Assessment of Severe Malnutrition Among Hospitalized Children in Rural Kenya

摘要: ContextSevere malnutrition has a high mortality rate among hospitalized children in sub-Saharan Africa. However, reports suggest that is often poorly assessed. The World Health Organization recommends using weight for height, but this method problematic and often not undertaken in practice. Mid upper arm circumference (MUAC) the clinical sign “visible severe wasting” are simple inexpensive methods have been evaluated in setting.ObjectivesTo evaluate MUAC visible severe wasting as predictors of inpatient mortality at district hospital Africa to compare these with weight-for-height z score (WHZ).Design, Setting, ParticipantsCohort study with data collected admission discharge or death. Predictive values for inpatient death were determined area under receiver operating characteristic curves. Participants children aged 12 59 months admitted rural Kenya between April 1, 1999, July 31, 2002.Main Outcome MeasureMUAC, WHZ, death.ResultsOverall, 4.4% (359) included died while in the hospital. Sixteen percent (1282/8190) had severe wasting (WHZ ≤−3) (n = 756), kwashiorkor (n = 778), or both. areas under receiver curves for predicting did significantly differ (MUAC: 0.75 [95% confidence interval, 0.72-0.78]; WHZ: 0.74 confidence interval, 0.71-0.77]) (P = .39). Although sensitivity specificity for subsequent 46% 91%, respectively, less than equal 11.5 cm, 42% 92% WHZ less than −3, and 47% 93% wasting, 3 indices identified different sets independently associated mortality. Clinical features more common with MUAC cm those or equal −3.ConclusionsMUAC practical screening tool performs least well as WHZ predicting severely malnourished children Kenya. Visible also potentially useful level, providing appropriate training given.