title: Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique.
abstract: OBJECTIVE
  To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years.
  
  
  METHODS
  Retrospective study of hospital-based data systematically collected from January 2001 to December 2010.
  
  
  METHODS
  Rural Mozambican district hospital.
  
  
  METHODS
  All children aged <5 years admitted with severe malnutrition.
  
  
  RESULTS
  During the 10-year long study surveillance, 274 813 children belonging to Manhiça’s Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6% (17 188/274 813) with severe malnutrition. Of these, only 15% (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7% (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum communitybased incidence rate was 15 cases per 1000 child-years at risk and children aged 12–23 months had the highest incidence.
  
  
  CONCLUSIONS
  Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.
authors: Centro de Investigação em Saúde da Manhiça (CISM), Vila da Manhiça, Rua 12, PO Box 1929, Maputo, Mozambique. tacilta.nhampossa@manhica.net
authors: Tacilta
authors: T
authors: Nhampossa
authors: Betuel
authors: B
authors: Sigaúque
authors: Sónia
authors: S
authors: Machevo
authors: Eusebio
authors: E
authors: Macete
authors: Pedro
authors: P
authors: Alonso
authors: Quique
authors: Q
authors: Bassat
authors: Clara
authors: C
authors: Menéndez
authors: Victoria
authors: V
authors: Fumadó
mesh_terms: D000554:Ambulatory Care Facilities; D001942:Breast Feeding; D002675:Child, Preschool; D015897:Comorbidity; D003967:Diarrhea; D017052:Hospital Mortality; D006760:Hospitalization; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D008288:Malaria / Q000469:parasitology; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D009073:Mozambique / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D012424:Rural Population; D012720:Severity of Illness Index
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