Thandile Nkosi-Gondwe1,2, Job Calis2,3,4, Michael Boele van Hensbroek2,3,4,5, Imelda Bates5, Björn Blomberg6,7, Kamija S Phiri2. 1. Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. 2. School of Public Health & Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi. 3. Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi. 4. Emma Children's Hospital, The Global Child Health Group, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 5. Liverpool School of Tropical Medicine, Liverpool, United Kingdom. 6. Department of Clinical Science, University of Bergen, Bergen, Norway. 7. Norwegian National Advisory Unit on Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway.
Abstract
INTRODUCTION: Moderate to severe acute malnutrition (SAM/MAM) and severe anaemia are important and associated co-morbidities in children aged less than five years. Independently, these two morbidities are responsible for high risk of in-hospital and post-discharge deaths and hospital readmissions. The primary objective of this study is to investigate the risk of death among severely anaemic children with moderate to severe acute malnutrition compared to children with severe anaemia alone. METHODS: This was a retrospective analysis of data collected from a large prospective study that was investigating severe anaemia in children aged less than 5 years old. The study was conducted at Queen Elizabeth Central Hospital in Blantyre and Chikhwawa district hospital in southern Malawi. Children aged less than five years old; with severe anaemia were screened and enrolled. Each child was followed up for eighteen months at one, three, six, twelve and eighteen months after enrolment. Data were analysed using STATA 15. RESULTS: Between July 2002 and July 2004, 382 severely anaemic children were enrolled in the main study. A total of 52 children were excluded due to missing anthropometric data. Out of the 330 included, 53 children were moderately to severely malnourished and 277 were not. At the end of the 18-month follow period, 28.3% of children with MAM/SAM died compared to 13% of children without MAM/SAM (RR 2.1, CI 0.9-4.2, p = 0.03). Similarly, children with moderate to severe malnutrition reported a significantly higher number of malaria infection cases (33.9%) compared to children with severe anaemia alone (27.9%, p = 0.02). However, the number of hospitalizations and recurrence of severe anaemia was similar and not statistically significant between the two groups (RR 0.8 (0.4-1.4), p = 0.6 and RR 1.1 (0.3-2.8), p = 0.8). CONCLUSION: Among children with severe anaemia, those who also had moderate to severe malnutrition had a twofold higher risk of dying compared to those who did not. It is therefore crucial to investigate acute malnutrition among severely anaemic children, as this might be treatable factor associated with high mortality.
INTRODUCTION: Moderate to severe acute malnutrition (SAM/MAM) and severe anaemia are important and associated co-morbidities in children aged less than five years. Independently, these two morbidities are responsible for high risk of in-hospital and post-discharge deaths and hospital readmissions. The primary objective of this study is to investigate the risk of death among severely anaemic children with moderate to severe acute malnutrition compared to children with severe anaemia alone. METHODS: This was a retrospective analysis of data collected from a large prospective study that was investigating severe anaemia in children aged less than 5 years old. The study was conducted at Queen Elizabeth Central Hospital in Blantyre and Chikhwawa district hospital in southern Malawi. Children aged less than five years old; with severe anaemia were screened and enrolled. Each child was followed up for eighteen months at one, three, six, twelve and eighteen months after enrolment. Data were analysed using STATA 15. RESULTS: Between July 2002 and July 2004, 382 severely anaemic children were enrolled in the main study. A total of 52 children were excluded due to missing anthropometric data. Out of the 330 included, 53 children were moderately to severely malnourished and 277 were not. At the end of the 18-month follow period, 28.3% of children with MAM/SAM died compared to 13% of children without MAM/SAM (RR 2.1, CI 0.9-4.2, p = 0.03). Similarly, children with moderate to severe malnutrition reported a significantly higher number of malaria infection cases (33.9%) compared to children with severe anaemia alone (27.9%, p = 0.02). However, the number of hospitalizations and recurrence of severe anaemia was similar and not statistically significant between the two groups (RR 0.8 (0.4-1.4), p = 0.6 and RR 1.1 (0.3-2.8), p = 0.8). CONCLUSION: Among children with severe anaemia, those who also had moderate to severe malnutrition had a twofold higher risk of dying compared to those who did not. It is therefore crucial to investigate acute malnutrition among severely anaemic children, as this might be treatable factor associated with high mortality.
Authors: E M Lackritz; A W Hightower; J R Zucker; T K Ruebush; C O Onudi; R W Steketee; J B Were; E Patrick; C C Campbell Journal: AIDS Date: 1997-10 Impact factor: 4.177
Authors: Michaël Boele van Hensbroek; Job C J Calis; Kamija S Phiri; Raymond Vet; Francis Munthali; Rob Kraaijenhagen; Henk van den Berg; Brian Faragher; Imelda Bates; Malcolm E Molyneux Journal: PLoS One Date: 2010-09-07 Impact factor: 3.240
Authors: Job C J Calis; Kamija S Phiri; E Brian Faragher; Bernard J Brabin; Imelda Bates; Luis E Cuevas; Rob J de Haan; Ajib I Phiri; Pelani Malange; Mirriam Khoka; Paul J M Hulshof; Lisette van Lieshout; Marcel G H M Beld; Yik Y Teo; Kirk A Rockett; Anna Richardson; Dominic P Kwiatkowski; Malcolm E Molyneux; Michaël Boele van Hensbroek Journal: N Engl J Med Date: 2008-02-28 Impact factor: 91.245
Authors: Aggrey Dhabangi; Richard Idro; Chandy C John; Walter H Dzik; Robert Opoka; Ronald Ssenyonga; Michael Boele van Hensbroek Journal: BMC Pediatr Date: 2019-01-18 Impact factor: 2.125