{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T20:43:09Z","timestamp":1786999389453,"version":"build-2736575974"},"reference-count":51,"publisher":"Cambridge University Press (CUP)","issue":"10","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Nutr"],"published-print":{"date-parts":[[2021,5,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Severe acute malnutrition (SAM) is associated with a complex pattern of various clinical conditions. We investigated how risk factors cluster in children with SAM, the relationship between clusters of risk factors and mortality as well as length of stay in children with SAM. A prospective observational study design was used. Data were extracted from medical records of 601 infants and children aged 0\u201359 months admitted and treated for SAM in three Ghanaian referral hospital between June 2013 and June 2018. Among the 601 medical records extracted, ninety-nine died. Three clusters of medical features clearly emerged from data analyses. Firstly, an association was defined by eye signs, pallor, diarrhoea and vomiting with gastrointestinal infections and malaria. In this cluster, pallor and eye signs were related to 2- to 5-fold increased mortality risk. Secondly, HIV, oedema, fast pulse, respiratory infections and tuberculosis; among those features, HIV increased child mortality risk by 2-fold. Thirdly, shock, convulsions, dermatitis, cold hands and feet, weak pulse, urinary tract infections and irritability were clustered. Among those features, cold hands and feet, dermatitis, convulsions and shock increased child mortality risk in a range of 2- to 9-fold. Medical conditions and clinical signs in children diagnosed with SAM associate in patterns and are related to clinical outcomes.<\/jats:p>","DOI":"10.1017\/s0007114520003396","type":"journal-article","created":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:37:44Z","timestamp":1599007064000},"page":"1157-1165","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Mortality in relation to profiles of clinical features in Ghanaian severely undernourished children aged 0\u201359 months: an observational study"],"prefix":"10.1017","volume":"125","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0656-503X","authenticated-orcid":false,"given":"H.","family":"Asare","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Carboo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. D.","family":"Nel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. C.","family":"Dolman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Conradie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2457-6456","authenticated-orcid":false,"given":"M. J.","family":"Lombard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Ricci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"S0007114520003396_ref23","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2019.33.81.16245"},{"key":"S0007114520003396_ref39","doi-asserted-by":"publisher","DOI":"10.1179\/2046904714Z.000000000218"},{"key":"S0007114520003396_ref2","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980018003415"},{"key":"S0007114520003396_ref24","doi-asserted-by":"publisher","DOI":"10.4081\/jphia.2011.e30"},{"key":"S0007114520003396_ref15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a2180"},{"key":"S0007114520003396_ref47","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0140327"},{"key":"S0007114520003396_ref14","doi-asserted-by":"publisher","DOI":"10.1301\/nr.2003.marr.81-90"},{"key":"S0007114520003396_ref5","unstructured":"5. WHO & UNICEF (2018) The Extension of the 2025 Maternal, Infant and Young Child Nutrition Targets to 2030. https:\/\/www.who.int\/nutrition\/global-target-2025\/discussion-paper-extension-targets-2030.pdf?ua (accessed September 2019)."},{"key":"S0007114520003396_ref9","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12722"},{"key":"S0007114520003396_ref30","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/71.6.1582"},{"key":"S0007114520003396_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60937-X"},{"key":"S0007114520003396_ref17","unstructured":"17. WHO (2010) Improving the Inpatient Management of Severe Acute Malnutrition: Toolkit to Monitor Current Management of Severe Acute Malnutrition. http:\/\/www.who.int\/nutrition\/publications\/severemalnutrition\/Toolkit_to_monitor_current_SAM.pdf?ua=1 (accessed November 2017)."},{"key":"S0007114520003396_ref45","unstructured":"45. Trenor, SL (2018) Epidemiology of invasive bacterial infections in HIV-infected and HIV-uninfected children under 5 years of age in Soweto, South Africa between 1998 and 2005. PhD Thesis, University of the Witwatersrand."},{"key":"S0007114520003396_ref27","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-7-104"},{"key":"S0007114520003396_ref7","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3156.1998.00283.x"},{"key":"S0007114520003396_ref32","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.17-0130"},{"key":"S0007114520003396_ref10","doi-asserted-by":"publisher","DOI":"10.4103\/0970-2113.45198"},{"key":"S0007114520003396_ref18","unstructured":"18. WHO (2010) Improving the Inpatient Management of Severe Acute Malnutrition: Toolkit to Monitor Current Management of Severe Acute Malnutrition. https:\/\/www.who.int\/nutrition\/publications\/severemalnutrition\/Toolkit_to_monitor_current_SAM.pdf?ua=1 (accessed July 2020)."},{"key":"S0007114520003396_ref35","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2010.205039"},{"key":"S0007114520003396_ref4","unstructured":"4. Ghana Statistical Service & Ghana Health Service ICF International (2015) Ghana Demographic and Health Survey 2014. https:\/\/dhsprogram.com\/pubs\/pdf\/FR307\/FR307.pdf (accessed November 2019)."},{"key":"S0007114520003396_ref22","unstructured":"22. WHO (2013) Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK154447\/pdf\/Bookshelf_NBK154447.pdf (accessed July 2020)."