Journal of Scientific Research & Reports 10(1): 1-12, 2016; Article no.JSRR.23095 ISSN: 2320-0227 SCIENCEDOMAIN international www.sciencedomain.org A Retrospective Study on Child Malnutrition in the Tamale Teaching Hospital, Ghana Williams Walana 1* , Samuel Ekuban Kwabena Acquah 1, Samuel Makinin 2, Mavis Sarfo 2, Abdul Bassit Muktar 2, Ezekiel Kofi Vicar 1, Ernestina Yirkyio 3, Mohammed Shaibu Osman 3, Alhasan Abdul-Mumin 4, Sylvanus Kampo 5, Iddrisu Baba Yabasin 6 and Juventus Benogle Ziem 1 1Department of Clinical Microbiology, University for Development Studies, Tamale, Ghana. 2Department of Nursing, University for Development Studies, Tamale, Ghana. 3Department of Nutrition, Tamale Teaching Hospital, Tamale, Ghana. 4Department of Paediatrics, University for Development Studies, Tamale, Ghana. 5Department of Anesthesia and Intensive Care, University for Development Studies, Tamale, Ghana. 6Department of Anesthesia, Tamale Teaching Hospital, Tamale, Ghana. Authors’ contributions Authors WW, SEKA and JBZ conceived, developed the study protocol and drafted the first manuscript. Authors EKV, SM, MS and ABM extracted the data for the study. Authors SK and IBY cleaned up and analyzed the data. Authors EY, MSO and AAM contributed in the drafting of the manuscript. All authors read and approved the final manuscript. Article Information DOI: 10.9734/JSRR/2016/23095 Editor(s): (1) Durjoy Majumder, Department of Physiology, West Bengal State University, India. (2) Shunpu Zhang, Department of Statistics, University of Nebraska – Lincoln, USA. Reviewers: (1) Mario Bernardo-Filho, Universidade do Estado do Rio de Janeiro, Brazil. (2) Isaac Kisiangani, Kenyatta University of Agriculture and Technology, Kenya. Complete Peer review History: http://sciencedomain.org/review-history/12986 Received 14 th November 2015 Accepted 31 st December 2015 Original Research Article th Published 15 January 2016 ABSTRACT Introduction: Malnutrition is an essential global public health challenge affecting millions of people. The burden of malnutrition is huge especially among children in developing countries and poverty stricken regions. Aims: This study investigated the distributions, co-morbidities, and admission outcomes among malnourished children in the paediatric ward of the Tamale Teaching Hospital, Ghana. Study Design: A retrospective health facility based study was employed. Place and Duration of Study: The study was conducted in the paediatric ward of the Tamale _____________________________________________________________________________________________________ *Corresponding author: E-mail: [email protected], [email protected]; Walana et al.; JSRR, 10(1): 1-12, 2016; Article no.JSRR.23095 Teaching Hospital, from May to June 2015. Data extracted covered the period March 2011 to March 2015. Methodology: Record books were manually reviewed and data on patients’ demography, nutritional status, clinical findings, co-morbid conditions, duration of admission and treatment outcomes were extracted using a structured excel template. Results: Out of a total 969 children admitted to the ward, 440 (45.4%) were females and 529 (54.6%) were males. Majority of the patients 537 (55.4%) were within the age bracket 7-24 months, with a mean age of 21.2±0.6 months. Approximately 95.3% of the children were severely malnourished. Treatment outcome were generally successful; 534 (58.6%) recovered and were referred to the outpatient clinic for further management, while 220 (23.7%) improved and were discharged. However, the total death rate for the period was 12.8% (119/927). Regarding duration of admission, majority 434 (45.7%) spent between 1-7 days on admission followed by 8-14 days 296 (31.2%). The commonest malnutrition related co-morbidity was malaria, recording 28.1% (236), followed by respiratory tract infections 12.7% (107), gastro-intestinal tract infections 12.0% (101), and sepsis 10.0% (84). Conclusion: The gradual increase in malnutrition cases recorded in the hospital suggests the existence of relatively high cases in the various communities within Northern Ghana. Thus scaling up community-based malnutritional interventions will be critical in ameliorating the challenges of malnutrition related admissions, particularly among children in the northern part of Ghana. Keywords: Malnutrition; co-morbidity; admission; Northern Ghana. DEFINITION OF TERMS Recovered: This describes patients who were well on discharge but needed continuation of complementary feeding. Such patients were referred to the outpatient clinic for periodic review until they are deemed fit by a nutritionist. Improved: This refers to patients who were declared fit by a nutritionist on discharge and did not need continuation of complementary food. Rare complications: This term