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  • Research Article   
  • J Paediatr Med Sur 2023, Vol 7(4): 237.
  • DOI: 10.4172/jpms.1000237

Prevalence and Associated Factors of Hypoglycemia among Sever Acute Malnourished Children Who Admitted in East Gojjam Zone Public Hospitals from 2018 to 2021, Northwest Ethiopia, 2022. Multi-Center Retrospective Cross Sectional Study

Mr. Yitayal Guadie Ashebir1*, Yohannes Godie2, Aster Tadesse2, Esmelalem Mihretu2 and Dires Birhanu2
1Department of Anesthesia (MSc in Advanced Clinical anesthesia), College of Health Science and Medicine, Debre Markos University, Debre Markos, Ethiopia
2Department of pediatric and Child Health, College of Health Science and Medicine, Debre Markos University, Debre Markos, Ethiopia
*Corresponding Author: Mr. Yitayal Guadie Ashebir, Department of Anesthesia (MSc in Advanced Clinical anesthesia), College of Health Science and Medicine, Debre Markos University, Debre Markos, Ethiopia, Email: guadyitu@gmail.com

Received: 02-Aug-2023 / Manuscript No. jpms-23-104005 / Editor assigned: 04-Aug-2023 / PreQC No. jpms-23-104005 / Reviewed: 18-Aug-2023 / QC No. jpms-23-104005 / Revised: 21-Aug-2023 / Manuscript No. jpms-23-104005 / Accepted Date: 28-Aug-2023 / Published Date: 28-Aug-2023 DOI: 10.4172/jpms.1000237

Abstract

Background: Globally, severe acute malnutrition (SAM) remains a major killer of children under 5 years of age. The highest magnitude is seen in sub-Saharan Africa, including Ethiopia. Hypoglycemia is the most common complication of severe acute malnutrition (SAM) and the most life-threatening condition in pediatric society. However, there is limited evidence from Ethiopia to assess the prevalence of hypoglycemia and associated factors among severely malnourished children. The aim of this study was to assess the prevalence of hypoglycemia and its associated factors among under-five children with severe acute malnutrition who were admitted to public hospitals in the East Gojjam zone.

Methods: A cross-sectional retrospective study was conducted from August 01 to 30/2022 among 378 randomly selected samples who admitted public hospitals in East Gojjam zone from 2018 to 2021. Data was extracted from the medical records of the children and entered into SPSS version 26, which analyzed it. Model goodness-of-fit was checked by the Hosmer and lemesho test. Variables with a p-value<0.25 in the Bivariate analysis were a candidate for multivariable logistic regression and those with a p-value<0.05 in the multivariable analysis were considered as having statistically significant association with hypoglycemia among sever acute malnutrition.

Result: Out of 378 respondents, 50 (13.2%) had hypoglycemia with sever acute malnutrition patient. Children admitted between the ages of 0-6 month were 2.93 (AOR = 1.57-6.25, p=0.000), shock were 4.6 (AOR = 1.25-17.42, p=0.034) and fully immunized children were (AOR: 2.61 (1.01- 6.77, p=0.048) was significantly associated with hypoglycemia with sever acute malnutrition.

Conclusion: The prevalence of hypoglycemia with severe acute malnutrition was 13.2%. Age between 0-6 month, shock and children fully immunized were statistically significant factors for hypoglycemia in severe acute malnutrition. We also recommend a longitudinal study should be done among children’s who develop hypoglycemia with sever acute malnutrition to determine the long-term consequences especially the neurodevelopmental sequelae associated with this condition.

