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Clinical outcome of febrile Tanzanian children with severe malnutrition using anthropometry in comparison to clinical signs

Tan, Rainer and Kagoro, Frank and Levine, Gillian A. and Masimba, John and Samaka, Josephine and Sangu, Willy and Genton, Blaise and D'Acremont, Valérie and Keitel, Kristina. (2020) Clinical outcome of febrile Tanzanian children with severe malnutrition using anthropometry in comparison to clinical signs. American journal of tropical medicine and hygiene, 102 (2). pp. 427-435.

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Official URL: https://edoc.unibas.ch/75656/

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Abstract

Children with malnutrition compared with those without are at higher risk of infection, with more severe outcomes. How clinicians assess nutritional risk factors in febrile children in primary care varies. We conducted a post hoc subgroup analysis of febrile children with severe malnutrition enrolled in a randomized, controlled trial in primary care centers in Tanzania. The clinical outcome of children with severe malnutrition defined by anthropometric measures and clinical signs was compared between two electronic clinical diagnostic algorithms: ePOCT, which uses weight-for-age and mid-upper arm circumference to identify and manage severe malnutrition, and ALMANACH, which uses the clinical signs of edema of both feet and visible severe wasting. Those identified as having severe malnutrition by the algorithms in each arm were prescribed antibiotics and referred to the hospital. From December 2014 to February 2016, 106 febrile children were enrolled and randomized in the parent study, and met the criteria to be included in the present analysis. ePOCT identified 56/57 children with severe malnutrition using anthropometric measures, whereas ALMANACH identified 2/49 children with severe malnutrition using clinical signs. The proportion of clinical failure, defined as the development of severe symptoms by day 7 or persisting symptoms at day 7 (per-protocol), was 1.8% (1/56) in the ePOCT arm versus 16.7% (8/48) in the Algorithm for the MANagement of Childhood illnesses arm (risk difference -14.9%, 95% CI -26.0%, -3.8%; risk ratio 0.11, 95% CI 0.01, 0.83). Using anthropometric measures to identify and manage febrile children with severe malnutrition may have resulted in better clinical outcomes than by using clinical signs alone.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Household Economics and Health Systems Research > Household Economy (Fink)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Medicine (MED) > Clinical Research (Reither)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Former Units within Swiss TPH > Management of Fevers (D'Acremont)
UniBasel Contributors:Tan, Rainer and Levine, Gillian and Genton, Blaise and D'Acremont, Valérie and Keitel, Kristina
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Williams and Wilkins
ISSN:0002-9637
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:05 Mar 2020 12:13
Deposited On:05 Mar 2020 12:13

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