Diagnostic criteria for severe acute malnutrition and fatal outcomes in children aged 6-59 months, Nigeria.

Objective: To determine factors associated with inpatient death among a cohort of children aged 6-59 months with severe acute malnutrition in north-western Nigeria. Methods: Our observational study used routine programmatic data of all children aged 6-59 months admitted to two inpatient facilities in Katsina State with severe acute malnutrition in 2022. We assessed nutritional status at admission by weight-for-height z-score (WHZ), mid-upper-arm circumference (MUAC) and bilateral nutritional oedema using World Health Organization definitions. We used Cox-proportional hazard models to identify predictors of mortality, with and without adjustment for sex, age group, nutritional status at admission, major clinical complications and comorbidities. Findings: Of 12 771 children included in the analysis, we observed an overall inpatient mortality of 8.4%. Compared with children admitted by the MUAC criterion alone, we noted that children admitted by the WHZ criterion alone had twice the risk of death; children admitted with kwashiorkor and low WHZ had more than four times the risk. Older children with marasmus had a higher risk of death than younger children (adjusted hazard ratio: 1.74; 95% confidence interval: 1.50-2.03). We did not observe any significant association between stunting and mortality. Our findings were not altered by any of the complications or comorbidities recorded. Conclusion: Children with a low WHZ at admission have a higher risk of death than those with a low MUAC, and should be subject to special considerations when associated with oedema. MUAC alone is an insufficient criterion to identify all the children at risk of death from malnutrition.