is used to refer to infrequent diagnoses too few to stand alone during the analysis of the data. 1. INTRODUCTION According to the World Health Organization (WHO), malnutrition is to a large extent the major Malnutrition literally means "bad nutrition". It is contributor to child mortality in the world, subdivided into two major components, thus over currently present in half of all cases [6,7]. nutrition and under-nutrition [1]. The World Food Moreover, out of a population of about 842 Program (WFP) defines malnutrition as "a state million folks who have fallen short in terms of in which the physical function of an individual is access to adequate food, 146 million are children impaired to the point where he or she can no [8]. Among the types of malnutrition identified, longer maintain adequate bodily performance severe acute malnutrition (SAM) and moderate process such as growth, pregnancy, lactation, acute malnutrition (MAM) are the most common, physical work and resisting and recovering from recording approximately 20 million and 35 million diseases" [1,2]. Malnutrition is a pandemic cases yearly among children under five years victimizing a substantial group of people among respectively [8]. The majority of these cases the world’s population. Even though there exist occur in Sub Saharan Africa and Southern Asia. global efforts geared toward ameliorating the The Report of the Commission for Africa (2005) situation, it still remains a significant public health and Copenhagen Consensus (2008) recognized menace due to the chunk of people affected and malnutrition as the biggest challenge facing the the health implications it poses. Malnutrition has world [9]. The crises have been exacerbated by been attributed to poverty, big family size, under-investment in nutrition programs, and the ignorance, illiteracy, climate change, policy and effect is that child under-nutrition is now highly corruption [3]. In poor developing nations, prevalent in low income and middle income malnutrition is usually caused by food shortages, countries, resulting in a corresponding increase food prices and distribution, and inadequate in morbidity, mortality and overall disease burden breastfeeding [4,5]. [10]. It has been estimated that as many as 200 2 Walana et al.; JSRR, 10(1): 1-12, 2016; Article no.JSRR.23095 million children under 5 years old fail to reach services to the people in the Northern, Upper their full potential in cognitive development East, Upper West regions and the northern parts because of poverty, poor health and malnutrition. of the Brong -Ahafo Region. The hospital also This loss of human potential has been estimated serves patients from neighboring countries to result in a 20% deficit in adult income and including La Cote D’ivoire, Burkina Faso and have implications for national development [11]. Togo. In 2002, the Northern Regional Coordinating Council in partnership with the In spite of countless interventions, malnutrition Ghana Health Service (GHS) and Ministry of continues to thrive and remain a major public Health (MOH) upgraded the hospital to the status health concern in many developing countries of a Teaching Hospital. The upgrade was to help including Ghana. According to the Ghana with the training of health professionals from the demographic and health survey [12], there exist University for Development Studies. The hospital regional variations of malnutrition in Ghana, with runs six clinical departments including the some of the poorest indicators found in the paediatric unit which attends to children up to 14 Northern part of the country. A 32.4% prevalence years old. The ward has a nutrition unit that rate comparable to the national average of admits, treats and provides nutritional care for chronic cases of malnutrition was estimated for children with acute malnutrition. the northern region. Moreover, a survey conducted by the United Nations Children Fund 2.2 Study Design showed an increase in prevalence in chronic malnutrition rate from 32% to 37% between 2008 This retrospective health facility-based study was and 2011 [13]. Also, a cross-sectional descriptive conducted at the nutritional unit of the survey to determine the prevalence of department of paediatrics of the TTH, reviewing malnutrition in the Tamale metropolis discovered data spanning from March, 2011 to March, 2015. that, there was a 22.6% prevalence rate of The study population included all malnourished malnutrition among children below age five years children admitted and treated at the nutrition unit [14]. The northern region is among the poorest of the TTH. The hospital uses globally regions in Ghana and poverty is strongly standardized methods to screen and diagnose associated with malnutrition. It can therefore be malnutrition