Mortality risk factors in severelymalnourished children hospitalised with diarrhoea

Summary of published research¹

Acase-control study conducted in the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) to identify the risk factors of mortality in severely malnourished children hospitalised with diarrhoea has recently been published. One hundred and three severely malnourished children (weight-for-age <60% of median of the National Centre for Health Statistics reference) who died during hospitalisation were compared with another 103 severely malnourished children who survived. These children were aged less than three years and admitted to the hospital during 1997. On admission, characteristics of the fatal cases and non-fatal controls were comparable, except for age. The median age of the cases and controls were six and eight months respectively (p=0.05). Patients with low pulse rate or imperceptible pulse had three times the odds of death compared to the control group (p<0.01). The presence of clinical septicaemia and clinical severe anaemia had 11.7 and 4.2 times the odds of death respectively (p<0.01). Patients with leukocytosis (>15,000/cm3) had 2.5 times the odds of death (p<0.01).

Using logistic regression, clinical septicaemia {adjusted odds ratio (AOR) = 8.8, confidence interval (CI) 3.7-21.1, p =<0.01}, hypothermia (AOR = 3.5, CI 1.3-9.4, p < 0.01), and bronchopneumonia (AOR =3.0, CI1.2-7.3, p <0.01) were identified as the significant risk factors of mortality. Severely malnourished children (n=129) with leukocytosis, imperceptible pulse, pneumonia, septicaemia, and hypothermia had a high risk of mortality.

The strength of this study is that it was a well-defined matched case-control study where the cases and controls were selected from among severely malnourished children with diarrhoea. However, the limitation of the study is that the data used were not representative of mortality among all severely malnourished children with diarrhoea in Bangladesh.

The authors conclude that septicaemia, pneumonia, and hypothermia were high risk factors of death among diarrhoeal children with severe malnutrition and that this fatality could be prevented by early use of antibiotics and supportive care.

¹Roy. K et al (2011). Risk factors of mortality in severelymalnourished children hospitalised with diarrhoea. Journal of Health, Population and Nutrition 2011, June 29 (3); 229-235