Ten-year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in Malawi (2011-2021): Declining admissions but worsened clinical profiles.
<h4>Background</h4>Severe acute malnutrition (SAM) constitutes a substantial burden in African hospitals. Despite adhering to international guidelines, high inpatient mortality rates persist and the underlying contributing factors remain poorly understood.<h4>Objective</h4>We...
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Public Library of Science (PLoS)
2024-01-01
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| Online Access: | https://doi.org/10.1371/journal.pone.0311534 |
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| author | Mphatso Nancy Chisala Celine Bourdon Emmanuel Chimwezi Allison I Daniel Chikondi Makwinja Dominic Wang Linnea Weise Isabel Potani Emmie Mbale Robert J H Bandsma Wieger P Voskuijl |
| author_facet | Mphatso Nancy Chisala Celine Bourdon Emmanuel Chimwezi Allison I Daniel Chikondi Makwinja Dominic Wang Linnea Weise Isabel Potani Emmie Mbale Robert J H Bandsma Wieger P Voskuijl |
| author_sort | Mphatso Nancy Chisala |
| collection | DOAJ |
| description | <h4>Background</h4>Severe acute malnutrition (SAM) constitutes a substantial burden in African hospitals. Despite adhering to international guidelines, high inpatient mortality rates persist and the underlying contributing factors remain poorly understood.<h4>Objective</h4>We evaluated the 10-year trend (2011-2021) in clinical factors and outcomes among children with severe wasting and/or nutritional edema at Malawi's largest nutritional rehabilitation unit (NRU).<h4>Methods</h4>This retrospective study analyzed trends in presentation and outcomes using generalized additive models. The association between clinical characteristics and mortality or readmission was examined and key features were also related to time to either mortality or discharge.<h4>Results</h4>1497 children (53%, females) were included. Median age at admission (23 months, IQR 14, 34) or anthropometry (i.e., weight-for-age, height-for-age and weight-for-height) did not change over the 10-years. But the prevalence of edema decreased by 40% whereas dehydration, difficulty breathing, and pallor became more common. Yearly HIV testing increased but positive-detection remained around 11%. Reporting of complete vaccination dropped by 49%, and no reduction in 'watch' antibiotic usage was detected. Overall admissions declined but mortality remained around 23% [95%CI; 21, 25], and deaths occurred earlier (5.6 days [95%CI; 4.6, 6.9] in 2011 vs. 3.5 days [95%CI; 2.5, 4.7] in 2021; p<0.001). Duration of hospitalization was shortened and readmissions surged from 4.9% [95%CI; 3.3, 7.4] in 2011 to 25% [95%CI; 18, 33] in 2021 (p<0.001). Age, wasting, having both dehydration and diarrhea, or having vomiting, cough, or difficulty breathing were associated with mortality but these associations did not show any interaction over time.<h4>Conclusion</h4>Over 10 years, mortality risk remained high among hospitalized children with SAM and coincided with worsened clinical presentation at admission and increased readmission. Longitudinal data from major NRUs can identify shifts in clinical profiles or outcomes, and this information can be leveraged to promote earlier care-seeking, improved risk stratification, and implementation of more patient-centered treatments. |
| format | Article |
| id | doaj-art-7244fdee5fff46e89327f025ee6ac7f0 |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-7244fdee5fff46e89327f025ee6ac7f02025-01-08T05:32:35ZengPublic Library of Science (PLoS)PLoS ONE1932-62032024-01-011912e031153410.1371/journal.pone.0311534Ten-year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in Malawi (2011-2021): Declining admissions but worsened clinical profiles.Mphatso Nancy ChisalaCeline BourdonEmmanuel ChimweziAllison I DanielChikondi MakwinjaDominic WangLinnea WeiseIsabel PotaniEmmie MbaleRobert J H BandsmaWieger P Voskuijl<h4>Background</h4>Severe acute malnutrition (SAM) constitutes a substantial burden in African hospitals. Despite adhering to international guidelines, high inpatient mortality rates persist and the underlying contributing factors remain poorly understood.<h4>Objective</h4>We evaluated the 10-year trend (2011-2021) in clinical factors and outcomes among children with severe wasting and/or nutritional edema at Malawi's largest nutritional rehabilitation unit (NRU).<h4>Methods</h4>This retrospective study analyzed trends in presentation and outcomes using generalized additive models. The association between clinical characteristics and mortality or readmission was examined and key features were also related to time to either mortality or discharge.<h4>Results</h4>1497 children (53%, females) were included. Median age at admission (23 months, IQR 14, 34) or anthropometry (i.e., weight-for-age, height-for-age and weight-for-height) did not change over the 10-years. But the prevalence of edema decreased by 40% whereas dehydration, difficulty breathing, and pallor became more common. Yearly HIV testing increased but positive-detection remained around 11%. Reporting of complete vaccination dropped by 49%, and no reduction in 'watch' antibiotic usage was detected. Overall admissions declined but mortality remained around 23% [95%CI; 21, 25], and deaths occurred earlier (5.6 days [95%CI; 4.6, 6.9] in 2011 vs. 3.5 days [95%CI; 2.5, 4.7] in 2021; p<0.001). Duration of hospitalization was shortened and readmissions surged from 4.9% [95%CI; 3.3, 7.4] in 2011 to 25% [95%CI; 18, 33] in 2021 (p<0.001). Age, wasting, having both dehydration and diarrhea, or having vomiting, cough, or difficulty breathing were associated with mortality but these associations did not show any interaction over time.<h4>Conclusion</h4>Over 10 years, mortality risk remained high among hospitalized children with SAM and coincided with worsened clinical presentation at admission and increased readmission. Longitudinal data from major NRUs can identify shifts in clinical profiles or outcomes, and this information can be leveraged to promote earlier care-seeking, improved risk stratification, and implementation of more patient-centered treatments.https://doi.org/10.1371/journal.pone.0311534 |
| spellingShingle | Mphatso Nancy Chisala Celine Bourdon Emmanuel Chimwezi Allison I Daniel Chikondi Makwinja Dominic Wang Linnea Weise Isabel Potani Emmie Mbale Robert J H Bandsma Wieger P Voskuijl Ten-year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in Malawi (2011-2021): Declining admissions but worsened clinical profiles. PLoS ONE |
| title | Ten-year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in Malawi (2011-2021): Declining admissions but worsened clinical profiles. |
| title_full | Ten-year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in Malawi (2011-2021): Declining admissions but worsened clinical profiles. |
| title_fullStr | Ten-year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in Malawi (2011-2021): Declining admissions but worsened clinical profiles. |
| title_full_unstemmed | Ten-year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in Malawi (2011-2021): Declining admissions but worsened clinical profiles. |
| title_short | Ten-year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in Malawi (2011-2021): Declining admissions but worsened clinical profiles. |
| title_sort | ten year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in malawi 2011 2021 declining admissions but worsened clinical profiles |
| url | https://doi.org/10.1371/journal.pone.0311534 |
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