A study on factors associated with outcome of SAM children admitted at NRC, PMCH, Patna

Abstract

Background: Nearly half of the deaths under 5 years of age is attributed to childhood undernutrition. According to NFHS-5, Bihar has 42.9% stunted, 22.9% wasted, 8.8% severely wasted and 41% underweight children under 5 years of age.
Objective: To determine factors associated with outcome of SAM children admitted and treated at NRC.
Methods: This is a hospital based descriptive study conducted at the Nutritional Rehabilitation Centre, Upgraded Department of Pediatrics, PMCH, Patna for 18 months between January 2021 to June 2022. 150 children aged 1 month to 5 years with complicated SAM were assessed on the basis of demography, diet, anthropometry, clinical complications and outcome at the time of discharge and follow up after treatment at NRC with standardized protocols.
Results: Final analysis was done on 150 children. The mean age of presentation was 17.5 months with a male preponderance. 79.3% belonged to rural areas. 58% children were exclusively breastfed. Major associated morbidities were anaemia(57.3%), diarrhoea(31.3%), pneumonia (26%), Vitamin A deficiency(18%). 78% had satisfactory outcome at discharge and 2% died. 61% children were considered to have good outcome at follow up. The factors significantly associated with failure or death of SAM children at NRC were presence of developmental delay (p-value <0.001), anaemia(p-value- 0.034), oedema (p-value <0.001) and tuberculosis (p-value <0.001). The major factors that significantly prolonged the NRC stay were presence of anaemia (p-value- 0.016), oedema (p-value <0.001) and sepsis (p-value- 0.024). The factors significantly associated with poor outcome of children after follow up were lack of exclusive breastfeeding (p-value- 0.033), presence of developmental delay (p-value- 0.002), illiteracy of mother (p-value- 0.023), presence of oedema (p-value- 0.019) and tuberculosis (p-value- 0.004). Children with satisfactory outcome at the time of discharge from NRC also had good outcome at the time of follow up (p-value <0.001).
Conclusion: Lack of breastfeeding and illiteracy in mother have surfaced as important modifiable factors that lead to poor outcome in children with SAM. Early identification of medical complications like oedema, sepsis can reduce mortality and hospital stay.