TY - JOUR
T1 - Association between diagnostic criteria for severe acute malnutrition and hospital mortality in children aged 6–59 months in the eastern Democratic Republic of Congo
T2 - the Lwiro cohort study
AU - Ngaboyeka, Gaylord
AU - Bisimwa, Ghislain
AU - Neven, Anouk
AU - Mwene-Batu, Pacifique
AU - Kambale, Richard
AU - Kingwayi, Petit Passy
AU - Chiribagula, Christian
AU - Battisti, Oreste
AU - Dramaix, Michèle
AU - Donnen, Philippe
N1 - Funding Information:
This study was supported by the Research Center “Politics and systems of international health-health” of the Université Libre de Bruxelles.
Funding Information:
This work is part of a scientific collaboration between the health schools of the Université Libre de Bruxelles (ULB) and the Université Catholique de Bukavu for a study on screening for malnutrition and its long-term effects in South-Kivu. We would like to thank the Université ULB through CEMUBAC for having contributed to the management of malnutrition in South Kivu and for having recorded this data in digital form, which enabled us to carry out this study. We would also like to thank the Research Center “Politics and systems of international health-health” of the School of Public Health of the ULB for having financially supported the realization of this work. We thank the authorities of CRSN and all the workers of the HPL. We also thank the General Reference Hospital of Bukavu for having served as a framework for a long stay at the Nutritional and Therapeutic Center to acquire experience and knowledge on severe acute malnutrition.
Publisher Copyright:
Copyright © 2023 Ngaboyeka, Bisimwa, Neven, Mwene-Batu, Kambale, Kingwayi, Chiribagula, Battisti, Dramaix and Donnen.
PY - 2023/5/16
Y1 - 2023/5/16
N2 - Background: Few studies have assessed the relationship between weight-for-height (WHZ) and mid-upper arm circumference (MUAC) with hospital mortality considering confounders. The particularity of MUAC for age (MUACZ) is less documented. Objective: This study aims to investigate this relationship in a region endemic for severe acute malnutrition (SAM). Methods: This is a retrospective cohort based on a database of children admitted from 1987 to 2008 in South Kivu, eastern DRC. Our outcome was hospital mortality. To estimate the strength of the association between mortality and nutritional indices, the relative risk (RR) with its 95% confidence interval (95% CI) was calculated. In addition to univariate analyses, we constructed multivariate models from binomial regression. Results: A total of 9,969 children aged 6 to 59 months were selected with a median age of 23 months. 40.9% had SAM (according to the criteria WHZ < -3 and/or MUAC<115 mm and/or the presence of nutritional edema) including 30.2% with nutritional edema and 35.2% had both SAM and chronic malnutrition. The overall hospital mortality was 8.0% and was higher at the beginning of data collection (17.9% in 1987). In univariate analyses, children with a WHZ < -3 had a risk almost 3 times higher of dying than children without SAM. WHZ was more associated with in-hospital mortality than MUAC or MUACZ. Multivariate models confirmed the univariate results. The risk of death was also increased by the presence of edema. Conclusion: In our study, WHZ was the indicator more associated with hospital death compared with MUAC or MUACZ. As such, we recommend that all criteria shall continue to be used for admission to therapeutic SAM programs. Efforts should be encouraged to find simple tools allowing the community to accurately measure WHZ and MUACZ.
AB - Background: Few studies have assessed the relationship between weight-for-height (WHZ) and mid-upper arm circumference (MUAC) with hospital mortality considering confounders. The particularity of MUAC for age (MUACZ) is less documented. Objective: This study aims to investigate this relationship in a region endemic for severe acute malnutrition (SAM). Methods: This is a retrospective cohort based on a database of children admitted from 1987 to 2008 in South Kivu, eastern DRC. Our outcome was hospital mortality. To estimate the strength of the association between mortality and nutritional indices, the relative risk (RR) with its 95% confidence interval (95% CI) was calculated. In addition to univariate analyses, we constructed multivariate models from binomial regression. Results: A total of 9,969 children aged 6 to 59 months were selected with a median age of 23 months. 40.9% had SAM (according to the criteria WHZ < -3 and/or MUAC<115 mm and/or the presence of nutritional edema) including 30.2% with nutritional edema and 35.2% had both SAM and chronic malnutrition. The overall hospital mortality was 8.0% and was higher at the beginning of data collection (17.9% in 1987). In univariate analyses, children with a WHZ < -3 had a risk almost 3 times higher of dying than children without SAM. WHZ was more associated with in-hospital mortality than MUAC or MUACZ. Multivariate models confirmed the univariate results. The risk of death was also increased by the presence of edema. Conclusion: In our study, WHZ was the indicator more associated with hospital death compared with MUAC or MUACZ. As such, we recommend that all criteria shall continue to be used for admission to therapeutic SAM programs. Efforts should be encouraged to find simple tools allowing the community to accurately measure WHZ and MUACZ.
KW - DRC
KW - hospital mortality
KW - MUAC
KW - MUACZ
KW - severe acute malnutrition
KW - South Kivu
KW - WHZ
UR - http://www.scopus.com/inward/record.url?scp=85161372286&partnerID=8YFLogxK
UR - https://pubmed.ncbi.nlm.nih.gov/37293673
U2 - 10.3389/fnut.2023.1075800
DO - 10.3389/fnut.2023.1075800
M3 - Article
C2 - 37293673
AN - SCOPUS:85161372286
SN - 2296-861X
VL - 10
JO - Frontiers in Nutrition
JF - Frontiers in Nutrition
M1 - 1075800
ER -