Diarrhea, dehydration, and the associated mortality in children with complicated severe acute malnutrition: A prospective cohort study in Uganda
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Diarrhea, dehydration, and the associated mortality in children with complicated severe acute malnutrition: A prospective cohort study in Uganda. / Grenov, Benedikte; Lanyero, Betty; Nabukeera-Barungi, Nicolette; Namusoke, Hanifa; Ritz, Christian; Friis, Henrik; Michaelsen, Kim F.; Mølgaard, Christian.
I: Journal of Pediatrics, Bind 210, 2019, s. 26-33(e1-e3).Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Diarrhea, dehydration, and the associated mortality in children with complicated severe acute malnutrition: A prospective cohort study in Uganda
AU - Grenov, Benedikte
AU - Lanyero, Betty
AU - Nabukeera-Barungi, Nicolette
AU - Namusoke, Hanifa
AU - Ritz, Christian
AU - Friis, Henrik
AU - Michaelsen, Kim F.
AU - Mølgaard, Christian
N1 - CURIS 2019 NEXS 130 Copyright © 2019 Elsevier Inc. All rights reserved.
PY - 2019
Y1 - 2019
N2 - Objective: To assess predictors of diarrhea and dehydration and to investigate the role of diarrhea in mortality among children with complicated severe acute malnutrition.Study design: A prospective cohort study, nested in a probiotic trial, was conducted in children with complicated severe acute malnutrition. Children were treated according to World Health Organization and national guidelines, and diarrhea and dehydration were assessed daily. Multiple linear and log-linear Poisson regression models were used to identify predictors of days with diarrhea and dehydration, respectively, and multiple logistic regression was used to assess their role in mortality.Results: Among 400 children enrolled, the median (IQR) age was 15.0 months (11.2-19.2 months), 58% were boys, and 61% had caregiver-reported diarrhea at admission. During hospitalization, the median (range) number of days with diarrhea was 5 (0-31), the median duration of hospitalization was 17 days (1-69 days), and 39 (10%) died. Of 592 diarrhea episodes monitored, 237 were admission episodes and 355 were hospital acquired. During hospitalization, young age was associated with days with diarrhea, and young age and HIV infection were associated with dehydration. Both days with diarrhea and dehydration predicted duration of hospitalization as well as mortality. The odds of mortality increased by a factor of 1.4 (95% CI, 1.2-1.6) per day of diarrhea and 3.5 (95% CI, 2.2-6.0) per unit increase in dehydration score.Conclusions: Diarrhea is a strong predictor of mortality among children with complicated severe acute malnutrition. Improved management of diarrhea and prevention of hospital-acquired diarrhea may be critical to decreasing mortality.
AB - Objective: To assess predictors of diarrhea and dehydration and to investigate the role of diarrhea in mortality among children with complicated severe acute malnutrition.Study design: A prospective cohort study, nested in a probiotic trial, was conducted in children with complicated severe acute malnutrition. Children were treated according to World Health Organization and national guidelines, and diarrhea and dehydration were assessed daily. Multiple linear and log-linear Poisson regression models were used to identify predictors of days with diarrhea and dehydration, respectively, and multiple logistic regression was used to assess their role in mortality.Results: Among 400 children enrolled, the median (IQR) age was 15.0 months (11.2-19.2 months), 58% were boys, and 61% had caregiver-reported diarrhea at admission. During hospitalization, the median (range) number of days with diarrhea was 5 (0-31), the median duration of hospitalization was 17 days (1-69 days), and 39 (10%) died. Of 592 diarrhea episodes monitored, 237 were admission episodes and 355 were hospital acquired. During hospitalization, young age was associated with days with diarrhea, and young age and HIV infection were associated with dehydration. Both days with diarrhea and dehydration predicted duration of hospitalization as well as mortality. The odds of mortality increased by a factor of 1.4 (95% CI, 1.2-1.6) per day of diarrhea and 3.5 (95% CI, 2.2-6.0) per unit increase in dehydration score.Conclusions: Diarrhea is a strong predictor of mortality among children with complicated severe acute malnutrition. Improved management of diarrhea and prevention of hospital-acquired diarrhea may be critical to decreasing mortality.
U2 - 10.1016/j.jpeds.2019.03.014
DO - 10.1016/j.jpeds.2019.03.014
M3 - Journal article
C2 - 30992218
VL - 210
SP - 26-33(e1-e3)
JO - Journal of Pediatrics
JF - Journal of Pediatrics
SN - 0022-3476
ER -
ID: 216875046