Predictors of morbidity & mortality in children hospitalized with severe acute malnutrition – Hospital based observational study

Abstract

Background: Severe Acute malnutrition is the major flog which needs utmost attention to bring down the under 5 mortality & morbidity significantly. Hospitalization and inpatient care of all such children is neither feasible nor cost effective intervention. Hence it is important to identify the factors which influence morbidity & mortality in children with Severe Acute Malnutrition (SAM) and utilize them as indicators to triage and targeting the interventions towards such children so as to optimally utilize the resources especially in developing countries. Aims and objectives: With this background the present study was planned to determine the predictors of morbidity in children with SAM. Methods: This hospital based observational study was conducted in Rama Medical College Hospital & Research centre. Ghaziabad, Uttar Pradesh where consecutive children between 2 months- 5 years fulfilling the WHO case definition of SAM and complications requiring hospitalization were enrolled. The sociodemographic, clinical and biochemical factors influencing the morbidity & mortality were evaluated. Results: Of 3704 children screened for SAM, 504 (13.6%) fulfilled the case definition but the final analysis was done on 425 children. The most common co morbidity in these children was diarrhea (63.5%) followed by pneumonia (40%), tuberculosis (5.1%) and HIV in 1% . After multivariate regression analysis, the present study observed shock, hypoglycemia, severe anemia and bacteremia as independent risk factors significantly associated with morbidity & mortality. Conclusion: The morbidity & mortality of children with SAM is influenced by multiple factors and it becomes imperative to identify the red flags responsible for early deaths so as to hospitalize, triage and prioritize the interventions especially in resource limited settings.