Clinical Outcome of Febrile Tanzanian Children with Severe Malnutrition Using Anthropometry in Comparison to Clinical Signs.

Details

Serval ID
serval:BIB_FF241A57CCB0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Clinical Outcome of Febrile Tanzanian Children with Severe Malnutrition Using Anthropometry in Comparison to Clinical Signs.
Journal
The American journal of tropical medicine and hygiene
Author(s)
Tan R., Kagoro F., Levine G.A., Masimba J., Samaka J., Sangu W., Genton B., D'Acremont V., Keitel K.
ISSN
1476-1645 (Electronic)
ISSN-L
0002-9637
Publication state
Published
Issued date
02/2020
Peer-reviewed
Oui
Volume
102
Number
2
Pages
427-435
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Children with malnutrition compared with those without are at higher risk of infection, with more severe outcomes. How clinicians assess nutritional risk factors in febrile children in primary care varies. We conducted a post hoc subgroup analysis of febrile children with severe malnutrition enrolled in a randomized, controlled trial in primary care centers in Tanzania. The clinical outcome of children with severe malnutrition defined by anthropometric measures and clinical signs was compared between two electronic clinical diagnostic algorithms: ePOCT, which uses weight-for-age and mid-upper arm circumference to identify and manage severe malnutrition, and ALMANACH, which uses the clinical signs of edema of both feet and visible severe wasting. Those identified as having severe malnutrition by the algorithms in each arm were prescribed antibiotics and referred to the hospital. From December 2014 to February 2016, 106 febrile children were enrolled and randomized in the parent study, and met the criteria to be included in the present analysis. ePOCT identified 56/57 children with severe malnutrition using anthropometric measures, whereas ALMANACH identified 2/49 children with severe malnutrition using clinical signs. The proportion of clinical failure, defined as the development of severe symptoms by day 7 or persisting symptoms at day 7 (per-protocol), was 1.8% (1/56) in the ePOCT arm versus 16.7% (8/48) in the Algorithm for the MANagement of Childhood illnesses arm (risk difference -14.9%, 95% CI -26.0%, -3.8%; risk ratio 0.11, 95% CI 0.01, 0.83). Using anthropometric measures to identify and manage febrile children with severe malnutrition may have resulted in better clinical outcomes than by using clinical signs alone.
Keywords
Anthropometry, Child Nutrition Disorders/diagnosis, Child Nutrition Disorders/diet therapy, Child Nutrition Disorders/epidemiology, Child, Preschool, Female, Humans, Infant, Infant Nutrition Disorders/diagnosis, Infant Nutrition Disorders/epidemiology, Male, Tanzania/epidemiology, Treatment Outcome
Pubmed
Web of science
Create date
15/12/2019 17:53
Last modification date
18/06/2020 5:21
Usage data