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

Tan, Rainer; Kagoro, Frank; Levine, Gillian A; Masimba, John; Samaka, Josephine; Sangu, Willy; Genton, Blaise; D'Acremont, Valérie; Keitel, Kristina (2020). Clinical Outcome of Febrile Tanzanian Children with Severe Malnutrition Using Anthropometry in Comparison to Clinical Signs. The American Journal of Tropical Medicine and Hygiene, 102(2), pp. 427-435. American Society of Tropical Medicine and Hygiene 10.4269/ajtmh.19-0553

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Notfallzentrum für Kinder und Jugendliche

UniBE Contributor:

Keitel, Kristina

ISSN:

0002-9637

Publisher:

American Society of Tropical Medicine and Hygiene

Language:

English

Submitter:

Kristina Keitel

Date Deposited:

06 Jul 2021 12:15

Last Modified:

05 Dec 2022 15:43

Publisher DOI:

10.4269/ajtmh.19-0553

PubMed ID:

31802732

BORIS DOI:

10.48350/150525

URI:

https://boris.unibe.ch/id/eprint/150525

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