Keywords

Severe acute malnutrition; Hypoglycemia under five children; Ethiopia

Introduction

At least one-third of all child fatalities worldwide are caused by malnutrition, which is a serious issue for global health. A state of abnormally low blood glucose levels is known as hypoglycemia. The definition of hypoglycemia varies within the scientific literature and across clinical practice but is defined by the WHO as RBS

The hippocampus is particularly sensitive to hypoglycemia and can lead to deficits in cognitive development, particularly with regard to working memory. Severe acute malnutrition (SAM) is thought to predispose children to develop either hypoglycemia. Low glycogen stores and wasting with reduced lean mass and adipose tissue reserves have been linked to hypoglycemia in SAM. In addition, hepatic glucose production has been found to be lower, especially in children with edematous SAM(11). he WHO guidelines on the inpatient treatment of SAM at nutritional rehabilitation units recommend small, 2–3 hourly feeds in the early stages of treatment to prevent episodes of hypoglycemia [1,2].

It is believed that children with severe acute malnutrition (SAM) are more likely to experience either hypo or hyperglycemia. Low glycogen stores and wasting with reduced lean mass and adipose tissue reserves have been linked to hypoglycemia in SAM. Hormonal changes with impaired insulin responses as well as impaired glucose clearance could potentially increase the risk of hyperglycemia in SAM. When compared to developed countries, hypoglycemia with SAM is a common health problem in developing countries. This is evident when visiting almost any hospital in a developing country, where severely malnourished children and hypoglycemia are likely to account for a significant proportion of pediatric mortality. Hypoglycemia with severe acute malnutrition is a common and serious condition that increases the mortality rate of children. Hypoglycemia in children with severe acute malnutrition can be easily treated and managed at a low cost, but there is a lack of awareness and materials in developing countries to assess hypoglycemia early in children with severe acute malnutrition. This study is intended to provide information and data on the prevalence of hypoglycemia among malnourished children admitted to health facilities. Such data is important for reassessing, evaluating, and reforming the policy. Reviewing previous studies on hypoglycemia in the malnourished yielded no clear and adequate data. The gap was addressed in this study. The goal of this study is to reduce morbidity and mortality associated with hypoglycemia caused by malnutrition and its risk factors [3].

Methods and Materials

Study design, area and period

A retrospective institutional-based cross-sectional study was conducted at public hospitals in the East Gojjam Zone from August 1 to August 30, 2022. This study was conducted at East Gojjam Zone public hospitals, Amara Region, Ethiopia. Debre Markos Town is the capital of the East Gojjam Zone, which is 254 kilometers away from Bahirdar, the capital of the Amhara National Regional State, and 304 kilometers away from Addis Ababa, the capital of Ethiopia. The study areas are Debre Markos Comprehensive Specialized Hospital, Lumamie Primary Hospital, and Bichena Primary Hospital. Debre Markos Comprehensive Specialized Hospital has a catchment area and five primary hospitals. The hospital provides care for around 5,000,000 of the population of Debre Markos town and its neighboring catchment area, and most of its patients come from the lower socioeconomic area; it admits 14 SAM patients per month. Lumamie primary hospital provides care for 154,612 of the population of Lumama town and has 3 SAM patients per month admitted to it. Bichena primary hospital provides care for around 522,000 of the population of Bichena town, including its catchment area, and had 5 SAM patients per month flow through it [4].

Eligible criteria and inclusion criteria

Under-five children admitted with SAM at the public hospital in East Gojjam Zone from 2018 to 2021 were included in this study. Children with incomplete data were excluded (i.e., outcome variable, age, sex, residence, routine medication, unknown admission and discharge date).

Sample size determination and sampling technique

Sample size determination

The sample size was determined using the single population proportion formula. The following assumptions were made: that the marginal error (d) on either side of the true proportion was 5%, that a 95% confidence level was used, P= In an Ethiopian study of children with SAM, hypoglycemia was found to be the most common comorbidity and complication on admission, affecting 8.8% of children admitted to the stabilize center at Gedo zone. In order to maximize precision in our study, we used the lowest possible margin of error (d) of 3%, or 0.03 [5].

