Adede Carboo was responsible for planning of the study, development of database, data collection and analysis, interpretation of data and writing of manuscript. All authors contributed to the amendment of the article and the final proof-reading and approval of the manuscript.

Disclosure statement

No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Additional information

Funding

This study was supported by the Nutricia Research Foundation. The funding agency had no influence whatsoever on the execution of the study and the content of the manuscript.