Predictors of mortality in children under 5 years of age hospitalized with severe acute malnutrition in a Tertiary Care Hospital.

Abstract

Objective: To determine the predictors and time of mortality in hospitalized children under 5 years with severe acute malnutrition (SAM). Study Design: Prospective, observational cohort study. Setting: Nutritional Rehabilitation Unit, Pediatric Medicine Department of National Institute of Child Health, Karachi, Pakistan. Period: August 2024 to April 2025. Methods: Enrollment of 273 SAM children, aged between 6 and 60 months, hospitalized and getting treatment, was made. All those children who had a weight-for-height Z score of <- 3, < 70% of the expected weight for height, or bilateral edema were considered as SAM children. The length of hospital stay and outcomes were recorded. Data were analyzed in SPSS 26 using chi-square and Mann-Whitney U tests, followed by multivariable logistic regression for variables with p<0.05. Results: In 273 children, 160 (58.6%) were male, with a median age of 18.0 months. Sepsis 102 (37.4%) and pneumonia 50 (18.3%) were leading diagnoses. Mortality occurred in 58 (21.2%) children. Multivariable analysis showed low weight adjusted odds ratio (aOR) 0.8 (95% CI 0.5 to 0.9, p=0.005), cough aOR 3.6 (1.2 to 10.1, p=0.018), reluctance to feed aOR 6.3 (1.9 to 20.3, p=0.002), SpO2 below 94% at admission aOR 28.7 (9.3 to 88.4, p<0.001), and skin changes aOR 6.4 (2.4 to 17.2, p<0.001) were independent predictors or mortality. Conclusion: Mortality in children with SAM is influenced by the presence of hypoxia, feeding difficulty, respiratory involvement, skin changes, deranged biochemical parameters and low body weight at admission.