Sampling procedure and technique

Under-five children with SAM admitted to public hospitals in East Gojjam Zone from 2018 to 2021 were obtained. Each year, the number of admitted children was counted. The medical record was extracted within the defined period, and a unique number was assigned. The samples were proportionally allocated for each year. Each year, the final sample size was determined using a simple random sampling method [6].

Variable of the study

Dependent variable: Hypoglycemia with SAM Independent variable: socio-demographic and admission status (age, sex, residence, history of TB contact and presence of edema, appetite test, admission criteria). Comorbidity (diarrhea, cough/pneumonia, malaria, sepsis, superficial infection (skin or ear infection), severe anemia, fever, HIV/AIDS, vomiting, hypothermia, hyperthermia)

Operational definition

Hypoglycemia: occurs when the random blood sugar level falls below 54 mg/dL.

SAM: the presence of nutritional edema (bilateral pitting edema) or severe wasting (MUAC < 11.5 cm or a WFH < -3 z-score [WHO standards]) in children > 6 months old.

New admission: patients who are directly admitted to inpatient care to start the nutritional treatment.

Defaulted: SAM cases that are signed (by parents on behalf of their child) against treatment to leave treatment before cure or lost for 2 consecutive days with unknown status

Relapse: If that patient has ever been severely malnourished before and cured.

Marasmic-kwash: SAM cases with both edema and severe wasting [7].

Data collection tool and procedure

Data collection has been done using a structured data extraction format accomplished by reviewing children’s medical record charts and the HMIS log book. After carefully observing the medical records of the children an appropriate data extraction checklist was made. The questionnaire was developed in English and used to collect data after being pre-tested before the study period. A modification of the questionnaire was made based on the pre-test. Socio-demographic characteristics, medical comorbidities, and treatment are given and follow-up characteristics of the study subject in the course of treatment of hypoglycemia with SAM. The data collection tools were adapted from several different related studies of hypoglycemia with SAM. Four BSc nurses working in the malnutrition center were collected for the data by reviewing children’s medical record charts and the HMIS log book [8].

Data quality control

The data was extracted by staff nurses working in malnutrition centers who were familiar with the malnutrition follow-up form. Two days of introductions about the objectives, significance, and variables of the research, and how to extract the data by using the data extraction tools were given to four data collectors and two supervisors. To assess the consistency of the data extraction tools, a pretest was performed on approximately 5% of the charts at Dejen Primary Hospital. The data collection process was closely monitored by the supervisors and the principal investigator for its completeness and consistency [9].

Data analysis technique

Data was checked for its completeness and consistency, then entered into SPSS and analyzed. SPSS 25 version statistical software was used for cleaning, coding, and analysis. Descriptive statistics were computed for categorical variables. The primary outcome variable was categorized as "0" for without hypoglycemia individuals and "1" for hypoglycemia with SAM individuals. The goodness-of-fit of the model was checked by the Hosmer–Lemeshow test. After checking the multi-collinearity and interaction terms, each independent variable with a p-value 10].

Result

Socio-demographic characteristics

From 2018 to 2021, 378 under-five patients with severe acute malnutrition were admitted to East Gojjam zone Public Hospitals, with a 100% response rate. Out of 378 children, 240 were male (63.5%). In total, 308 (81.5%) of the respondents were aged 6-59 months; additionally, the majority of the children came from 250 rural (66.1%) homes, and half of the Marasmus respondents, 192 (50.8%), were 131 (34.7%). The 378 SAM children had a mean weight of 6.21 kg (SD = 4.61) and a mean height or length of 72.28 cm (SD = 13.8) at admission. (Table 1)

Characteristics Category Frequency n=378 Percentage (%)
Sex Male 240 63.5
  Female 138 36.5
Age 0-6 month 70 18.5
  6-59 month 308 81.5
Residence Urban 128 33.9
  Rural 250 66.1
Clinical Classification Only edema (kwa

