The levels of malnutrition and risk factors for mortality at Harare Central Hospital-Zimbabwe: an observation study.

OBJECTIVES: To determine the prevalence of malnutrition, and identify risk factors associated with mortality in acute severe malnutrition in a major referral hospital in Harare.

DESIGN: Cross sectional analytical study.

SETTING: Harare Central Hospital, paediatric wards.

SUBJECTS: All children admitted to the general paediatric medical wards between 12 October 2003 and 19 January 2004 were surveyed.

MAIN OUTCOME MEASURES: Prevalence and mortality in hospitalized children with acute severe malnutrition.

STUDY FACTORS: Patient's age, sex, vaccination status, type of malnutrition, weight-for-height, breast feeding status (age <24 months), care giver details, orphanage, area of residence, new or re-admission, time of admission, admission temperature, co-morbidity conditions, HIV status and selected laboratory tests.

RESULTS: A total of 784 infants and children were admitted during the study period, of whom 619 were eligible for the study. Of the 619 children, 259 (41.8%) had acute severe malnutrition, 79 (12.8%) moderate malnutrition and 281 (45.5%) had no malnutrition. Fatality rates were 42.9% (acute severe malnutrition), 32.9% (moderate malnutrition), and 21% (no malnutrition) respectively. Factors predictive of mortality by multivariate analysis were age <18 months (O.R=2.27; 95% CI 1.20-4.29), weight-for-height <70% (O.R=2.63; 95% CI=1.24-5.56), acute diarrhoea (O.R=3.42; 95% CI=1.53-7.65), persistent diarrhoea (O.R=2.67; 95% CI= 1.26-5.66), and pneumonia (O.R=2.21; 95% CI= 1.08-4.52).

CONCLUSION: Mortality among children with acute severe malnutrition at this institution was unacceptably high. Case management needs strengthening particularly for malnutrition, diarrhoea and pneumonia. The role of high HIV prevalence rates on mortality in this population needs evaluating.