Diagnosis and short term prognosis of malnutrition in adults in complex emergencies
The aim of this thesis is to identify the characteristics of malnourished adults at risk of imminent death during complex humanitarian emergencies (i.e. in need of intensive medical and nutritional treatment). I studied the anthropometric and clinical presentation of 2409 out-patients from Supplementary Feeding Centres (SFC) and 2500 in-patients from Therapeutic Feeding Centres (TFC) in Burundi and Congo. SFC patients were admitted with BMI below 17 kg/m2 and only received weekly food distribution. Those in TFC were admitted with BMI below 16 kg/m2 and received intensive medical and nutritional treatment. Overall, 9.7% of patients observed in SFC did not recover. Among those in SFC with BMI below 16 kg/m2, 570 (76.7%) recovered, including some with BMI below 13 kg/m2. BMI on admission is associated with outcome of treatment, but its ability to predict outcome is insufficient (positive predictive value 23.3%). MUAC is associated with outcome as well, but has a lower predictive ability than BMI. Symptoms of weakness (e.g. muscle hypotony), associated infection (e.g. fever and cough of more than one month) and malnutrition (typical skin lesions, sunken eyes), identified patients with a negative outcome of treatment. Logistic regression modelling showed the need to consider separately three groups of patients i) patients with malnutrition secondary to disease (suspicion of tuberculosis) ii) patients with stable weight, and iii) patients with active weight loss. Only the latter are equated to “Acute Malnutrition”. Among them, BMI and muscular hypotony identified patients in need of intensive treatment (“Sever Acute Malnutrition”). Low BMI or MUAC with stable weight are not absolute markers of risk of death in the short term. Patients with stable weight are equated to “Chronic Malnutrition”. In TFC, BMI and MUAC are good prognostic indicators, with the second identifying better patients with associated infectious disease. The clinical characteristics and the survival experience of patients in Congo approaches that expected in a population of patients with Acute Malnutrition, but not in Burundi. This suggests the presence in Burundi TFCs of important number of patients with Chronic Malnutrition or Moderate Acute Malnutrition, rather than Severe Acute Magnetron, and confirms findings in SFC. More than half of the deaths in TFC happened in patients with associated disease or malnutrition secondary to chronic disease, during the Rehabilitation phase of treatment.