Abstract
Background: Childhood undernutrition causes significant morbidity and mortality in low- and middle-income countries (LMICs). In Tanzania, the in-hospital prevalence of undernutrition in children under five years of age is approximated to be 30% with a case fatality rate of 8.8%. In Tanzania, the burden of undernourished children under five years of age presenting to emergency departments (EDs) and their outcomes are unknown. This study describes the clinical profiles and outcomes of this population presenting to the emergency department of Muhimbili National Hospital (ED-MNH), a large, urban hospital in Dar es Salaam, Tanzania.MethodsThis was a prospective descriptive study of children aged 1–59 months presenting to the ED-MNH over eight weeks in July and August 2016. Enrolment occurred through consecutive sampling. Children less than minus one standard deviation below World Health Organization mean values for Weight for Height/Length, Height for Age, or Weight for Age were recruited. Structured questionnaires were used to document primary outcomes of patient demographics and clinical presentations, and secondary outcomes of 24-h and 30-day mortality. Data was summarised using descriptive statistics and relative risks (RR).ResultsA total of 449 children were screened, of whom 34.1% (n = 153) met criteria for undernutrition and 95.4% (n = 146) of those children were enrolled. The majority of these children, 56.2% (n = 82), were male and the median age was 19 months (IQR 10–31 months). They presented most frequently with fever 24.7% (n = 36) and cough 24.0% (n = 35). Only 6.7% (n = 9) were diagnosed with acute undernutrition by ED-MNH physicians. Mortality at 24 h and 30 days were 2.9% (n = 4) and 12.3% (n = 18) respectively. A decreased level of consciousness with Glasgow Coma Scale below fifteen on arrival to the ED and tachycardia from initial vital signs were found to be associated with a statistically significant increased risk of death in undernourished children, with mortality rates of 16.1% (n = 23), and 24.6% (n = 35), respectively.ConclusionsIn an urban ED of a tertiary referral hospital in Tanzania, undernutrition remains under-recognized and is associated with a high rate of in-hospital mortality.
Highlights
Childhood undernutrition causes significant morbidity and mortality in low- and middle-income countries (LMICs)
This protocol calls for prompt management of dehydration and/or shock, hypoglycaemia, and hypothermia, the treatment of infection, the correction of micronutrient deficiencies and electrolyte abnormalities, and the careful reintroduction of feeding, along with rehabilitation, emotional support, time for recovery, and a follow-up plan [3]. This World Health Organization (WHO) protocol has been shown to improve mortality rates of undernourished children under five years of age in LMICs [1, 11]. These guidelines focus on longitudinal hospital management, and the initial management of acutely ill undernourished children in Emergency Department (ED) in LMICs remains variable in terms of care, resources, and local protocols [4, 11, 12]
Our results provide an opportunity to begin to define the role of emergency medicine providers in the initial recognition and management of acutely ill, undernourished children
Summary
Childhood undernutrition causes significant morbidity and mortality in low- and middle-income countries (LMICs). Most healthcare facilities in LMICs use the World Health Organization (WHO) recommended 10 step protocol [3] in the management of undernourished children [1, 4, 10, 11] This protocol calls for prompt management of dehydration and/or shock, hypoglycaemia, and hypothermia, the treatment of infection, the correction of micronutrient deficiencies and electrolyte abnormalities, and the careful reintroduction of feeding, along with rehabilitation, emotional support, time for recovery, and a follow-up plan [3]. This WHO protocol has been shown to improve mortality rates of undernourished children under five years of age in LMICs [1, 11]. These guidelines focus on longitudinal hospital management, and the initial management of acutely ill undernourished children in EDs in LMICs remains variable in terms of care, resources, and local protocols [4, 11, 12]
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