Fraction of all hospital admissions and deaths attributable to malnutrition among children in rural Kenya
Author(s)
Type
Journal Article
Abstract
ABSTRACT
Background: Malnutrition is common in the developing world and
associated with disease and mortality. Because malnutrition frequently
occurs among children in the community as well as those
with acute illness, and because anthropometric indicators of nutritional
status are continuous variablesthat preclude a single definition
of malnutrition, malnutrition-attributable fractions of admissions
and deaths cannot be calculated by simply enumerating individual
children.
Objective: We determined the malnutrition-attributable fractions
among children admitted to a rural district hospital in Kenya, among
inpatient deaths and among children with the major causes of severe
disease.
Design: We analyzed data from children between 6 and 60 mo of
age, comprising 13 307 admissions, 674 deaths, 3068 admissions
with severe disease, and 562 community controls by logistic regression,
using anthropometric z scores as the independent variable and
admission or death as the outcome, to calculate the probability of
admission as a result of “true malnutrition” for individual cases.
Probabilities were averaged to calculate attributable fractions.
Results: Z scores 3 were insensitive for malnutritionattributable
deaths and admissions, and no single threshold was both
specific and sensitive. The overall malnutrition-attributable fraction for
in-hospital deaths was 51% (95% CI: 42%, 61%) with midupper arm
circumference. Similarmalnutrition-attributable fractionswere seen for
themajorcauses of severe disease (severemalaria, gastroenteritis,lower
respiratory tract infection, HIV, and invasive bacterial disease).
Conclusions: Despite global improvements, malnutrition still underlies
half of the inpatient morbidity and mortality rates among
children in rural Kenya. This contribution is underestimated by using conventional clinical definitions of severe malnutrition.
Background: Malnutrition is common in the developing world and
associated with disease and mortality. Because malnutrition frequently
occurs among children in the community as well as those
with acute illness, and because anthropometric indicators of nutritional
status are continuous variablesthat preclude a single definition
of malnutrition, malnutrition-attributable fractions of admissions
and deaths cannot be calculated by simply enumerating individual
children.
Objective: We determined the malnutrition-attributable fractions
among children admitted to a rural district hospital in Kenya, among
inpatient deaths and among children with the major causes of severe
disease.
Design: We analyzed data from children between 6 and 60 mo of
age, comprising 13 307 admissions, 674 deaths, 3068 admissions
with severe disease, and 562 community controls by logistic regression,
using anthropometric z scores as the independent variable and
admission or death as the outcome, to calculate the probability of
admission as a result of “true malnutrition” for individual cases.
Probabilities were averaged to calculate attributable fractions.
Results: Z scores 3 were insensitive for malnutritionattributable
deaths and admissions, and no single threshold was both
specific and sensitive. The overall malnutrition-attributable fraction for
in-hospital deaths was 51% (95% CI: 42%, 61%) with midupper arm
circumference. Similarmalnutrition-attributable fractionswere seen for
themajorcauses of severe disease (severemalaria, gastroenteritis,lower
respiratory tract infection, HIV, and invasive bacterial disease).
Conclusions: Despite global improvements, malnutrition still underlies
half of the inpatient morbidity and mortality rates among
children in rural Kenya. This contribution is underestimated by using conventional clinical definitions of severe malnutrition.
Date Issued
2008-12-01
Date Acceptance
2008-08-15
Citation
American Journal of Clinical Nutrition, 2008, 88, pp.1626-1631
ISSN
0002-9165
Publisher
American Society for Nutrition
Start Page
1626
End Page
1631
Journal / Book Title
American Journal of Clinical Nutrition
Volume
88
Copyright Statement
© 2008 American Society for Nutrition
Subjects
Science & Technology
Life Sciences & Biomedicine
Nutrition & Dietetics
NUTRITION & DIETETICS
NUTRITIONAL-STATUS
DEVELOPING-COUNTRIES
AFRICAN CHILDREN
CASE DEFINITIONS
MORTALITY
MALARIA
ANTHROPOMETRY
INDICATORS
DISTRICT
Anthropometry
Child Nutrition Disorders
Child, Preschool
Female
Hospital Mortality
Hospitalization
Humans
Infant
Infant Nutrition Disorders
Kenya
Kwashiorkor
Logistic Models
Male
Rural Health
Rural Population
Wasting Syndrome
11 Medical And Health Sciences
09 Engineering
Article Number
6