Inpatient Morbidity and Mortality of Severely Underweight Children Was Comparable to That of Severely Wasted Children in Dhaka, Bangladesh

Md Ridwan Islam Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Sharika Nuzhat Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Jinat Alam Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Sayeeda Huq Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Mohammod Jobayer Chisti Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;

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Tahmeed Ahmed Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh;
Office of the Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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ABSTRACT.

Both wasting and undernutrition are responsible for multiple morbidities and increased mortality in younger children hospitalized for acute illnesses. The question of whether children who are suffering from severe underweight are as vulnerable as children suffering from severe wasting needs to be researched further. We aimed to compare the morbidity and mortality of severely underweight but not severely wasted (SU-nSW) children with that of severely wasted (SW) children admitted to inpatient wards of a hospital. Data from 12,894 children aged < 5 years were collected using cross-sectional methods from Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh between March 2019 and December 2021. After exclusion of non-desired populations (N = 8,834), comparisons between SU-nSW (N = 1,876) and SW (N = 2,184) children were observed. The risk of morbidities and mortality among SU-nSW and SW children was analyzed after adjusting for age and sex. Inpatient morbidities were mostly similar among children with sepsis (adjusted odds ratio [aOR]: 0.90; 95% CI: 0.69, 1.19; P = 0.472) and convulsions (aOR: 0.84; 95% CI: 0.51, 1.37; P = 0.475). Dehydration (aOR: 0.71; 95% CI: 0.62, 0.81; P < 0.001) and hypokalemia (aOR: 0.58; 95% CI: 0.42, 0.79; P = 0.001) were more likely associated with SW children than with SU-nSW children. Pneumonia/severe pneumonia was more likely to affect SU-nSW children (aOR: 1.24; 95% CI: 1.02, 1.48; P = 0.018). Death was comparable between the two groups (aOR: 1.32; 95% CI: 0.70, 2.49; P = 0.386). This study underscores the importance of implementing present treatment guidelines for severe acute malnutrition in the facility-based management of severely underweight children as well.

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Author Notes

Address correspondence to Sharika Nuzhat, Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh. E-mail: sharika.nuzhat@icddrb.org

Financial support: This research was funded by core donors who provided unrestricted support to International Centre for Diarrhoeal Disease Research, Bangladesh for its operations and research. Current donors providing unrestricted support include the Governments of Bangladesh, Canada, Sweden, and the United Kingdom. Donors had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the paper for publication. The corresponding author has full access to all the data in the study and accepts responsibility for submission for publication.

Data were extracted from the electronic database of patients’ records at the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Approval was obtained from the institutional review board of icddr,b (the Research Review Committee and Ethical Review Committee) for data analysis and publication. Data related to this manuscript are available upon request for researchers who meet the criteria for access to confidential data, who may contact Armana Ahmed (armana@icddrb.org) for the Research Administration of icddr,b (http://www.icddrb.org/).

Authors’ addresses: Md Ridwan Islam, Jinat Alam, and Sayeeda Huq, Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: ridwan.islam@icddrb.org, jinat.alam@icddrb.org, and sayeeda@icddrb.org. Sharika Nuzhat and Mohammod Jobayer Chisti, Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: sharika.nuzhat@icddrb.org and chisti@icddrb.org. Tahmeed Ahmed, Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, Clinical and Diagnostic Services, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, and Office of the Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mail: tahmeed@icddrb.org.

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