Edema melting length and therapeutic failure during hospitalization as factors associated with long-term mortality after basic treatment of severe acute malnutrition: Lwiro cohort follow-up in the Eastern Democratic Republic of the Congo

Abstract

Abstract Purpose The aim of this study was to identify the factors associated with long-term mortality in subjects treated for SAM in childhood 11 to 30 years after nutritional rehabilitation. Methodology Referring to the data collected from December 2017 to November 2018 from the Lwiro cohort; we updated this database with additional data. Records of subjects admitted for SAM between 1988 and 2007 were extracted from the archives of the pediatric hospital in Lwiro, South Kivu, Democratic Republic of Congo (DRC). A multivariate Cox proportional hazards regression was used to identify factors associated with long-term mortality. Results A total of 816 subjects were found to be alive and 119 died. The mean age at admission to nutritional rehabilitation was 46 months. Around two third of the subjects had edema, and in 6,8% of these subjects, edema had subsided after thirty days in hospital. Almost one in ten (9.5%) cases of SAM resulted in treatment failure. The risk of death was significantly higher in subjects with a history of therapeutic failure (hospital stay ≥ 45 days) and in those whose edema had melted late (≥ 30 days) during their hospitalization, with respective risks of HR = 1.98 (1.07; 3.67) and 2.81 (1.12; 7.03) respectively. Conclusion Good follow-up after hospital discharge is imperative to ensure the success of SAM management in the medium and long term. However, this follow-up must be more intensive in patients who have failed treatment and whose edema has melted late during hospitalization.