Skip to main content

Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique

  • Tacilta Nhampossa (a1) (a2), Betuel Sigaúque (a1) (a2), Sónia Machevo (a1) (a3), Eusebio Macete (a1) (a4), Pedro Alonso (a1) (a3), Quique Bassat (a1) (a5), Clara Menéndez (a1) (a5) and Victoria Fumadó (a5) (a6)...

To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years.


Retrospective study of hospital-based data systematically collected from January 2001 to December 2010.


Rural Mozambican district hospital.


All children aged <5 years admitted with severe malnutrition.


During the 10-year long study surveillance, 274 813 children belonging to Manhiça's Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6 % (17 188/274 813) with severe malnutrition. Of these, only 15 % (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7 % (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum community-based incidence rate was 15 cases per 1000 child-years at risk and children aged 12–23 months had the highest incidence.


Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique
      Available formats
Corresponding author
*Corresponding author. Email or
Hide All
1.Black RE, Cousens S, Johnson HLet al. (2010) Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375, 19691987.
2.Rajaratnam JK, Marcus JR, Flaxman ADet al. (2010) Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet 375, 19882008.
3.Morris SS, Cogill B & Uauy R (2008) Effective international action against undernutrition: why has it proven so difficult and what can be done to accelerate progress? Lancet 371, 608621.
4.UNICEF (2004). Millennium Development Goals: 1. Eradicate extreme poverty and hunger. (accessed October 2012).
5.World Health Organization (2005) Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Illnesses with Limited Resources. Geneva: WHO.
6.Bassat Q, Machevo S, O'Callaghan-Gordo Cet al. (2011) Distinguishing malaria from severe pneumonia among hospitalized children who fulfilled integrated management of childhood illness criteria for both diseases: a hospital-based study in Mozambique. Am J Trop Med Hyg 85, 626634.
7.Nhacolo A, Nhalungo D, Sacoor Cet al. (2006) Levels and trends of demographic indices in southern rural Mozambique: evidence from demographic surveillance in Manhica district. BMC Public Health 6, 291.
8.Guinovart C, Bassat Q, Sigauque Bet al. (2008) Malaria in rural Mozambique. Part I: children attending the outpatient clinic. Malar J 7, 36.
9.Gonzalez R, Munguambe K, Aponte Jet al. (2012) High HIV prevalence in a southern semi-rural area of Mozambique: a community-based survey. HIV Med 13, 581588.
10.Sigauque B, Roca A, Mandomando Iet al. (2009) Community-acquired bacteremia among children admitted to a rural hospital in Mozambique. Pediatr Infect Dis J 28, 108113.
11.Glisser M (editor) (1997) Normas Pediatricas. Maputo: Ministério da Saúde.
12.World Health Organization (2009) Handbook on Integrated Management of Childhood Illness (IMCI). Geneva: WHO.
13.Shann F (1993) Nutritional indices: Z, centile, or percent? Lancet 341, 526527.
14.Kuczmarski RJ, Ogden CL, Grummer-Strawn LMet al. (2000) CDC growth charts: United States. Adv Data issue 314, 127.
15.Cole TJ (1990) The LMS method for constructing normalized growth standards. Eur J Clin Nutr 44, 4560.
16.Suh JS, Hahn WH & Cho BS (2010) Recent advances of oral rehydration therapy (ORT). Electrolyte Blood Press 8, 8286.
17.World Health Organization (1999) Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Worker. Geneva: WHO; available at
18.World Health Organization (2003) Guidelines for the Inpatient Treatment of Severely Malnourished Children. Geneva: WHO; available at
19.Joosten KF & Hulst JM (2008) Prevalence of malnutrition in pediatric hospital patients. Curr Opin Pediatr 20, 590596.
20.Cartmell E, Natalal H, Francois Iet al. (2005) Nutritional and clinical status of children admitted to the malnutrition ward, Maputo central hospital: a comparison of data from 2001 and 1983. J Trop Pediatr 51, 102105.
21.Thakwalakwa C, Phuka J, Flax Vet al. (2009) Prevention and treatment of childhood malnutrition in rural Malawi: Lungwena nutrition studies. Malawi Med J 21, 116119.
22.Ashorn P, Phuka JC, Maleta Ket al. (2009) Undernutrition malnutrition in infants in developing countries. Arch Pediatr Adolesc Med 163, 186.
23.Bhutta ZA, Ahmed T, Black REet al. (2008) What works? Interventions for maternal and child undernutrition and survival. Lancet 371, 417440.
24.Fawzi WW, Herrera MG, Spiegelman DLet al. (1997) A prospective study of malnutrition in relation to child mortality in the Sudan. Am J Clin Nutr 65, 10621069.
25.Briend A & Bari A (1989) Breastfeeding improves survival, but not nutritional status, of 12–35 months old children in rural Bangladesh. Eur J Clin Nutr 43, 603608.
26.Dadhich JP & Agarwal RK (2009) Mainstreaming early and exclusive breastfeeding for improving child survival. Indian Pediatr 46, 1117.
27.Alvarez-Uria G, Midde M, Pakam Ret al. (2012) Effect of formula feeding and breastfeeding on child growth, infant mortality, and HIV transmission in children born to HIV-infected pregnant women who received triple antiretroviral therapy in a resource-limited setting: data from an HIV cohort study in India. ISRN Pediatr 2012, 763591.
28.Saloojee H, De Maayer T, Garenne MLet al. (2007) What's new? Investigating risk factors for severe childhood malnutrition in a high HIV prevalence South African setting. Scand J Public Health Suppl 69, 96106.
29.Kimani-Murage EW, Norris SA, Pettifor JMet al. (2011) Nutritional status and HIV in rural South African children. BMC Pediatr 11, 23.
30.Mandomando I, Macete E, Sigauque Bet al. (2009) Invasive non-typhoidal Salmonella in Mozambican children. Trop Med Int Health 14, 14671474.
31.Mandomando I, Sigauque B, Morais Let al. (2010) Antimicrobial drug resistance trends of bacteremia isolates in a rural hospital in southern Mozambique. Am J Trop Med Hyg 83, 152157.
32.Nyakeriga AM, Troye-Blomberg M, Chemtai AKet al. (2004) Malaria and nutritional status in children living on the coast of Kenya. Am J Clin Nutr 80, 16041610.
33.Muller O, Garenne M, Kouyate Bet al. (2003) The association between protein-energy malnutrition, malaria morbidity and all-cause mortality in West African children. Trop Med Int Health 8, 507511.
34.Fillol F, Sarr JB, Boulanger Det al. (2009) Impact of child malnutrition on the specific anti-Plasmodium falciparum antibody response. Malar J 8, 116.
35.Friedman JF, Kwena AM, Mirel LBet al. (2005) Malaria and nutritional status among pre-school children: results from cross-sectional surveys in western Kenya. Am J Trop Med Hyg 73, 698704.
36.Deen JL, Walraven GE & von Seidlein L (2002) Increased risk for malaria in chronically malnourished children under 5 years of age in rural Gambia. J Trop Pediatr 48, 7883.
37.Genton B, Al-Yaman F, Ginny Met al. (1998) Relation of anthropometry to malaria morbidity and immunity in Papua New Guinean children. Am J Clin Nutr 68, 734741.
38.Naniche D, Bardaji A, Lahuerta Met al. (2009) Impact of maternal human immunodeficiency virus infection on birth outcomes and infant survival in rural Mozambique. Am J Trop Med Hyg 80, 870876.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 20
Total number of PDF views: 509 *
Loading metrics...

Abstract views

Total abstract views: 530 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th November 2017. This data will be updated every 24 hours.