Abstract

Research Article

Prevalence and Associated Factors of Hypoglycemia among Severe Acute Malnourished Children who admitted in East Gojjam Zone Public Hospitals from 2018 to 2021, Northwest Ethiopia, 2022. Multi-center Retrospective Cross Sectional Study

Yitayal Guadie Ashebir*, Yohannes Godie, Aster Tadesse, Esmelalem Mihretu and Dires Birhanu

Published: 29 April, 2024 | Volume 7 - Issue 1 | Pages: 037-044

Background: Globally, severe acute malnutrition (SAM) remains a major killer of children under 5 years of age. The highest magnitude is seen in sub-Saharan Africa, including Ethiopia. Hypoglycemia is the most common complication of severe acute malnutrition (SAM) and the most life-threatening condition in pediatric society. This study aimed to assess the prevalence of hypoglycemia and its associated factors among under-five children with severe acute malnutrition.
Methods: A cross-sectional retrospective study was conducted among 378 randomly selected samples who were admitted to public hospitals in the East Gojjam zone from 2018 to 2021. Data was extracted from the medical records of the children and entered into SPSS version 26, Variables with a p – value < 0.25 in the Bivariate analysis were candidates for multivariable logistic regression and those with a p – value < 0.05 in the multivariable analysis were considered as having a statistically significant association with hypoglycemia among severe acute malnutrition.
Results: Out of 378 respondents, 50 (13.2%) had hypoglycemia with severe acute malnutrition patients. Children admitted between the ages of 0-6 months were 2.93 (AOR = 1.57-6.25, p = 0.000), shocks were 4.6 (AOR = 1.25-17.42, p = 0.034), and fully immunized children were (AOR: 2.61 (1.01- 6.77, p = 0.048) was significantly associated with hypoglycemia with severe acute malnutrition. 
Conclusion and recommendation: The prevalence of hypoglycemia with severe acute malnutrition was 13.2%. We also recommend a longitudinal study should be done among children who develop hypoglycemia with severe acute malnutrition to determine the long-term consequences, especially the neurodevelopmental sequelae associated with this condition.

Read Full Article HTML DOI: 10.29328/journal.japch.1001066 Cite this Article Read Full Article PDF

Keywords:

