Clinical Profiles, Initial Management and Outcomes of Malnourished Children Presenting to the Emergency Medicine Departiment of Muhimbili National Hospital, Dar Es Salaam

Abstract

Background: In Tanzania, the burden of malnourished children presenting to Emergency Departments, their management and outcomes are unknown. Aim of the study: To describe the clinical profiles, initial management and outcomes of acutely ill malnourished children aged under 5 years presenting to the Emergency Medicine Department of Muhimbili National Hospital (EMD-MNH). Methods and Material: This was an eight weeks prospective cohort study of children aged 1- 59 months presenting to the EMD-MNH from July, 2016 and August, 2016. A consecutive sample of children under 5years were screened using standardized World Health Organization (WHO) growth charts (‘Weight for Height/length’, ‘Height for Age’, and ‘Weight for Age’), children below minus one SD z-score were recruited. Case report forms (CRF) were completed to obtain demographic, clinical presentation, initial interventions and outcomes of the enrolled children. Data was summarized using descriptive statistics and analyzed using counts, percentages, median, interquartile ranges (IQR), 95% confidence interval (CI), relative risk (RR) and P-value. Results: A total of 449 children were screened, of which 153 (34.1%) met definitions for malnutrition. 146 (95.4%) were enrolled. Of those enrolled, 42 (28.8%) mild, 51 (34.9%) moderate, and 53 (36.3%) had severe malnutrition. 46 (31.5%) were under 12 months old. Common co-morbidities included congenital heart disease 29 (19.9%), cerebral palsy 19 (12.8%), and hydrocephalus 5 (3.4%). The most common complaints were fever 36 (24.7%), cough 35 (24%) and weight loss 28 (19.2%). Within 24-hours follow up, 4 (2.9%) children died. At 30 days, 18 (13.3%) children had died, and eleven (7.5%) lost to follow up. Malnourished children under 5 years with low AVPU score (GCS <15) had statistical significance increased risk of mortality. Conclusion and Recommendation: More one third of acutely ill children under 5 years presenting to EMD-MNH have malnutrition, and mortality rate in these children is high. EMD physician should be educated on early recognition and management of malnourished children to optimise outcome