Mortality risk in infants receiving therapeutic care for malnutrition: A secondary analysis

Abstract

AbstractBackgroundSmall and nutritionally at-risk infants aged <6 months are at high risk of death, but important evidence gaps exist on how to best identify them. We aimed to determine associations between anthropometric deficits and mortality among infants <6m admitted to inpatient therapeutic care.MethodsA secondary analysis of 2002-2008 data included 5,034 infants aged <6m from 12 countries. The prevalence, concurrence, and severity of wasted, stunted, underweight, and the Composite Index of Anthropometric Failure (CIAF) were analysed. We used logistic regression to examine the association of different anthropometric deficits with in-programme mortality.ResultsAmong 3,692 infants aged <6m with complete data, 3,539 (95.8%) were underweight, 3,058 (82.8%) were wasted, 2,875 (77.8%) were stunted, and 3,575 (96.8%) had CIAF. Infants with multiple anthropometric deficits were more severely wasted, stunted, and underweight. A total of 141 infants died during inpatient therapeutic care. Among these, severely wasted (116) and severely underweight (138) infants had higher odds of mortality than normal infants (OR=2.1, 95% CI: 1.2-2.7, p=0.009, and OR=3.3, 95% CI: 0.8-13.6, p=0.09, respectively). Boys had higher odds of inpatient mortality than girls (OR=1.40, 95% CI: 1.02-1.92, p=0.03).ConclusionMultiple anthropometric deficits (CIAF) is common among infants <6m. Future work needs to explore which are the most useful indicator for programme admission and in-programme prognosis: our data supports both WLZ and WAZ, but future work which better accounts for admission bias is urgently needed. Boys appear to be most at-risk. Programmes should ensure that all infants receive timely, evidence-based, effective care.