Background: Severe acute malnutrition is a serious public health problem, and a challenge to clinicians. Why some\nchildren with malnutrition develop oedema (kwashiorkor) is not well understood. The objective of this study was to\ninvestigate socio-demographic, dietary and clinical correlates of oedema, in children hospitalised with severe acute\nmalnutrition.\nMethods: We recruited children with severe acute malnutrition admitted to Mulago Hospital, Uganda. Data was\ncollected using questionnaires, clinical examination and measurement of blood haemoglobin, plasma c-reactive\nprotein and ?1-acid glycoprotein. Correlates of oedema were identified using multiple logistic regression analysis.\nResults: Of 120 children included, 77 (64%) presented with oedematous malnutrition. Oedematous children were\nslightly older (17.7 vs. 15.0 months, p = 0.006). After adjustment for age and sex, oedematous children were less\nlikely to be breastfed (odds ratio (OR): 0.19, 95%-confidence interval (CI): 0.06; 0.59), to be HIV-infected (OR: 0.10,\nCI: 0.03; 0.41), to report cough (OR: 0.33, CI: 0.13; 0.82) and fever (OR: 0.22, CI: 0.09; 0.51), and to have axillary\ntemperature > 37.5�°C (OR: 0.28 CI: 0.11; 0.68). Household dietary diversity score was lower in children with\noedema (OR: 0.58, CI: 0.40; 85). No association was found with plasma levels of acute phase proteins, household\nfood insecurity or birth weight.\nConclusion: Children with oedematous malnutrition were less likely to be breastfed, less likely to have HIV\ninfection and had fewer symptoms of other infections. Dietary diversity was lower in households of children who\npresented with oedema. Future research may confirm whether a causal relationship exists between these factors\nand nutritional oedema.
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