Severe acute malnutrition; Hypoglycemia; Under-five children; Ethiopia

References

  1. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R; Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013 Aug 3;382(9890):427-451. doi: 10.1016/S0140-6736(13)60937-X. Epub 2013 Jun 6. Erratum in: Lancet. 2013. 2013 Aug 3;382(9890):396. PMID: 23746772.
  2. Organization WH. Guideline: Updates on Paediatric Emergency Triage, Assessment, and Treatment: Care of Critically-Ill Children. World Health Organization Geneva. 2016.
  3. UNICEF/WHO/. World Bank Levels and Trends in Child Malnutrition – UNICEF WHO the World Bank Joint Child Malnutrition Estimates, key findings of the 2019 edition UNICEF. 2019.
  4. Ledger E, Harawa PP, Daniel AI, Candler T, Prentice AM, Bandsma RHJ. Dysglycemia in Children with Severe Acute Malnutrition: A Systematic Review and Meta-Analysis. Adv Nutr. 2021 Jun 1;12(3):959-968. doi: 10.1093/advances/nmaa138. PMID: 33179024; PMCID: PMC8166557.
  5. Bitew ZW, Ayele EG, Worku T, Alebel A, Alemu A, Worku F, Yesuf A. Determinants of mortality among under-five children admitted with severe acute malnutrition in Addis Ababa, Ethiopia. Nutr J. 2021 Dec 20;20(1):94. doi: 10.1186/s12937-021-00750-0. PMID: 34930311; PMCID: PMC8691009.
  6. Spoelstra MN, Mari A, Mendel M, Senga E, van Rheenen P, van Dijk TH, Reijngoud DJ, Zegers RG, Heikens GT, Bandsma RH. Kwashiorkor and marasmus are both associated with impaired glucose clearance related to pancreatic β-cell dysfunction. Metabolism. 2012 Sep;61(9):1224-30. doi: 10.1016/j.metabol.2012.01.019. Epub 2012 Mar 3. PMID: 22386944.
  7. Roberfroid D, Verstraeten R. Management of oedematous malnutrition in infants and children aged >6 months: a systematic review of the evidence. World Health Organization. 2013.
  8. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998 Jul;15(7):539-53. doi: 10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S. PMID: 9686693.
  9. Wintergerst KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM. Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics. 2006 Jul;118(1):173-9. doi: 10.1542/peds.2005-1819. PMID: 16818563.
  10. Faustino EVS, Hirshberg EL, Asaro LA, Biagas KV, Pinto N, Srinivasan V, Bagdure DN, Steil GM, Coughlin-Wells K, Wypij D, Nadkarni VM, Agus MSD, Mourani PM, Chima R, Thomas NJ, Li S, Pinto A, Newth C, Hassinger A, Bysani K, Rehder KJ, Kandil S, Wintergerst K, Schwarz A, Marsillio L, Cvijanovich N, Pham N, Quasney M, Flori H, Federman M, Nett S, Viteri S, Schneider J, Medar S, Sapru A, McQuillen P, Babbitt C, Lin JC, Jouvet P, Yanay O, Allen C; Heart And Lung Failure-Pediatric INsulin Titration (HALF-PINT) Study Investigators. Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children. Crit Care Med. 2019 May;47(5):706-714. doi: 10.1097/CCM.0000000000003699. PMID: 30789401.
  11. Ratter JM, Rooijackers HM, Tack CJ, Hijmans AG, Netea MG, de Galan BE, Stienstra R. Proinflammatory Effects of Hypoglycemia in Humans With or Without Diabetes. Diabetes. 2017 Apr;66(4):1052-1061. doi: 10.2337/db16-1091. Epub 2017 Jan 23. PMID: 28115398.
  12. Mahajan G, Mukhopadhyay K, Attri S, Kumar P. Neurodevelopmental Outcome of Asymptomatic Hypoglycemia Compared With Symptomatic Hypoglycemia and Euglycemia in High-Risk Neonates. Pediatr Neurol. 2017 Sep;74:74-79. doi: 10.1016/j.pediatrneurol.2017.05.028. Epub 2017 Jun 7. PMID: 28739364.
  13. GOMEZ F, GALVAN RR, CRAVIOTO J, FRENK S. Malnutrition in infancy and childhood, with special reference to kwashiorkor. Adv Pediatr. 1955;7:131-69. PMID: 14349775.
  14. Waterlow JC. Classification and definition of protein-calorie malnutrition. Br Med J. 1972 Sep 2;3(5826):566-9. doi: 10.1136/bmj.3.5826.566. PMID: 4627051; PMCID: PMC1785878.
  15. Debremarkos Compressive Specialized Hospital. undrefive SAM patient IPD LOG registration book. 2022.
  16. Lumama primary hospital. Under five SAM patient ITP registration books. 2022.
  17. Bichena Primary Hospital. under five SAM patient ITP registration book. 2022.
  18. Ayanssa AB, Hailemariam TW, Melke AS. Determinants of acute malnutrition among children aged 6–59 months in Public Hospitals, Oromia region, West Ethiopia. 2017.
  19. Federal Ministry of Health. Protocol for the management of severe acute malnutrition Addis Ababa. 2014.
  20. Madrid L, Acacio S, Nhampossa T, Lanaspa M, Sitoe A, Maculuve SA, Mucavele H, Quintó L, Sigaúque B, Bassat Q. Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique. Am J Trop Med Hyg. 2016 Jan;94(1):218-26. doi: 10.4269/ajtmh.15-0475. Epub 2015 Oct 26. PMID: 26503282; PMCID: PMC4710433.
  21. Samya V, Shriraam V, Jasmine A, Akila GV, Anitha Rani M, Durai V, Gayathri T, Mahadevan S. Prevalence of Hypoglycemia Among Patients With Type 2 Diabetes Mellitus in a Rural Health Center in South India. J Prim Care Community Health. 2019 Jan-Dec;10:2150132719880638. doi: 10.1177/2150132719880638. PMID: 31631765; PMCID: PMC6804359.
  22. Maitland K, Berkley JA, Shebbe M, Peshu N, English M, Newton C. Children with severe malnutrition: can those at highest risk of death be identified with the WHO protocol. PLoS Med. 2016; 3(500).
  23. Abhinay A, Kumar D, Rao SK. Triage of children with severe acute malnutrition and its outcome: single centre cross-sectional study. JCDR 2019; 13:4-6. DOI:10.7860/JCDR/2019/41044.12856
  24. Girum T, Kote M, Tariku B, Bekele H. Survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study. Ther Clin Risk Manag. 2017 Jan 23;13:101-110. doi: 10.2147/TCRM.S119826. PMID: 28176953; PMCID: PMC5271381.
  25. Vonasek BJ, Chiume M, Crouse HL, Mhango S, Kondwani A, Ciccone EJ, Kazembe PN, Gaven W, Fitzgerald E. Risk factors for mortality and management of children with complicated severe acute malnutrition at a tertiary referral hospital in Malawi. Paediatr Int Child Health. 2020 Aug;40(3):148-157. doi: 10.1080/20469047.2020.1747003. Epub 2020 Apr 3. PMID: 32242509.

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