Abstract
BackgroundSevere acute malnutrition has two main clinical manifestations, i.e., oedematous and non-oedematous. However, factors associated with oedema are not well established.MethodsChildren 0.5-14 years of age with SAM (MUAC < 11.0 cm or weight-for-height < 70 % of median and/or nutritional oedema) admitted to the nutrition unit were included. Information on infections before and during admission was collected together with anthropometry. Predictors of oedema was analysed separately for younger (< 60 months) and older children (≥ 60 months).Results351 children were recruited (median age: 36 months (interquartile range 24 to 60); 43.3% females). Oedema was detected in 61.1%. The prevalence of oedema increased with age, peaked at 37–59 months (75%) and declined thereafter. Infection was more common in the younger group (33% vs. 8.9%, p < 0.001) and in this group children with oedema had less infections (25.2% vs. 45.1%, p = 0.001). In the older group the prevalence of infections was not different between oedematous and non-oedematous children (5.5% v. 14.3%, p = 0.17). In the younger group oedema was less common in children with TB (OR = 0.20, 95% CI: 0.06, 0.70) or diarrhea (OR = 0.40, 95% CI: 0.21, 0.73).ConclusionsThe proportion of oedema in SAM peaked at three to five years of age and a considerable proportion was above 5 years. Furthermore, the prevalence of infection seemed to be lower among children with oedema. Further studies are needed to better understand the role of infection-immunity interaction.
Highlights
Severe acute malnutrition has two main clinical manifestations, i.e., oedematous and non-oedematous
Oedema in severe malnutrition was explained by dietary protein deficiency [6], and subsequently free-radical-mediated cellular injury was suggested as a mechanism [7]
No differences were found between excluded and studied children when comparing their mean age (1.6 months, 95% confidence interval (CI), -4.2, 7.4), and the proportions of females (38.6% v. 43.3%, p = 0.30), presence of oedema (66.1% v. 61.1%, p = 0.26) and proportion of children under the age of five years (75.6% v. 74.4%, p = 0.76)
Summary
Severe acute malnutrition has two main clinical manifestations, i.e., oedematous and non-oedematous. Factors associated with oedema are not well established. Severe acute malnutrition (SAM) affects an estimated 20 million children under 5 years of age [3]. Despite recent improvement in the protocols for treatment of SAM, case-fatality rates of 20-30% are still seen and are higher for oedematous malnutrition [4]. There are two main clinical manifestations of SAM, i.e. oedematous and non-oedematous [5]. Which factors lead to oedema and the mechanisms behind have been discussed extensively, but remains unknown. Oedema in severe malnutrition was explained by dietary protein deficiency [6], and subsequently free-radical-mediated cellular injury was suggested as a mechanism [7]. Researchers suggested a developmental origin, based on a finding in a retrospective observational study [8]
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