Date of Award
8-2022
Document Type
Dissertation
Degree Name
Master of Medicine (MMed)
First Supervisor/Advisor
Sean Del-rossi Quadros
Second Supervisor/Advisor
Anthony Ngugi
Third Supervisor/Advisor
Naomi Gachara
Department
Paediatrics and Child Health (East Africa)
Abstract
Background: Congenital heart disease (CHD) is the commonest birth defect. Children with CHD have a high burden of undernutrition and its consequences. Some of the factors that are associated with undernutrition in children with CHD include the type and complexity of the heart defect, associated pulmonary hypertension, late diagnosis, timing of surgical correction, low socioeconomic status, lack of adequate nutritional support, associated genetic conditions and the presence of other clinical comorbidities.
Justification: Although these factors are well defined, they vary geographically in their distribution and extent to which they influence the level of undernutrition. This limits the extrapolation of findings from one setting to another. This information will help identify and prioritize management of those patients who are at a higher risk of developing undernutrition and its clinical consequences.
Objectives: The objective of this study was to establish the prevalence of undernutrition and its association with the type of CHD and the provision of nutritional support among children with CHD. The secondary objective was to establish the association between undernutrition and pulmonary hypertension, socio-demographic factors, patient comorbidities, age at diagnosis, presence and timing of surgical intervention in children with CHD.
Methods: This was both a descriptive and an analytical cross-sectional study that was conducted at three tertiary care hospitals in Nairobi, Kenya; The Aga Khan University Hospital, Nairobi, Kenyatta National Hospital and Mater Misericordiae Hospital. The study was conducted between July 2021 and March 2022 and recruited 242 children aged 1 month to 18 years who were diagnosed with CHD. The nutritional status was assessed using the relevant WHO standard Z-scores. Undernutrition included any child who had at least one indicator of stunting, wasting, underweight or thinness. Associations between the nutritional outcome and the key factors of interest was performed using univariate logistic regression analysis. Variables with a p-value iv <0.2 at bivariate analysis were subjected to multivariate logistic regression analysis. Any factor with a p-value ≤0.05 was considered statistically significant.
Results: There were 116 children that were undernourished giving a prevalence of 47.9% (95% CI: 41.5%-54.4%). Among those who were undernourished, 35.5% (n=86) were underweight, 25.6% (n=62) were wasted, 17.4% (n=42) were stunted and 8.3% (n=20) had thinness. In the multivariate analysis, children who were undernourished were 2.8 times more likely to receive nutritional support than those who were well nourished (p=0.001,OR: 2.88; 95% CI:1.57-5.34). The cyanotic type of CHD was not significantly associated with undernutrition (p=0.847, OR:0.94; 95% CI: 0.48-1.84). Children with co-ocurring comorbidities were 3.2 times more likely to be undernourished (p<0.001, OR: 3.26; 95% CI:1.61-6.84). Other factors that were not statistically significantly associated with undernutrition included sociodemographic factors, presence of pulmonary hypertension, surgical correction of defect, age at diagnosis.
The prevalence of undernutrition is high among children with CHD. Children who were undernourished were more likely to receive nutritional support than those who were well nourished. This reiterates the importance of the need to advocate for early adequate nutritional support for all children with CHD regardless of their nutritional status. The type of CHD had no significant association with undernutrition therefore both the cyanotic and acyanotic group should be given equal priority during nutritional management. Children with comorbidities were more likely to be undernourished. This highlights the need to identify these children early and prioritize their care during follow up. We additionally recommend a similar study that will utilize growth charts specific to some of the comorbidities such as Downs syndrome and prematurity.
Recommended Citation
Yahya, S. (2022). Prevalence and factors associated with undernutrition among children with congenital heart disease at three tertiary hospitals in Nairobi, Kenya. (Unpublished master's dissertation). Aga Khan University, East Africa.