Diagnostic criteria for severe acute malnutrition and fatal outcomes in children aged 6–59 months, Nigeria

OBJECTIVE

To determine factors associated with inpatient death among a cohort of children aged 6-59 months with severe acute malnutrition in north-western Nigeria.

METHODS

Our observational study used routine programmatic data of all children aged 6-59 months admitted to two inpatient facilities in Katsina State with severe acute malnutrition in 2022. We assessed nutritional status at admission by weight-for-height z-score (WHZ), mid-upper-arm circumference (MUAC) and bilateral nutritional oedema using World Health Organization definitions. We used Cox-proportional hazard models to identify predictors of mortality, with and without adjustment for sex, age group, nutritional status at admission, major clinical complications and comorbidities.

FINDINGS

Of 12 771 children included in the analysis, we observed an overall inpatient mortality of 8.4%. Compared with children admitted by the MUAC criterion alone, we noted that children admitted by the WHZ criterion alone had twice the risk of death; children admitted with kwashiorkor and low WHZ had more than four times the risk. Older children with marasmus had a higher risk of death than younger children (adjusted hazard ratio: 1.74; 95% confidence interval: 1.50-2.03). We did not observe any significant association between stunting and mortality. Our findings were not altered by any of the complications or comorbidities recorded.

CONCLUSION

Children with a low WHZ at admission have a higher risk of death than those with a low MUAC, and should be subject to special considerations when associated with oedema. MUAC alone is an insufficient criterion to identify all the children at risk of death from malnutrition.