Clinical Determinants of Nutritional Deterioration among Children Under Five Years Admitted at Fort Portal Regional Referral Hospital, Western Uganda

Abstract

Background: Malnutrition among hospitalised children is closely intertwined with clinical status: underlying illness can raise nutrient requirements, promote inflammation, reduce intake, and increase nutrient losses, while poor nutritional status in turn compromises immunity. Despite this well-documented bidirectional relationship, few studies examine the specific clinical determinants of nutritional deterioration occurring after admission, as opposed to malnutrition already present at the point of admission. This study assessed the clinical determinants of nutritional deterioration among children under five admitted at Fort Portal Regional Referral Hospital (FPRRH), Kabarole District, Western Uganda.

Methods: A hospital-based prospective cohort study was conducted among 85 children under five years purposively selected from the general and surgical paediatric wards, who had spent a minimum of 72 hours on admission. Anthropometric measurements were taken at admission and after 72 hours, and children were classified by nutritional deterioration status. Clinical factors — history of exclusive breastfeeding, duration of hospital stay, history of vomiting, appetite/food tolerance, other co-morbidities, and immunization status — were assessed for association with deterioration using Pearson chi-square (likelihood-ratio χ²) tests at bivariate level; variables with p<0.2, or with strong biological plausibility, were entered into a multivariable Poisson regression model (also adjusted for relevant socio-demographic covariates reported separately) to estimate adjusted relative risks (RR) at 95% confidence and α=0.05.

Results: Overall, 18.8% (16/85) of children developed nutritional deterioration within the 72-hour follow-up period. At bivariate level, only immunization status was significantly associated with deterioration (LR χ²=9.549; p=0.008); history of vomiting approached significance (p=0.082). At multivariable level, children who had never been immunized had roughly sixty one times the risk of nutritional deterioration compared to those up-to-date with immunization (RR=61.388; 95% CI 1.264–2980.462; p=0.038). No significant association was found with history of exclusive breastfeeding, duration of hospital stay, appetite/food tolerance, or other co-morbidities.

Conclusion: Incomplete or absent immunization was the principal clinical determinant of nutritional deterioration identified in this study, increasing risk roughly sixty one fold. Strengthening childhood immunization coverage and caregiver education on its nutritional benefits should be prioritised alongside routine inpatient nutritional monitoring to reduce hospital-acquired nutritional decline.