SERUM-ALBUMIN CONCENTRATION, ARM CIRCUMFERENCE, AND EDEMA AND SUBSEQUENT RISK OF DYING IN CHILDREN IN CENTRAL-AFRICA

Objective-To measure the prognostic value of Clinical, anthropometric, and biological indicators of protein energy malnutrition in hospitali sed children. Design-Hospital based follow up study from admission to discharge or death of a cohort of children. Setting-Paediatric hospita l in Zaire. Subjects-1129 children consecutively admitted between Augu st 1986 and October 1988. Main outcome measures-Height, weight, arm ci rcumference, skinfold thicknesses, serum albumin concentration, and mo rtality. Results-Mortality was higher in wasted children and in those with a mid-upper arm circumference <125 mm, a serum albumin concentrat ion <16 g/l, and oedema. After multivariate analysis, serum albumin co ncentration was the best predictor of subsequent risk of dying. Mid-up per arm circumference and oedema, however, still contributed considera bly to evaluation of mortality. Conclusions-In this specific environme nt of central Africa an isolated clinical sign such as oedema is not e nough to detect children with a high risk of dying among those admitte d to paediatric wards with severe protein energy malnutrition. Measure ment of additional indicators such as arm circumference and serum albu min concentration seems to be of crucial importance.