Severe malnutrition is responsible for the deaths of millions of children every year. Even when such children are admitted to hospital, up to one in five of them will die. Research published in PLoS Medicine has shown that certain clinical signs in severely malnourished children can predict those who are most likely to die. This should help health care workers focus their attentions on those who are most at risk.
The international group of researchers work in a hospital in Kilifi District Hospital in Kenya, where 920 children were admitted with severe malnutrition between Septemb er 2000 and June 2002. Although the children were treated according to guidelines from the World Health Organization, 176 of them (19%) died. The WHO says that use of the guidelines can reduce the death rate to around 5%, but the Kilifi figures are not unusual for Africa.
The researchers found that four clinical features, which can be easily noted at the bedside on admission, were associated with a large proportion of the early deaths. These four signs were: slow heart rate, weak pulse volume, depressed level of consciousness, and delayed capillary refilling time (i.e. pressing a fingernail bed to blanch the finger, releasing it, and observing the time taken to recolor the nailbed).
The researchers proposed that these findings (together with a number of other features that were associated with the later deaths) could be used to identify three groups of patients differing in their need for emergency care: a high-risk group (with any of the four signs above, or with low blood sugar, among whom mortality was 34%); a moderate-risk group (among whom mortality was 23%); and a low-risk group (mortality 7%).
The signs reported here as indicators of poor outcome may prove useful in future in identifying high-risk individuals to ensure they receive the right treatment. However, the indicators proposed by the researchers would need further evaluation before current guidelines for treatment of the severely malnourished child could be changed.
Citation: Maitland K, Berkley JA, Shebbe M, Peshu N, English M, et al. (2006) Children with severe malnutrition: Can those at highest risk of death be identified with the WHO protocol? PLoS Med 3(12): e500. (http://dx.doi.org/10.1371/journal.pmed.0030500)
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