Abstract
BackgroundGlobally, malnutrition underlies 45% of under-5 s mortality, mainly from potentiating common infections such as diarrhoea and pneumonia. Malnutrition as a public health problem is not evenly disbursed because of disparities in food insecurity and health, and children commonly suffer recurrent episodes of opportunistic infections. We aimed to understand better the spatial and temporal structure of multiple paediatric hospital admissions associated with malnutrition-related illnesses. This paper aimed to investigate the spatial-temporal variations in malnutrition-related recurrent morbidity of children under-5 years from the Kilifi County in Kenya between 2002 and 2015.MethodsThe study included data from children under-5 years old who had more than one admission to a rural district hospital in Kenya within the Kilifi Health and Demographic Surveillance System (KHDSS). The primary outcome was a malnutrition-related admission, based on wasting (WHZ < -2) or nutritional oedema. Individual, household and environmental level covariates were examined as exposures. We first fitted a SARIMA model for the temporality, and the Moran’s Index affirmed spatial clustering in malnutrition admissions. Kulldorf Statistics using SaTScan were applied to detect hotspots. Then, bivariate analysis was done using repeated values tabulation and analysis of covariance (ANCOVA). Inferential analysis was done using a mixed effect multivariable negative-binomial regression model, adjusting for spatiotemporal random effects.ResultsA total of 2821 children were admitted more than once, giving a total of 6375 admissions. Of these 6375 admissions, 1866 were malnutrition-related, and 3.9% (109/2821) of the children with repeat admissions died. There was a seasonal pattern of re-admissions, peaking from May to July over the years. Hotspots were found in both the Northern and Southern areas of the KHDSS, while the areas near Kilifi Town were least affected. We found that disease severity was most likely associated with a malnutrition re-admission to the hospital.ConclusionDisease severity was strongly associated with admission with malnutrition but its effect reduced after adjusting for the spatial and temporal random effects. Adjusting for clustering in space and in time (spatial-temporal) in models helps to improve the understanding of recurrent hospitalisations involving malnutrition.
Highlights
Malnutrition underlies 45% of under-5 s mortality, mainly from potentiating common infections such as diarrhoea and pneumonia
Globally, malnutrition is a cause of 45% of childhood mortality, predominantly by potentiating morbidity due to common infections such as diarrhoea and pneumonia [1, 2]
Kilifi County is located in the Coastal region of Kenya; it is a semi-arid area with subsistence farming being the main economic activity
Summary
Malnutrition underlies 45% of under-5 s mortality, mainly from potentiating common infections such as diarrhoea and pneumonia. This paper aimed to investigate the spatialtemporal variations in malnutrition-related recurrent morbidity of children under-5 years from the Kilifi County in Kenya between 2002 and 2015. Malnutrition is a cause of 45% of childhood mortality, predominantly by potentiating morbidity due to common infections such as diarrhoea and pneumonia [1, 2]. Sub-Saharan Africa and South Asia remain the areas with the highest prevalence of malnutrition [2]. It remains a significant contributor to in-patient morbidity and mortality among children in rural areas in Kenya, despite efforts to overcome malnutrition [4,5,6]. Malnutrition complicates their management and increases their case fatality [7]. Malnutrition majorly affects childhood development and increases the risk of non-communicable diseases and socioeconomic productivity in adulthood [1]
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