Characteristics
Category Frequency  n=378 Percentage (%)
Sex Male 240 63.5
  Female 138 36.5
Age 0-6 month 70 18.5
  6-59 month 308 81.5
Residence Urban 128 33.9
  Rural 250 66.1
Clinical Classification Only edema (kwashiokor) 131 34.7
of SAM Only wasting (weight for height)    
  or marasmus 192 50.8
  Both edema & wasting    
  (marasmus-kwashiokor) 55 24.3
Admission criteria Bilateral pitting edema 92 24.3
  (any grade)    
  WFH15641.3
  Severe wasting (MUAC    
  7118.8
  Edema + severe    
  Wasting + complication 59 15.6
Grade of no edema 164 43.4
nutritional edema Grade 1 or + 106 28
  Grade 2 or ++ 74 19.6
  Grade 3 or +++ 34 9
MUAC at admission 30881.5
in mm Not indicated 70 18.5
Admission status New 268 70.9
  Repeated 43 11.4
  Return after defaulter 67 17.7
Appetite test Pass 48 12.7
at admission Fail 330 87.3
Exclusive breast No 139 36.8
Feeding Yes 239 63.2
shiokor)
131 34.7
of SAM Only wasting (weight for height)    
  or marasmus 192 50.8
  Both edema & wasting    
  (marasmus-kwashiokor) 55 24.3
Admission criteria Bilateral pitting edema 92 24.3
  (any grade)    
  WFH15641.3
  Severe wasting (MUAC    
  7118.8
  Edema + severe    
  Wasting + complication 59 15.6
Grade of no edema 164 43.4
nutritional edema Grade 1 or + 106 28
  Grade 2 or ++ 74 19.6
  Grade 3 or +++ 34 9
MUAC at admission 30881.5
in mm Not indicated 70 18.5
Admission status New 268 70.9
  Repeated 43 11.4
  Return after defaulter 67 17.7
Appetite test Pass 48 12.7
at admission Fail 330 87.3
Exclusive breast No 139 36.8
Feeding Yes 239 63.2

Table 1: Socio-demographic and admission information on enrolment of children with SAM treated by therapeutic center under-five children admitted East Gojjam zone public hospitals from 2018 to 2021, Ethiopia, 2022. (n=378).

Medical comorbidities

There was no found hypoglycemia in 261 (69%) of the 378 SAM patients who presented, and 50 (13.2%) had found hypoglycemia with SAM. During admission, all but one of the respondents (346 out of 91.5) had comorbidity. (Table 2)

Characteristics Category Frequency n=378 Percentage (%)
Had the child comorbidities? No 32 8.5
  Yes 346 91.5
  No comorbidity 32 8.5
Different comorbidity Hyperthermia (temp >37.5 oc) 20 5.3
  Hypothermia (temp10026.5
  Diarrhoea 90 23.8
  Cough or pneumonia 35 9.3
  Malaria 5 1.3
  Vomiting 62 16.4
  Sepsis 11 2.9
  superficial infection (skin or ear) 4 1.1
  Severe anaemia 10 2.6
  HIV/AIDS 3 0.8
  Others 6 1.6
Types of diarrhoea No diarrhoea 302 79.9
  Watery diarrhoea 60 15.9
  Dysentery 10 2.6
  Other 6 1.6
Degree of dehydration no dehydration 300 79.4
  some dehydration 70 18.5
  severe dehydration 8 2.1
Level of consciousness Normal 105 27.8
  Altered 273 72.2
Shock No 359 95
  Yes 19 5
Failure to treatment No 335 88.6
  Yes 43 11.4
TB No 368 97.4
  Yes 10 2.6
Types of TB has no TB 368 97.4
  Pulmonary TB 6 1.6
  Other 4 1.1

Table 2: Distribution of hypoglycaemia and other medical comorbidities under-five children with SAM admitted East Gojjam zone public hospitals from 2018 to 2021, Ethiopia, 2022. (n=378).

