Time to death and predictors of mortality among under-five children with severe acute malnutrition hospitalized at Mulanje District Hospital in Southern Malawi: a retrospective cohort study

Abstract

Abstract Introduction Severe acute malnutrition (SAM) is a leading cause of inpatient mortality in children in sub-Saharan Africa (SSA). In Malawi, there is limited data that explains why this is the case. Therefore, this study determined the time to death and its predictors among children under five years of age with SAM admitted at Mulanje District Hospital. Methods We conducted a retrospective cohort study by reviewing the medical charts of 454 randomly selected children under five years of age who were admitted to Mulanje District Hospital from January 2017 to February 2021. We collected data using data collection forms and analyzed the data with STATA version 16. Cox proportional hazard regression was used to identify predictors of mortality. A statistical significance was declared at a p-value < 0.05 Results A total of 7,685 children under five years of age were admitted to Mulanje District Hospital between January 2017 and February 2021. We enrolled and analyzed 454 cases, of which 227 were SAM children and the other 227 belonged to non-SAM children. The overall death rate was 14.8%. For SAM children, the death rate was 8.4%, compared to 21.2% for non-SAM children. The median time to death was 5 days (IQR: 2–8) for SAM and 1 day (IQR: 1–2) for non-SAM children. Among SAM children, shock (AHR: 15.3; CI: 2.08–113.42) and not having received amoxicillin (AHR: 4.15; CI: 1.24–13.90) were significant predictors of death. Among non-SAM children, shock (AHR: 2.33; CI: 1.18–4.6), diarrhoea (AHR: 2.07; CI: 1.00–2.30), oxygen therapy (AHR: 3.17; CI: 1.66–6.05), and not having received amoxicillin (AHR: 20.78; CI: 2.81–153.67) were significant predictors of death. Conclusion Clinical and nursing interventions should be more focused on predictors of mortality to address the high incidence of deaths among children under five years of age.