Risk factors for severe acute malnutrition among children aged 6-59 months admitted at Lubango Pediatric Hospital, Angola.

Abstract

Background: The 4th Millennium Development Goal (MDG) is to reduce the mortality rates among underfives by two thirds between 1990 and 2015. Efforts to prevent child deaths need to be stepped up in order to meet that target but the challenge is how to reduce morbidity and mortality among children with SAM. In SSA, the nutritional and health situation is worsening. The hospital case fatality rates(CFR) for SAM remain high due to faulty case management in resource-poor settings. Despite the improved understanding of the clinical management of SAM, the CFR among admitted children in SSA has remained between 20- 30%. This study sought to determine the social demographic and clinical risk factors associated with severe acute malnutrition among children admitted at Lubango Pediatric Hospital.

Methods: This was a case-control design where cases were compared with age and sex -matched controls with weight for height. Data was collected using an interviewer administered structured questionnaire, with caregivers as respondents: Clinical history and examination was conducted by a trained clinician eliciting duration of illness and categorizing symptoms such as fever and cough among others. The Nutritional status of the child was determined using anthropometric measurement. A pre- HIV test counselling was done to the care takers and the ones who gave consent, an HIVantibody test was conducted to the child using Determine and unigold HIV rapid test followed by a post-test counselling for both the HIV positive and negative children. For children who had been admitted the same year, the files were found for confirmation of the diagnosis of the previous admission(s).

Results: The significant predictors of severe malnutrition were family order, HIV test results, previous history of admission with diarrhea and malnutrition, duration of breast feeding and number of previous admissions

Conclusion: The burden of severe malnutrition is still high among children admitted in hospital. There is need to strengthen breast feeding campaigns and family planning strategies. Further clinicians need to be proactive in assessing the risk of malnutrition in HIV positive children and children with recurrent admissions especially with malnutrition and diarrhea.