ArticleThe American journal of clinical nutrition2021
Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia.
Article in The American journal of clinical nutrition, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 5 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 5 syntheses or guidelines pooled it, 42 citations in OpenAlex.
- Prevalence and risk factors of under-five mortality due to severe acute malnutrition in Africa: a systematic review and meta-analysis.Systematic reviews · 2025Pooled it
- Effect of Fish-Based Diet on Malnourished Children: A Systematic Review.Iranian journal of medical sciences · 2024Pooled it
- Analysis of Postdischarge Interventions for Children Treated for Moderate or Severe Wasting, Growth Faltering or Failure, or Edema: A Systematic Review.JAMA network open · 2023Pooled it
- Post-discharge morbidity and mortality in children admitted with severe anaemia and other health conditions in malaria-endemic settings in Africa: a systematic review and meta-analysis.The Lancet. Child & adolescent health · 2022Pooled it
- Outcomes of people living with HIV after hospital discharge: a systematic review and meta-analysis.The lancet. HIV · 2022Pooled it
- High-dose vitamin DNature communications · 2025Trial
- Malnutrition enteropathy in Zambian and Zimbabwean children with severe acute malnutrition: A multi-arm randomized phase II trial.Nature communications · 2024Trial
- Death after discharge among children living with HIV admitted with suspected sepsis in Uganda: A secondary analysis of two prospective observational studies.HIV medicine · 2026Observational
- Intestinal Permeability Is Associated with Mortality and Readmission in Children Hospitalized with Severe Acute Malnutrition.The Journal of nutrition · 2026Observational
- Restoration of anti-bacterial innate immune cell function lags behind nutritional recovery among children convalescing from complicated severe acute malnutrition.Nature communications · 2026Article
- Structural and Hormonal Changes Associated With Starvation in Zambian Adult Patients With Esophageal Strictures: A Cross-Sectional Study.Health science reports · 2026Article
- Article
- Time to stabilization among under-five children with severe acute malnutrition in Ethiopia: a retrospective cohort study.BMC public health · 2025Article
- Long-term survival after therapeutic failure during hospitalization for severe acute malnutrition: Lwiro cohort follow-up in the Eastern Democratic Republic of the Congo.BMC nutrition · 2025Article
- Adaptive Responses in Severe Acute Malnutrition: Endocrinology, Metabolomics, Mortality, and Growth.Nutrients · 2025Review
- Article
- Addressing dual deficiencies of SAM indicators; gaps and insights from inpatient admission to outpatient discharge, in conflict-affected Yemen; a retrospective study.Conflict and health · 2025Article
- Child play and caregiver support to promote convalescence following severe acute malnutrition in Zimbabwe: The Tamba-SAM pilot study.Maternal & child nutrition · 2025Article
- Micronutrient status in children aged 6-59 months with severe wasting and/or nutritional edema: implications for nutritional rehabilitation formulations.Nutrition reviews · 2025Review
- Systemic biological mechanisms underpin poor post-discharge growth among severely wasted children with HIV.Nature communications · 2024Article
Corrections and comments
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Authors and funding
13 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundChildren discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk of mortality, especially HIV-positive children. Few studies have examined mortality in the antiretroviral therapy (ART) era.
objectivesOur objectives were to ascertain 52-wk mortality in children discharged from hospital for management of complicated SAM, and to identify independent predictors of mortality.
methodsA prospective cohort study was conducted in children enrolled from 3 hospitals in Zambia and Zimbabwe between July 2016 and March 2018. The primary outcome was mortality at 52 wk. Univariable and multivariable Cox regression models were used to identify independent risk factors for death, and to investigate whether HIV modifies these associations.
resultsOf 745 children, median age at enrolment was 17.4 mo (IQR: 12.8, 22.1 mo), 21.7% were HIV-positive, and 64.4% had edema. Seventy children (9.4%; 95% CI: 7.4, 11.7%) died and 26 exited during hospitalization; 649 were followed postdischarge. At discharge, 43.9% had ongoing SAM and only 50.8% of HIV-positive children were receiving ART. Vital status was ascertained for 604 (93.1%), of whom 55 (9.1%; 95% CI: 6.9, 11.7%) died at median 16.6 wk (IQR: 9.4, 21.9 wk). Overall, 20.0% (95% CI: 13.5, 27.9%) and 5.6% (95% CI: 3.8, 7.9%) of HIV-positive and HIV-negative children, respectively, died [adjusted hazard ratio (aHR): 3.83; 95% CI: 2.15, 6.82]. Additional independent risk factors for mortality were ongoing SAM (aHR: 2.28; 95% CI: 1.22, 4.25), cerebral palsy (aHR: 5.60; 95% CI: 2.72, 11.50) and nonedematous SAM (aHR: 2.23; 95% CI: 1.24, 4.01), with no evidence of interaction with HIV status.
conclusionsHIV-positive children have an almost 4-fold higher mortality than HIV-negative children in the year following hospitalization for complicated SAM. A better understanding of causes of death, an improved continuum of care for HIV and SAM, and targeted interventions to improve convalescence are needed.
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