Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Linda Arnold

Subject Area(s)

Medicine, Public health

Abstract

Background: In many resource-limited hospital settings, families struggle to pay for both food and medical expenses. To date, no study has looked at the nutritional status of pediatric inpatients in resource-limited countries or at factors related to food access in this vulnerable population.

Aims: This study investigates nutritional status and food intake of pediatric inpatients at Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda to identify children at risk for inpatient food insecurity.

Methods: Caregivers of patients > 6 months of age and hospitalized for at least 1 week completed a validated food diversity survey. Individual Food Consumption Scores (FCS) were calculated, reflecting diet quality and caloric intake. Weights charted on admission and at one week were converted to WHO weight-for-age z-scores (WAZ) for children <10 yrs of age as measures of nutritional status. WAZ, FCS, weight loss and changes in meal frequency were analyzed and compared between groups, and regression analysis was used to identify correlations.

Results: During a 6-week period from July-August 2013, anthropometric data was available for 40 children (mean age 4.6 years, SD 4.6), 33 of whom were < 10 years of age. WAZ scores on admission for 45% of this group fell equal to or greater than 2 SD below the mean, meeting WHO criteria for wasting. Over the first week of hospitalization, 55% of all children (n=40) lost weight, 37% gained and 8% had no change, with greater percentages of weight loss on the malnutrition ward (82% of n=11) and children <3 yrs of age (82% of n=22.) While dietary surveys for 80% of children (n=75) had FCS in the "acceptable" range, 53% reported eating fewer meals/day at the hospital compared to home, which correlated with greater home distance from CHUK.

Conclusions: Nearly half the children in our study met WHO criteria for wasting, and the majority lost weight and had decreased meal frequency during the first week of hospitalization. Our findings suggest very young children and inpatients on the malnutrition ward are at increased risk for weight loss during hospitalization, and children hospitalized farther from home at greater risk for food insecurity. Further study is needed to assess nutritional status and food intake among a larger sample over longer periods in order to better characterize the nutritional needs of these children.

Comments

This is an Open Access Thesis.

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