Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia
Author:
Bwakura-Dangarembizi Mutsa12, Dumbura Cherlynn2, Amadi Beatrice3, Ngosa Deophine3, Majo Florence D2, Nathoo Kusum J1, Mwakamui Simutanyi3, Mutasa Kuda2, Chasekwa Bernard2, Ntozini Robert2, Kelly Paul34ORCID, Prendergast Andrew J24, Besa Ellen, Claire D Bourke, Chakara Pamela, Chidamba Leah, Chidawanyika Theodore, Chidhanguro Tafadzwa, Chifunda Kapula, Chilala Esther, Chingaoma Lovemore, Chipunza Miyoba, Chulu Nivea, Dandadzi Adlight, Dumba Tenzeni, Dune Washington, Gondwe Temwaninge, Govha Margaret, Gwanzura Karen, Humphrey H Jean, Kaingu Tomola, Kapoma Chanda, Kasaru Sarudzai, Kazhila Lydia, Kureva Chipo, Macwani Lucy, Mapurisa Idah, Mashayanembwa Patience, Masimba Faithful, Moyo Stephen, Mpofu Eddington, Mpundu Mary, Mukusho Edith, Mushonga Johnson, Muyenga Agatha, Mwaba Sophreen, Mwanza Mpala, Mwapenya Benjamin, Nayame Gwendolyn, Nkiwane Sibongile, Nyamwino Penias, Nyendwa Evelyn, Phiri Dennis, Rambanepasi Phillipa, Robertson Ruairi, Rukobo Sandra, Runodamoto Thompson, Sauramba Virginia, Seremwe Shepherd, Simango Pururudzai, Sturgeon Jonathan, Swann R Jonathan, Tembo Andreck, Tembo Dalitso, Tsenesa Blessing, Wells C K Jonathan, Zyambo Kanekwa, Zyambo Khozya,
Affiliation:
1. Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe 2. Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe 3. Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia 4. Blizard Institute, Queen Mary University of London, London, UK
Abstract
ABSTRACT
Background
Children discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk of mortality, especially HIV-positive children. Few studies have examined mortality in the antiretroviral therapy (ART) era.
Objectives
Our objectives were to ascertain 52-wk mortality in children discharged from hospital for management of complicated SAM, and to identify independent predictors of mortality.
Methods
A prospective cohort study was conducted in children enrolled from 3 hospitals in Zambia and Zimbabwe between July 2016 and March 2018. The primary outcome was mortality at 52 wk. Univariable and multivariable Cox regression models were used to identify independent risk factors for death, and to investigate whether HIV modifies these associations.
Results
Of 745 children, median age at enrolment was 17.4 mo (IQR: 12.8, 22.1 mo), 21.7% were HIV-positive, and 64.4% had edema. Seventy children (9.4%; 95% CI: 7.4, 11.7%) died and 26 exited during hospitalization; 649 were followed postdischarge. At discharge, 43.9% had ongoing SAM and only 50.8% of HIV-positive children were receiving ART. Vital status was ascertained for 604 (93.1%), of whom 55 (9.1%; 95% CI: 6.9, 11.7%) died at median 16.6 wk (IQR: 9.4, 21.9 wk). Overall, 20.0% (95% CI: 13.5, 27.9%) and 5.6% (95% CI: 3.8, 7.9%) of HIV-positive and HIV-negative children, respectively, died [adjusted hazard ratio (aHR): 3.83; 95% CI: 2.15, 6.82]. Additional independent risk factors for mortality were ongoing SAM (aHR: 2.28; 95% CI: 1.22, 4.25), cerebral palsy (aHR: 5.60; 95% CI: 2.72, 11.50) and nonedematous SAM (aHR: 2.23; 95% CI: 1.24, 4.01), with no evidence of interaction with HIV status.
Conclusions
HIV-positive children have an almost 4-fold higher mortality than HIV-negative children in the year following hospitalization for complicated SAM. A better understanding of causes of death, an improved continuum of care for HIV and SAM, and targeted interventions to improve convalescence are needed.
Funder
Medical Research Council Canada Wellcome Trust Royal Society
Publisher
Oxford University Press (OUP)
Subject
Nutrition and Dietetics,Medicine (miscellaneous)
Cited by
27 articles.
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