Determinants of mortality during severe acute malnutrition in children under 5 years old in Mahajanga Madagascar

Abstract

Introduction: Severe acute malnutrition is responsible for one million deaths in children under five years old every year worldwide. The aim was to determine mortality risk factors in children hospitalized for severe acute malnutrition. Methods: This was a case-control study over a 39-month period from January 1, 2019 to March 31, 2022 in the pediatrics department of the University Hospital Center Professeur Zafisaona Gabriel (CHU PZaGa) Mahajanga Madagascar. Cases were represented by severe acute malnourished patients who died, and controls by severe acute malnourished patients who were discharged alive. Results: During the study period, 178 children were enrolled, representing a hospital prevalence of 5%. The mean age was 18.6 ± 13.9 months, with a sex ratio of 1.02. The case-fatality rate was 17.4% (n=31). The main complications encountered were anemia 34.3% (n=61), respiratory infections 24.2% (n= 43) and gastroenteritis 19.6% (n=35). The completion of 2 or more consultations prior to admission was associated with the occurrence of death (OR= 3.9 [1.5-9.9], p=0.002), as was the absence of vaccination (OR=2.6 [1.1-6.5], p=0.02). Convulsion (OR=8.04 [1.99-32.47], p=0.001), disturbed consciousness (OR= 5.2 [2.06-13.2], p=0.0003), respiratory distress (OR= 6.85 [2.63-17.83], p=0.0011) and hepatomegaly (OR= 8.04 [1.99-32.47], p=0.0011) were also associated with the occurrence of death. Conclusion: Early and optimal management in a specialized setting is essential, especially for the most severe cases associated with a complication.