Mortality outcome of hospitalized children aged six to fifty-nine months in relation to different anthropometric indices: an observational cohort study

Praveen Kumar, Abner Daniel, Rajesh Kumar Sinha, Virendra Kumar, Anju Seth, Harish Pemde, Srikanta Basu, Jagdish Chandra, Arjan de Wagt


Background: Malnutrition among children is a major public health problem and an underlying cause of millions of child deaths across the globe. The WHO has provided criteria for identifying malnourished children aged 6-59 months however, these criteria have not been fully evaluated against the risk of in-patient mortality. The observational study was conducted to assess the predictability of in-patient mortality of children aged 6-59 months for different anthropometric criteria to understand which diagnostic criteria most accurately predict in-patient mortality.

Methods: Data from a cohort of children aged 6-59 months, admitted to Kalawati Saran Children’s Hospital, New Delhi between January to October 2019 was analysed. The effect of anthropometric indexes, individually and in combinations, to predict in-patient mortality was assessed using cox regression survival analysis and receivers operating characteristics curves.

Results: A total of 3101 children aged 6-59 months were admitted, of which 123 (4.0%) died in the hospital. Among them, 30.1% were severely underweight, 19.3% were severely wasted and 23.0% were severely stunted. WHZ<˗3 and/or MUAC<115 mm was the most sensitive predictor of mortality (sensitivity: 75.0%; specificity: 42.3%; PPV: 6.5%; NPV: 96.9%; AUC: 0.59, 95% CI: 0.53-0.64) with the largest adjusted hazard ratio (aHR=1.53; p value <0.05).

Conclusions: WHZ<˗3 and/or MUAC<115 mm was the most sensitive predictor out of all individual and combined anthropometric indexes in identifying children aged 6-59 months at risk of mortality. Children in this category should be properly managed during their inpatient stay.


Children aged 6-59 months, In-patient mortality, Malnutrition, Mid-upper-arm-circumference, Weight-for-height z-score

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