The impact of rickets on growth and morbidity during recovery among children with complicated severe acute malnutrition in Kenya: A cohort study

Maternal and Child Nutrition - Tập 14 Số 2 - 2018
Moses M. Ngari1,2, Johnstone Thitiri1,2, Laura Mwalekwa1, Molline Timbwa1,2, Per Ole Iversen3,4, Greg Fegan1,5, James A. Berkley6,1,2
1KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
2The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
3Department of Haematology, Oslo University Hospital, Oslo, Norway
4Department of Nutrition, IMB, University of Oslo, Oslo, Norway
5Swansea Trials Unit, Swansea University Medical School, Swansea, UK
6Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK

Tóm tắt

AbstractThe effects of rickets on children recovery from severe acute malnutrition (SAM) are unknown. Rickets may affect both growth and susceptibility to infectious diseases. We investigated the associations of clinically diagnosed rickets with life‐threatening events and anthropometric recovery during 1 year following inpatient treatment for complicated SAM. This was a secondary analysis of clinical trial data among non‐human immunodeficiency virus‐infected Kenyan children with complicated SAM (2–59 months) followed for 1 year posthospital discharge (ClinicalTrials.gov ID NCT00934492). The outcomes were mortality, hospital readmissions, and growth during 12 months. The main exposure was clinically diagnosed rickets at baseline. Of 1,778 children recruited, 230 (12.9%, 95% CI [11.4, 14 .6]) had clinical signs of rickets at baseline. Enrolment at an urban site, height‐for‐age and head circumference‐for‐age z scores were associated with rickets. Rickets at study enrolment was associated with increased mortality (adjusted Hazard Ratio [aHR] 1.61, 95% CI [1.14, 2.27]), any readmission (aHR 1.37, 95% CI [1.09, 1.72]), readmission for severe pneumonia (aHR 1.37, 95% CI [1.05, 1.79]), but not readmission with diarrhoea (aHR 1.05, 95% CI [0.73, 1.51]). Rickets was associated with increased height gain (centimetres), adjusted regression coefficient 0.19 (95% CI [0.10, 0.28]), but not changes in head circumference, mid‐upper arm circumference, or weight. Rickets was common among children with SAM at urban sites and associated with increased risks of severe pneumonia and death. Increased height gain may have resulted from vitamin D and calcium treatment. Future work should explore possibility of other concurrent micronutrient deficiencies and optimal treatment of rickets in this high‐risk population.

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Maternal and Child Nutrition

Tập 14 Số 2

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