Mortality in severe protein-energy malnutrition at Nchelenge, Zambia.

At St Paul's Hospital, Nchelenge district, north-eastern Zambia, routine clinical management of 299 children up to 5 years of age with severe and/or complicated protein-energy malnutrition (PEM) was monitored and predictors of outcome analysed. PEM was typed according to a modified Wellcome classification. Overall mortality was 25.8 per cent with 13.4 per cent for kwashiorkor, 17.8 per cent for marasmus, 28.0 per cent for marasmic kwashiorkor, and 48.3 per cent for untyped cases of PEM. Mortality up to 18 months of age was related to the presence of dehydration, pneumonia or another infectious disorder, severe stunting, and a mid-upper arm circumference < or = 104 mm, suggesting that these children may have been born pre- and/or dysmaturely. At ages 19-60 months, the main predictor of mortality was pneumonia, with other infectious disorders and dehydration showing less impact. Routine administration of broad-spectrum antibiotics, irrespective of clinical signs of infection, is most probably the single most effective measure to reduce the high case-fatality rate due to PEM in developing countries.