Characteristics of severely malnourished under-five children hospitalized with diarrhoea, and their policy implications

Aim: Identify clinical and nutritional features, and complications among severely malnourished, under-five children in an urban diarrhoeal disease facility in Bangladesh. Methods: For this case-control design, children of both sexes, aged 0-59 months were studied. Severely (<-3 z-score) underweight, stunted or wasted constituted cases and those with better nutritional status (z-score >=-3) constituted controls. Results: During 2000-2005, of the total 6881 children, 1103 (16%) were severely underweight, 705 (11%) severely stunted and 217 (3%) severely wasted. In logistic regression analysis, severely underweight children were more likely to be older than 11 months (OR 3.7, 95% CI 3.1-4.3, p < 0.001), non-breastfed (OR 1.5, 95% CI 1.3-1.8, p < 0.001), have illiterate mothers (OR 2.6, 95% CI 2.2-3.0, p < 0.001), non-sanitary toilet (OR 1.4, 95% CI 1.2-1.6, p < 0.001), a history of measles in preceding 6 months (OR 1.7, 95% CI 1.3-2.4, p = 0.001), dehydrating diarrhoea (OR 1.9, 95% CI 1.6-2.2, p < 0.001), abnormal findings in lung auscultation (OR 1.7, 95% CI 1.3-2.3, p < 0.001) and require hospitalization >= 48 h (OR 2.2, 95% CI 1.8-2.5, p < 0.001). Conclusion: There thus is a need to incorporate appropriate, cost-effective and sustainable preventive strategies and improved management policies in the health systems as well as in social support systems in Bangladesh.