Diarrhoea Complicating Severe Acute Malnutrition in Kenyan Children A Prospective Descriptive Study of Risk Factors and Outcome 英文参考文献.docVIP

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Diarrhoea Complicating Severe Acute Malnutrition in Kenyan Children A Prospective Descriptive Study of Risk Factors and Outcome 英文参考文献.doc

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Diarrhoea Complicating Severe Acute Malnutrition in Kenyan Children A Prospective Descriptive Study of Risk Factors and Outcome 英文参考文献

DiarrhoeaComplicatingSevereAcuteMalnutritionin KenyanChildren:AProspectiveDescriptiveStudyofRisk FactorsandOutcome AlisonTalbert1,NahashonThuo1,JaphetKarisa1,CharlesChesaro1,EricOhuma1,JamesIgnas1, JamesA.Berkley1,2,ChristopherToromo1,SarahAtkinson1,3,KathrynMaitland1,4 * 1Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya, 2Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford,UnitedKingdom,3DepartmentofPaediatrics,UniversityofOxford,Oxford,UnitedKingdom,4WellcomeTrustCentreforClinicalTropicalMedicine,Facultyof Medicine,ImperialCollege,NorfolkPlace,London,UnitedKingdom Abstract Background: Severeacutemalnutrition(SAM)accountsfortwomilliondeathsworldwideannually.Inthosehospitalised withSAM,concomitantinfectionsanddiarrhoeaarefrequentcomplicationsresultinginadverseoutcome.Weexaminedthe clinicalandlaboratoryfeaturesonadmissionandoutcomeofchildrenwithSAManddiarrhoeaataKenyandistricthospital. Methods:A4-yearprospectivedescriptivestudyinvolving1,206childrenaged6monthsto12years,hospitalizedwithSAM and managed in accordance with WHO guidelines. Data on clinical features, haematological, biochemical and microbiological findings for children with diarrhoea ($3 watery stools/day) were systematically collected and analyzed toidentifyriskfactorsassociatedwithpooroutcome. Results:Atadmission592children(49%)haddiarrhoeaofwhich122(21%)diedcomparedto72/614(12%)deathsinthose without diarrhoea at admission (X2=17.6 p,0.001). A further 187 (16%) children developed diarrhoea after 48 hours of admissionand33died(18%).Anydiarrhoeaduringadmissionresultedinasignificantlyhighermortality161/852(19%)than thoseuncomplicatedbydiarrhoea33/351(9%)(X2=16.6p,0.001).Featuresassociatedwithafataloutcomeinchildren presenting with diarrhoea included bacteraemia, hyponatraemia, low mid-upper arm circumference ,10cm, hypoxia, hypokalaemia andoedema.Bacteraemia hadthehighestrisk ofdeath (adjusted OR6.1;95% C.I2.3,16.3p,0.001);and complicate