Hospital-acquired malnutrition in children at a tertiary care hospital

Objectives: This study sought to investigate the incidence and factors associated with hospital-acquired malnutrition in children.Design: A hospital-based longitudinal survey carried out between December 2013 and February 2014.Setting: Aga Khan University Hospital, Nairobi, Kenya, a tertiary care hospital.Subjects: One hundred and seventy children who met the inclusion criteria were included in the study.Outcome measures: Anthropometry was done at admission and discharge. Incidence of hospital-acquired malnutrition was estimated from the total number of children showing a decrease in weight-for-height/length (WFH) or Body Mass Index (BMI) z-scores from the time of admission to discharge. Logistic regression analysis was performed to determine associations between selected variables and weight loss during hospitalisation.Results: Albeit a borderline level of significance, a decrease in calculated z-scores occurred in 60.6% (Confidence Interval (CI) 53.1-67.6%) of children during hospitalisation with a mean weight decrease of 0.5kg (Standard Deviation (SD)3.37, p= 0.055). Children60months of age demonstrated a mean decrease in weight-for-height/length z-score of 0.145 (SD +/- 0.73, p= 0.042); and those>60months, a mean decrease in BMI z-score of 0.152 (SD +/- 0.39, p= 0.004). The majority with weight loss had been admitted with a diagnosis of gastroenteritis (81.2%), gastritis (64.3%) and pneumonia (55.6%). Weight loss was associated with duration of admission: 3 - 5days (Odds Ratio (OR) 2.43, CI 1.46-4.03), 5 - 7days (OR 4.67, CI 1.34-16.24), and >7days (OR 2.75, CI 0.88-8.64); score test for trend of odds is OR 1.37 (95% CI 1.11-1.69, p = 0.003).Conclusion: This study found a high incidence of hospital-acquired malnutrition in children. The most affected were those with gastroenteritis, gastritis and pneumonia. Hospital-acquired malnutrition was associated with an increased duration of hospitalisation.