a1 Centro de Investigação em Saúde da Manhiça (CISM), Vila da Manhiça, Rua 12, PO Box 1929, Maputo, Mozambique
a2 Instituto Nacional de Saúde, Ministerio de Saúde, Maputo, Mozambique
a3 Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
a4 Direcção Nacional de Saúde, Ministerio de Saúde, Maputo, Mozambique
a5 Barcelona Center for International Health Research (CRESIB), Hospital Clínic, Universitat of Barcelona, Barcelona, Spain
a6 Hospital Universitari Sant Joan de Déu, Barcelona, Spain
Objective To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years.
Design Retrospective study of hospital-based data systematically collected from January 2001 to December 2010.
Setting Rural Mozambican district hospital.
Subjects All children aged <5 years admitted with severe malnutrition.
Results During the 10-year long study surveillance, 274 813 children belonging to Manhiça's Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6 % (17 188/274 813) with severe malnutrition. Of these, only 15 % (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7 % (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum community-based incidence rate was 15 cases per 1000 child-years at risk and children aged 12–23 months had the highest incidence.
Conclusions Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.
(Received September 05 2012)
(Revised March 06 2013)
(Accepted March 15 2013)
(Online publication May 02 2013)