The nutritional status of sick children seeking care at Kenyatta national hospital using the new who standards.

Abstract

Background: Despite malnutrition being the single most important potentiating factor in childhood morbidities and mortalities, it remains poorly diagnosed and managed. The diagnostic tool used in a facility is important because of differences in sensitivity and specificity. The new World Health Organization (WHO) growth charts rolled out in the year 2006 to be used for routine diagnosis of malnutrition are yet to be adopted at Kenyatta National Hospital (KNH) amongst other hospitals. Objectives: Primary objective: To determine the prevalence of malnutrition in children seeking care at KNH using the new WHO growth charts. Secondary objectives: 1. To determine the prevalence of malnutrition in children presenting with acute versus chronic illnesses. 2. To determine the socio-demographic, feeding and health factors associated with malnutrition in this population. Methods: A hospital based cross-sectional study done in the Pediatric Emergency Unit (PEU) at KNH. All eligible patients were administered a standardized structured questionnaire aimed at finding the socio-demographic, feeding and medical history. Height and weight were taken and converted to z scores and nutritional status analyzed in reference to the WHO standards. Results: 585 children were recruited into the study, 570 children were analyzed. The mean z scores for weight for age, weight for height and height for age were less than -1z score even when stratified by age except for the first 6 months. One third of the patients (33.3%) were malnourished (moderate 29.8%, severe 3.5%). None severe malnutrition accounted for 89.5% of the cases of malnutrition. Moderate wasting was slightly higher than underweight and stunting (27%, 20% and 20% respectively). A third of the children who were acutely ill and a quarter of the chronically ill were moderately malnourished. All the children with severe malnutrition were acutely ill. The acutely ill children were more likely to be moderately wasted (p=0.001) and so were the children who did not achieve the minimum dietary diversity (p=0.004). None of the other feeding indicators and the socioeconomic factors were significantly associated with malnutrition. Conclusion: Malnutrition is a major co morbidity in sick children seeking care at KNH PEU. Malnutrition starts within the first 6 months and is independent of age. For every one child diagnosed as severely wasted, 8.05 are moderately wasted. These cases need to be correctly diagnosed and managed.