Prognostic factors in severely malnourished hospitalized Nigerian children. Anthropometric and biochemical factors.

Abstract

To determine the clinical factors that are of prognostic importance in protein-energy malnutrition (PEM), 150 patients admitted into the paediatric wards at the University College Hospital, Ibadan, Nigeria, were studied. Detailed clinical history, anthropometry and biochemical investigations were done immediately on admission. Case fatality rate decreased with age: 75% and 33% in those aged 12 months and below, and 30 to 36 months, respectively. The mortality in marasmus, kwashiorkor and marasmic-kwashiorkor were 35%, 47% and 60%, respectively. Hepatomegaly on admission had no significant impact on prognosis, but mortality increased with increasing hepatomegaly. Growth failure on admission, as measured by weight-for-age, weight-for-height and mid-upper-arm circumference were significantly associated with poor prognosis (p < 0.01, p < 0.01 and p < 0.001, respectively). Hypokalaemia and hyponatraemia were each separately associated with poor prognosis. When both electrolytes were low, more patients died (81%) than when both were normal (24%) (p < 0.001). Similarly, hypoproteinaemia and hypoalbuminaemia were associated with poor prognosis singly and in combination. When both serum proteins and albumin were low, the mortality was 32%, and there were no deaths when both were normal. The outcome in severe PEM is still poor. Good clinical precision in identifying clinical and biochemical prognostic factors, early intervention and good subsequent management are important in reducing mortality in PEM.