Risk factors in hospital deaths in severely malnourished children in Kampala, Uganda

In 2003, two hundred and twenty consecutively admitted, severely malnourished children were followed in the paediatric wards of Mulago, Uganda's national referral and teaching hospital. The children's baseline health conditions were established by physical examination, along with haematological, biochemical, microbiological and immunological indices.Of the 220 children, 52 (24%) died, with over 70% of the deaths occurring in the first week of admission. There was no significant difference by sex or age group. The presence of oedema increased the adjusted odds-ratio, but did not reach significance (OR = 2.0; 95% CI = 0.8 – 4.7), similarly for a positive HIV status (OR = 2.6, 95% CI = 0.8 – 8.6). Twenty four out of 52 children who received blood transfusion died (OR = 5.0, 95% CI = 2 – 12); while, 26 out of 62 children who received intravenous infusion died (OR = 4.8, 95% CI = 2 – 12). The outcome of children who received blood or intravenous fluids was less favourable than of children who did not receive them. Adjustment for severity of disease did not change this.The main risk factors for excess hospital deaths among severely malnourished children in Mulago hospital include blood transfusion and intravenous infusion. An intervention to reduce deaths needs to focus on guideline compliance with respect to blood transfusions/infusions.Under-nutrition is associated with >50% of all childhood mortality in developing countries [1,2], with the risk of mortality being 5–8 fold among severely compared to moderately malnourished children [3]. Because of the high risk of death, most severely malnourished children are managed in hospital. Unfortunately, the number of children hospitalised with severe malnutrition continues to rise in sub-Saharan Africa [4,5]. For instance, in Mulago Hospital, Uganda's national referral hospital, the number of children suffering from severe malnutrition increased from 11 to 45 per 1000 paediatric admissions between 1995 and 2002 [6]. Likewise, t