Prevalence, factors associated and short term outcomes of children with selected electrolyte abnormalities aged 2-59 months admitted with acute watery diarrhoea at Mulago Hospital

Abstract

Worldwide, diarrhoeal diseases are a leading cause of death among children under the age of five years and contributing over 20% of deaths of children in this age group in developing nations. Diarrhoea is the second most common cause if illness in children under five years of age in Uganda. Rotavirus is the commonest cause accounting for 45.4% of all hospital admissions due to diarrhea in Uganda. Severe dehydration, electrolyte abnormalities and acid base disturbances are responsible for most of the mortality and morbidity due to acute diarrhoea. The current burden and outcome of electrolyte abnormalities among children with acute watery diarrhoea (AWD) at Mulago hospital are not well known.

Objectives: This study was aimed to determine the prevalence, associated factors and short term outcome of children with sodium and potassium electrolyte abnormalities among children aged 2-59 months with acute watery diarrhea admitted at Mulago hospital.

Methods: This was a hospital based cross sectional study with a longitudinal component of children ages 2 – 59 months presenting with acute watery diarrhoea at Mulago hospital. Participants were recruited consecutively as they presented at Acute Care Unit (ACU). A semi-structured questionnaire was used to obtain social demographic data and the clinical history. The physical examination and laboratory findings were recorded in the same tool. Blood samples were taken for a complete blood count, serum electrolytes and comorbidities like malaria and HIV. The participants were then followed until discharge or for a maximum of 7 days. Data were analysed in Stata version 14.1. The proportion with and types of electrolyte abnormalities were determined together with the factors associated with these. Categorical outcome variables were presented as percentages whereas continuous variables were presented as means/medians with their measures of dispersion as appropriate. Multi-variate analysis using binomial logistic regression was carried out to determine factors that were independently associated with electrolyte abnormalities.

Results: Out of the 163 participants enrolled, 83/163(51%) had at least one electrolyte abnormality. Hyponatraemia was the predominant electrolyte abnormality (43/163 (26%, (95% CI 20-34), followed by hypokalaemia (38/163 (23%, (95% CI 17 – 31). Having an HIV positive mother, being an infant and having a care taker attaining only primary education and below increased participant’s chances of having an electrolyte abnormality. Factors associated with hyponatraemia were age under 12 months (95%CI: 0.02, 0.34, P=0.001), capillary refill > 3 seconds, AOR=8.04, 95%CI: 1.56, 41.27, P= 0.013). In this study 5/163 (3%) of the children died, all deaths occurred in male participants and 4/5 were less than one year of age. Children who died were more likely to be hyponatraemic.

Conclusions: More than half of the children with acute watery diarrhoea presenting to Mulago hospital have electrolyte abnormalities and hyponatraemia is the leading abnormality. Factors associated with electrolyte abnormalities include: child in shock, being HIV exposed and low maternal education. Among children with acute watery diarrhoea, hyponatraemia and respiratory distress are associated with mortality.