Triage of Children with Severe Acute Malnutrition and its Outcome: Single Centre Cross-sectional Study
Dr. Sunil Kumar Rao,
Associate Professor, Department of Paediatric, Institute of Medical Science, BHU, Varanasi, Uttar Pradesh, India.
Introduction: World Health Organisation (WHO), Emergency Triage, Assessment and Treatment (ETAT) guidelines categorised three most common presentations of sick children at admission; these are Respiratory distress and Hypoxemia, Severely impaired circulation or Shock and Seizures with Altered consciousness. Limited data is available on triage in sick children with Severe Acute Malnutrition (SAM).
Aim: To describe the triage of children with SAM at time of hospitalisation and its outcome.
Materials and Methods: This was a prospective cross- sectional study, conducted on malnourished children recruited from September 2017 to August 2018, over one year period at Department of Paediatrics, Banaras Hindu University. The inclusion criteria were children aged 6 to 60 months fulfilling the WHO criteria of SAM. Triage of SAM children was done in paediatric emergency by resident on duty and A (airway), B (breathing), C (circulation, coma and convulsion), D (severe dehydration) model was used to identify the presence of emergency sign. Outcome was defined as discharge and/or death. Criteria used to indentify the clinical status were taken from WHO-ETAT2016. The demographic characteristics, clinical information is presented as frequencies with percentages. All data were entered into excel sheet and analysed by using SPSS version 18.
Results: There were 122 SAM children, out of these, almost two third children (63.2%) were male and most common affected age group of children was less than 3 year (77%). The common emergency sign was hypoxemia (37.96%) followed by dehydration (32.40%), hypoglycemia (21.29%), shock (18.51%), severe respiratory distress (18.5%), and convulsion (10.18%). SAM children with fatal outcome were 11.29 times more likely to have shock (0.001), 10.2 times more likely to have dehydration (<0.001), 7.2 times more likely to have severe respiratory distress (<0.001). There was presence of three or more emergency signs in SAM children who died.
Conclusion: Early recognition of clinical signs of shock, severe respiratory distress and dehydration would identify SAM children who are at risk of early death on arrival to facility.