Determinants of mortality in children younger than five years admitted with severe acute malnutrition to three hospitals in Vhembe district, Limpopo

Background: In 2014, one-third of child deaths occurring in South African hospitals were attributed to severe acute malnutrition. This study sought to determine demographic, family, socio-economic, clinical, and case-management factors contributing to mortality in severely malnourished children younger than 5 years admitted to three hospitals in Vhembe district, Limpopo, South Africa. Methods: A retrospective record review of children aged 6 to 59 months admitted with severe acute malnutrition over 30 months was conducted. Bivariable and multivariable regression analyses of determinants of mortality were undertaken. Results: Two hundred and forty-five children with severe acute malnutrition were identified. Their median (interquartile [IQR]) age was 14 (10, 18) months. The overall mortality was 26.9% (66/245). Determinants of mortality, based on the multivariable analysis, included diarrhoea on presentation (odds ratio [OR]=3.34, 95% CI 1.38, 8.10); anaemia (OR=3.30, 95% CI 1.28, 8.50]); a raised CRP (OR=9.29, 95% CI 2.81, 30.76]); and hyponatraemia (OR=6.64, 95% CI 2.70, 16.31). HIV status and a diagnosis of shock were not significant determinants of mortality. Conclusion: Severe acute malnutrition mortality was high, particularly for a high middle-income country setting. Factors that may be amenable to intervention include better management of the presenting illness, particularly diarrhea, a focus on electrolyte imbalance correction, and treatment of anemia.
A research report submitted in partial fulfilment of the requirement for the degree of Master of Science in Medicine (Child Health (Community Paediatrics) to the Faculty of Health Sciences, University of the Witwatersrand, School of Public Health, Johannesburg, 2023
South African hospitals, Acute malnutrition, Socio-economic