Nutritional status and disease severity in children acutely presenting to a primary health clinic in rural Gambia

• Published in: BMC public health Vol. 19; no. 1; p. 668
• Main Authors: Mark, Henry, Been, Jasper V, Sonko, Bakary, Faal, Abdoulie, Ngum, Mohammed, Hasan, Jahid, Prentice, Andrew M, Unger, Stefan A
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30.05.2019; BioMed Central; BMC
• Subjects: Age; Ambulatory care; Ambulatory care facilities; Analysis; Antibiotics; Archives & records; Binomial distribution; Child Mortality - trends; Child nutrition; Child, Preschool; Children; Children & youth; Childrens health; Clinical decision making; Communicable diseases; Decision making; Disease; Electronic health records; Electronic medical records; Electronic records; Female; Gambia - epidemiology; Girls; Health aspects; Health care; Health care facilities; Health facilities; Health surveillance; Heat affected zone; Humans; Illnesses; Infant; Infectious disease; Infectious diseases; Low income groups; Male; Malnutrition; Medical Records; Medical research; Morbidity; Mortality; Nutrition; Nutrition status; Nutritional Status; Pediatric diseases; Pediatric research; Population; Primary care; Primary Health Care; Public health; Retrospective Studies; Rural areas; Rural Health Services; Rural population; Severity of Illness Index; Statistics; Sub-Saharan Africa; Gambia; England; South Africa; United Kingdom > UK; Infectious disease; Nutrition status; Primary health care; Electronic medical records; Sub-Saharan Africa
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-019-6959-y

Accurate and timely data on the health of a population are key for evidence-based decision making at both the policy and programmatic level. In many low-income settings, such data are unavailable or outdated. Using an electronic medical records system, we determined the association between nutritional status and severe illness and mortality among young children presenting to a rural primary health care facility in the Gambia. Clinical data collected over five years (2010-2014) on children aged under 60 months making acute visits to a primary health care clinic in the rural Gambian district of Kiang West were retrospectively extracted from the medical records system. Generalised estimating equation models were used to investigate associations between nutritional status and illness severity, accounting for repeat visits, gender, age and access to transport to the clinic. The Population Attributable Fraction (PAF) was used to determine the proportion of severe illness likely attributable to different grades of malnutrition. 3839/5021 (77%) children under 60 months of age living in Kiang West presented acutely to the clinic at least once, yielding 21,278 visits (47% girls, median age 20.2 months (Interquartile Range (IQR) 23.92 months)) and 26,001 diagnoses, 86% being infectious diseases. Severe illness was seen in 4.5% of visits (961/21,278). Wasting was associated with an increased risk of severe illness in a dose-dependent manner, ('WHZ < -1' adjusted Odds Ratio (aOR) 1.68, 95% CI:1.43-1.98, p < 0.001, 'WHZ <-2 and ≥-3' aOR 2.78, 95% CI:2.31-3.36, p < 0.001 and 'WHZ < -3' aOR 7.82, 95% CI:6.40-9.55, p < 0.001) the PAF for wasting (WHZ < -2) was 0.21 (95% CI: 0.18-0.24). Stunting, even in the most severe form (HAZ < -3), was not significantly associated with severe illness (aOR 1.19 95% CI:0.94-1.51) but was associated with a significantly increased risk of death (aOR 6.04 95% CI:1.94-18.78). In this population-based cohort of young children in rural Gambia, wasting was associated with disease severity in a dose-dependent manner. Further research is needed into strategies to identify and reach these children with effective interventions to improve their nutritional status.