title: Social, dietary and clinical correlates of oedema in children with severe acute malnutrition: a cross-sectional study.
abstract: BACKGROUND
  Severe acute malnutrition is a serious public health problem, and a challenge to clinicians. Why some children with malnutrition develop oedema (kwashiorkor) is not well understood. The objective of this study was to investigate socio-demographic, dietary and clinical correlates of oedema, in children hospitalised with severe acute malnutrition.
  
  
  METHODS
  We recruited children with severe acute malnutrition admitted to Mulago Hospital, Uganda. Data was collected using questionnaires, clinical examination and measurement of blood haemoglobin, plasma c-reactive protein and α1-acid glycoprotein. Correlates of oedema were identified using multiple logistic regression analysis.
  
  
  RESULTS
  Of 120 children included, 77 (64%) presented with oedematous malnutrition. Oedematous children were slightly older (17.7 vs. 15.0 months, p = 0.006). After adjustment for age and sex, oedematous children were less likely to be breastfed (odds ratio (OR): 0.19, 95%-confidence interval (CI): 0.06; 0.59), to be HIV-infected (OR: 0.10, CI: 0.03; 0.41), to report cough (OR: 0.33, CI: 0.13; 0.82) and fever (OR: 0.22, CI: 0.09; 0.51), and to have axillary temperature > 37.5 °C (OR: 0.28 CI: 0.11; 0.68). Household dietary diversity score was lower in children with oedema (OR: 0.58, CI: 0.40; 85). No association was found with plasma levels of acute phase proteins, household food insecurity or birth weight.
  
  
  CONCLUSIONS
  Children with oedematous malnutrition were less likely to be breastfed, less likely to have HIV infection and had fewer symptoms of other infections. Dietary diversity was lower in households of children who presented with oedema. Future research may confirm whether a causal relationship exists between these factors and nutritional oedema.
authors.affiliation: Department of Paediatrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. marenrytter@hotmail.com.|Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, 1958, Frederiksberg C, Denmark. marenrytter@hotmail.com.
authors.forename: Maren Johanne Heilskov
authors.initials: MJ
authors.lastname: Rytter
authors.affiliation: Mwanamugimu Nutrition Unit, Department of Paediatrics, Mulago Hospital, Kampala, Uganda. n6471277@gmail.com.
authors.forename: Hanifa
authors.initials: H
authors.lastname: Namusoke
authors.affiliation: Mwanamugimu Nutrition Unit, Department of Paediatrics, Mulago Hospital, Kampala, Uganda. ebabirekere@yahoo.com.|Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, 1958, Frederiksberg C, Denmark. ebabirekere@yahoo.com.
authors.forename: Esther
authors.initials: E
authors.lastname: Babirekere-Iriso
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, 1958, Frederiksberg C, Denmark. pern@nexs.ku.dk.
authors.forename: Pernille
authors.initials: P
authors.lastname: Kæstel
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, 1958, Frederiksberg C, Denmark. tsinuel@yahoo.com.|Department of Paediatrics and Child Health, Jimma University Specialized Hospital, Jimma, Ethiopia. tsinuel@yahoo.com.
authors.forename: Tsinuel
authors.initials: T
authors.lastname: Girma
authors.affiliation: Department of Paediatrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. brixchr@dadlnet.dk.
authors.forename: Vibeke Brix
authors.initials: VB
authors.lastname: Christensen
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, 1958, Frederiksberg C, Denmark. kfm@nexs.ku.dk.
authors.forename: Kim F
authors.initials: KF
authors.lastname: Michaelsen
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 30, 1958, Frederiksberg C, Denmark. hfr@nexs.ku.dk.
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
mesh_terms: D000209:Acute-Phase Proteins / Q000378:metabolism; D001724:Birth Weight; D001942:Breast Feeding; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D015658:HIV Infections; D006801:Humans; D007223:Infant; D007732:Kwashiorkor / Q000097:blood / Q000209:etiology*; D008297:Male; D012307:Risk Factors; D000067011:Severe Acute Malnutrition / Q000150:complications*; D012959:Socioeconomic Factors; D014454:Uganda
chemical_list: D000209:Acute-Phase Proteins