Browsing by Author "Thomas, Aldona EC."

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    The influence of parental immigration status on outcomes of children with severe acute malnutrition at Worcester Provincial Hospital
    (Stellenbosch : Stellenbosch University, 2022, 2021-12) Thomas, Aldona EC.; Slogrove, Amy; Nel, Etienne De la Rey; Engelbrecht, Arnold; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Background: Severe acute malnutrition (SAM) accounts for ±30% of in-hospital deaths in South Africa. Children of immigrants with vulnerable legal status are also vulnerable to malnutrition as they have limited economic rights and are excluded from national social interventions. As there is often a perception that children of immigrant parents with SAM do worse than other children, this study aimed to evaluate the relationship between parent immigrant status and outcomes of children with SAM admitted to Worcester Provincial Hospital (WPH), a rural regional hospital in the Western Cape. The primary objective was to compare in-hospital outcomes of children with SAM who had immigrant parents with those who had South African parents. The secondary objectives were: 1) to estimate the proportion of children admitted with SAM whose parents were immigrants; 2) to describe socio-economic, nutritional and medical characteristics associated with severe acute malnutrition. Methods: A retrospective cohort study of children <5 years with SAM, admitted to WPH, between 01 June 2015 and 30 June 2017 was conducted. Participants were identified from the dietician and ward registers. SAM was defined as WHO weight-for-height Z-score below minus 3 or the presence of nutritional oedema or severe wasting with a MUAC less than 11.5cm (19,20). Hospital records and regional dietician’s notes were used to determine outcomes including in-hospital death, recurrent admission and discharged without readmission. Results: A total of 109 children were admitted to WPH with SAM, 14 (13%) were excluded due to missing records, resulting in a final sample of 95 children. Thirty one children (33%) were children of immigrant parents and 64 (67%) were children of South African parents. Median (interquartile range) age at admission was 12 (8-18) compared to 10 (8-13) months in children of South African and immigrant parents respectively. No significant difference was seen in the age or HIV status of immigrant compared to South African mothers. There was no difference between groups in preterm delivery, breastfeeding practices, concurrent illness, duration of hospital stay or number of previous admissions. However, 24 (38%) children of South African parents had low birth weight in comparison to 3 (10%) children of immigrant parents. No children of immigrant parents received a child support grant in comparison to 29 (45%) South African children. Sixty one (95%) children of South African parents were discharged well compared to 23 (74%) children of immigrant parents (p=0.005). In-hospital deaths occurred in 6 (19%) and 3 (5%) children of immigrant and South African parents respectively. One specific deeply impoverished neighbourhood accounted for 52/95 (51%) children admitted with SAM and 24/31 (77%) children of immigrant parents. By multivariable analysis correcting for possible factors associated with child mortality there was an at least four times greater odds of in-hospital SAM-associated mortality among children of immigrant compared to South African parents. Conclusion: In this rural setting, 33% of children admitted with SAM were of immigrant parents and experienced in-hospital SAM-associated mortality at least four times higher than children of South African parents. This was despite no difference in birth weight, gestational age and breastfeeding exposure, suggesting a role for socioeconomic factors associated with migration and vulnerability of children of immigrant parents.