| dc.description.abstract | Introduction: Diarrhoea is the second commonest cause of under-five mortality globally
(second to Pneumonia) and kills one (10 percent) out of every 10 children who die before their
fifth birthday. In Zambia dehydration due to diarrhoea is a leading cause of morbidity and
mortality among under-five children. Hypernatraemic dehydration is the most dangerous and
fatal form of dehydration. Despite the availability of well known effective treatment modalities
for dehydration in diarrhoea, mortality remains high in many developing countries. The situation
is not any different in Zambia and at The University Teaching Hospital (UTH) Department of
Paediatrics. In view of the high mortality of children due to diarrhoea, it is not known whether
hypernatraemic dehydration could be a significant contributing factor. This study therefore
sought to determine the prevalence and outcome of hypernatraemic dehydration as a possible
contributing factor to the high mortality rate among children with diarrhoea.
Objective
To determine the prevalence and outcome of hypernatraemic dehydration among under-five
children presenting with diarrhoea associated dehydration to UTH Department of Paediatrics.
Method: The study was a prospective cohort study conducted at the UTH Department of
Paediatrics. The study population was under-five children presenting with acute diarrhoea with
dehydration. Independent variables were age, sex, feeding modality, prior ORS therapy, rotavirus
vaccine status and serum sodium. The dependent or outcome variables were discharge/mortality
and duration of hospital stay. Data analysis was done with the help of SPSS version 20.
vi
Results: There were a total of 148 participants with an almost 1:1 male/female ratio (73/75),
mean age of 14.7 months ranging 1-60 months. The prevalence of hypernatraemic dehydration
was approximately 19 percent (29/148) among children presenting with diarrhoea and
dehydration. The prevalence is within the range of 10-20 percent cited in many previous studies,
however relatively higher than most previous studies done in other countries. Hypernatraemia
was associated with a high risk of mortality (7/29) with an OR 5.8 (adjusted OR 3.6, 95% CI 2.9-
8.0, p 0.002), compared to (7/74) OR 1.8 (adjusted OR 1.1, 95% CI 0.8-2.2, p 0.06), and (5/33)
OR 3.1 (adjusted OR 2.3, 95% CI 1.7-4.4, p 0.03) for normal and low initial sodium level
respectively. Hypernatraemia was also associated with longer hospital stay with a mean duration
of 3.09 days (74.2hrs) compared to 2.01 days (48.2 hours) and 2.13 days (51.1 hours) for normal
and low sodium respectively.
Conclusion: Hypernatraemia is prevalent among under-five children presenting with diarrhoea
at UTH department of peadiatrics and probably a major contributing factor to high diarrhoeal
associated mortality. Recognition of its occurrence through diligent laboratory services is
therefore critical for appropriate patient care.
Key words: Under-five years, diarrhoea, dehydration, and hypernatraemia. | en |
