Mortality risk factors in acute protein-energy malnutrition

The records of 45 children admitted to the Save The Children Fund (UK) Clinic, Dhankuta, East Nepal for nutritional rehabilitation, and who subsequently died, were compared with those of 200 survivors admitted during the same period. Children who died were more likely to have attended the clinic previously (P less than 0.02), and tended to be younger and lighter than controls. A poor outcome was associated with oedema (P less than 0.02), hepatomegaly (P less than 0.01), suspected tuberculosis (P less than 0.001) and various socioeconomic factors: children who died came from larger families, 'single parent' families (P less than 0.01), and were more likely to have lost a sibling (P less than 0.01). The irrigated landholdings of dying children's families were on average approximately half the size of those of survivors' families. These socioeconomic factors were associated with more severe malnutrition at presentation. The identification of factors associated with a poor prognosis can help to focus admission criteria and to monitor especially high-risk children where services for the acutely malnourished are limited.