},{"key":"S0007114520003396_ref28","unstructured":"28. Asare, H (2019) Associations of admission \u2013 and transfer criteria with clinical outcomes of infants (6\u201323 months) treated for severe acute malnutrition in Ghanaian referral hospitals \u2013 the SAMAC Study. MSc mini-dissertation, North-West University."},{"key":"S0007114520003396_ref8","doi-asserted-by":"publisher","DOI":"10.1080\/02724936.1995.11747744"},{"key":"S0007114520003396_ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.survophthal.2003.12.005"},{"key":"S0007114520003396_ref46","doi-asserted-by":"publisher","DOI":"10.1186\/s13690-018-0309-x"},{"key":"S0007114520003396_ref49","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/fmv100"},{"key":"S0007114520003396_ref40","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-13-204"},{"key":"S0007114520003396_ref11","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1186\/s12879-015-0952-6","article-title":"Prevalence of malnutrition among HIV-infected children in Central and West-African HIV-care programmes supported by the Growing Up Programme in 2011: a cross-sectional study","volume":"15","author":"Jesson","year":"2015","journal-title":"BMC Infect Dis"},{"key":"S0007114520003396_ref25","doi-asserted-by":"publisher","DOI":"10.1002\/1096-9071(200101)63:1<67::AID-JMV1010>3.0.CO;2-T"},{"key":"S0007114520003396_ref37","doi-asserted-by":"publisher","DOI":"10.4314\/mmj.v21i3.45645"},{"key":"S0007114520003396_ref44","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-018-0016-x"},{"key":"S0007114520003396_ref34","doi-asserted-by":"publisher","DOI":"10.31018\/jans.v10i1.1568"},{"key":"S0007114520003396_ref33","first-page":"62","article-title":"Prevalence of vitamin A deficiency among children of Lahore, Pakistan","volume":"6","author":"Fatima","year":"2018","journal-title":"Asian J Multidiscip Stud"},{"key":"S0007114520003396_ref51","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780111409"},{"key":"S0007114520003396_ref20","first-page":"307","article-title":"Extension of multiple range tests to group means with unequal numbers of replications","volume":"12","author":"Kramer","year":"1956","journal-title":"J Biom"},{"key":"S0007114520003396_ref50","first-page":"233","article-title":"Demographic, clinical profile of severe acute malnutrition and our experience of nutrition rehabilitation centre at children hospital Srinagar Kashmir","volume":"2","author":"Tariq","year":"2015","journal-title":"Int J Contemp Pediatr"},{"key":"S0007114520003396_ref48","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1976.25.229"},{"key":"S0007114520003396_ref6","doi-asserted-by":"publisher","DOI":"10.1097\/00005176-200105000-00011"},{"key":"S0007114520003396_ref26","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1046\/j.1365-3156.2003.01097.x","article-title":"Incidence and risk factors of paediatric rotavirus diarrhoea in northern Ghana","volume":"8","author":"Binka","year":"2003","journal-title":"Trop Med Int Health"},{"key":"S0007114520003396_ref12","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3156.2003.01043.x"},{"key":"S0007114520003396_ref41","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1179\/2046905514Y.0000000154","article-title":"Oedema in kwashiorkor is caused by hypoalbuminaemia","volume":"35","author":"Coulthard","year":"2015","journal-title":"Paediatr Int Child Health"},{"key":"S0007114520003396_ref42","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0171020"},{"key":"S0007114520003396_ref43","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0211628"},{"key":"S0007114520003396_ref29","unstructured":"29. University of Ghana, GroundWork, University of Wisconsin-Madison, et al. (2017) Ghana Micronutrient Survey 2017. http:\/\/groundworkhealth.org\/wp-content\/uploads\/2018\/06\/UoG-GroundWork_2017-GHANA-MICRONUTRIENT-SURVEY_Final_180607.pdf (accessed November 2019)."},{"key":"S0007114520003396_ref13","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.050342"},{"key":"S0007114520003396_ref36","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-015-0398-4"},{"key":"S0007114520003396_ref19","unstructured":"19. WHO (2018) WHO Anthro Survey Analyser and Other Tools. https:\/\/www.who.int\/childgrowth\/software\/en\/ (accessed November 2019)."},{"key":"S0007114520003396_ref21","unstructured":"21. Ashworth, A , Khanum, S , Jackson, A , et al. (2003) Inpatient Treatment of Severely Malnourished Children. http:\/\/www.who.int\/nutrition\/publications\/guide_inpatient_text.pdf (accessed July 2020)."},{"key":"S0007114520003396_ref16","doi-asserted-by":"crossref","first-page":"241","DOI":"10.11604\/pamj.2020.36.241.19584","article-title":"Evaluation of the treatment guidelines, practices and outcomes of complicated severe acute malnutrition in children aged 0\u201359 months in sub-Saharan Africa: a study protocol for the SAMAC study","volume":"36","author":"Carboo","year":"2020","journal-title":"Pan Afr Med J"},{"key":"S0007114520003396_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61698-6"},{"key":"S0007114520003396_ref38","doi-asserted-by":"publisher","DOI":"10.3329\/jhpn.v31i3.16516"}],"container-title":["British Journal of Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007114520003396","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T04:15:10Z","timestamp":1618805710000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007114520003396\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,2]]},"references-count":51,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2021,5,28]]}},"alternative-id":["S0007114520003396"],"URL":"https:\/\/doi.org\/10.1017\/s0007114520003396","relation":{},"ISSN":["0007-1145","1475-2662"],"issn-type":[{"value":"0007-1145","type":"print"},{"value":"1475-2662","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,2]]},"assertion":[{"value":"\u00a9 The Author(s), 2020. Published by Cambridge University Press on behalf of The Nutrition Society","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}