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Open Access 01-12-2019 | Nutrition | Research article

Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia

Published in: BMC Public Health | Issue 1/2019

Abstract

Background

Accurate and timely data on the health of a population are key for evidence-based decision making at both the policy and programmatic level. In many low-income settings, such data are unavailable or outdated. Using an electronic medical records system, we determined the association between nutritional status and severe illness and mortality among young children presenting to a rural primary health care facility in the Gambia.

Methods

Clinical data collected over five years (2010–2014) on children aged under 60 months making acute visits to a primary health care clinic in the rural Gambian district of Kiang West were retrospectively extracted from the medical records system. Generalised estimating equation models were used to investigate associations between nutritional status and illness severity, accounting for repeat visits, gender, age and access to transport to the clinic. The Population Attributable Fraction (PAF) was used to determine the proportion of severe illness likely attributable to different grades of malnutrition.

Results

3839/5021 (77%) children under 60 months of age living in Kiang West presented acutely to the clinic at least once, yielding 21,278 visits (47% girls, median age 20.2 months (Interquartile Range (IQR) 23.92 months)) and 26,001 diagnoses, 86% being infectious diseases. Severe illness was seen in 4.5% of visits (961/21,278). Wasting was associated with an increased risk of severe illness in a dose-dependent manner, (‘WHZ < -1’ adjusted Odds Ratio (aOR) 1.68, 95% CI:1.43–1.98, p < 0.001, ‘WHZ <-2 and ≥-3’ aOR 2.78, 95% CI:2.31–3.36, p < 0.001 and ‘WHZ < -3’ aOR 7.82, 95% CI:6.40–9.55, p < 0.001) the PAF for wasting (WHZ < -2) was 0.21 (95% CI: 0.18–0.24). Stunting, even in the most severe form (HAZ < -3), was not significantly associated with severe illness (aOR 1.19 95% CI:0.94–1.51) but was associated with a significantly increased risk of death (aOR 6.04 95% CI:1.94–18.78).

Conclusion

In this population-based cohort of young children in rural Gambia, wasting was associated with disease severity in a dose-dependent manner. Further research is needed into strategies to identify and reach these children with effective interventions to improve their nutritional status.

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Title: Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia
Publication date: 01-12-2019
Keyword: Nutrition
Published in: BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-019-6959-y

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Springer Medicine

Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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