Mortality in severe protein-energy malnutrition at Nchelenge, Zambia
Gernaat, H.B.; Dechering, W.H.; Voorhoeve, H.W.
Journal of Tropical Pediatrics 44(4): 211-217
1998
ISSN/ISBN: 0142-6338 PMID: 9718906 DOI: 10.1093/tropej/44.4.211Document Number: 278550
At St Paul's Hospital, Nchelenge district, north-eastern Zambia, routine clinical management of 299 children (<=5 years old) with severe and/or complicated protein-energy malnutrition (PEM) was monitored between April 1987 and March 1989 and predictors of outcome analysed. PEM was typed according to a modified Wellcome classification. Overall mortality was 25.8%, with 13.4, 17.8, 28.0 and 48.3% for kwashiorkor, marasmus, marasmic kwashiorkor and untyped cases of PEM, respectively. Mortality up to 18 months of age was related to the presence of dehydration, pneumonia or another infectious disorder, severe stunting and a mid-upper arm circumference <=104 mm, suggesting that these children may have been born pre- and/or dysmaturely. At 19-60 months, the main predictor of mortality was pneumonia, with other infectious disorders and dehydration showing less impact. It is concluded that routine administration of broad-spectrum antibiotics, irrespective of clinical signs of infection, is most probably the single most effective measure to reduce the high case-fatality rate due to PEM in developing countries.