Treatment given and follow up characteristics

East Gojjam Zone Public Hospitals used the national guideline for SAM Ethiopia inpatient treatment protocol for treatment given and follow-up characteristics of under-five children with SAM. Due to that, those under-five children admitted to the SAM room took different types of routine medication at admission, such as ampicillin and gentamicin (41.8%), amoxicillin (22.7%), and Albendazole or Mebendazole (8.7%). (Table 3)

Characteristics Category Frequency Percentage (%)
does the child had given routine medication No 7 1.9
  Yes 361 95.5
  Not indicated 10 2.6
Type of routine medication not indicated for medication 10 1.1
  Amoxicillin 84 22.2
  Ampicillin & Gentamicin 158 41.8
  Vitamin A 5 1.3
  Albendazole/mebendazole 33 8.7
  folic acid 30 7.9
  Anti-malaria 3 0.8
  measles vaccination 24 6.3
  Others 37 9.8
child who had given zinc tab No 320 84.7
  Yes 20 5.3
  Not indicated 38 10.1
Immunization status fully immunized 250 66.1
  up to date 70 18.5
  not yet immunized 58 15.3
Child had fever No 20 5.3
  Yes 358 94.5
Child had given special IV medication No 25 6.6
  Yes 353 93.4
Child had given special IV medication No 0 0
  Yes 353 93.4
Types of IV medication had not taken special IV medication 0 0
  Blood 10 2.6
  IV fluid 70 18.5
  IV anti-biotic 293 77.5
  Others 5 1.3

Table 3: Distribution of treatment given and follow up characteristic under-five children with SAM admitted East Gojjam zone public hospitals from 2018 to 2021, Ethiopia, 2022. (n=378).

About 66.1% of under five children were fully immunized. (Figure 1) In terms of the prevalence of hypoglycemia among 378 patients studied, 50 (13.2%) were SAM patients. (Figure 2)

journal-paediatric-status

Figure 1: Immunization status of under-five children with SAM admitted east Gojjam zone public hospitals from 2018 to 2021, Ethiopia, 2022. (n=378).

journal-paediatric-hypoglycemia

Figure 2: Prevalence of hypoglycemia with severe acute mal nutrition among under-five children who admitted East Gojjam public hospitals from 2018 to 2021, Ethiopia, 2022. (n=378).

Factors associated with hypoglycemic among severe acute malnutrition

In the bivariate analysis, sex, age, residence, admission status, MUAC at admission, Appetite test at admission, shock, failure to treatment, TB, child who had given ReSoMal, type of IV medication and immunization status were associated with significant variables. In contrast, age, shock and children fully immunized were significantly associated with hypoglycemia among SAM in multivariate logistic regression analysis (P-value less than 0.05).

Age was significantly associated with hypoglycemia with SAM; children admitted between the ages of 0-6 months were 5.9 times more likely than those admitted between the ages of 6 and 59 months to develop hypoglycemia [AOR: 5.92 (2.41–14.52, p=0.000)]. Children who had shock were 4.4 times more likely than those who did not have shock to develop hypoglycemia among SAM [AOR: 4.35 (1.12– 16.91, p = 0.034)]. Children who had fully immunized were 2.6 times more likely than those who did not have yet immunized to develop hypoglycemia among SAM (AOR: 2.61 (1.01- 6.77, p=0.048) (Table 4).

Variable (n=378) Category Hypoglycemia with   Binary regression p- value Multivariate regression P- value
    SAM( n=50)          
    Yes No COR (95%CI)   AOR (95%CI)  
Sex Male 143(59.8%) 96(40.2%) 3.77(2.22-6.42) 0 1.71(0.78-3.75) 0.185
  Female 118(84.9%) 21(15.1%) 1   1  
Age 0-6 month 21(30.0%) 49(70.0%) 8.24(4.62-14.68) 0 5.92(2.41-14.52) 0
  6-59 month 240(77.9%) 68(22.1%) 1   1  
Residence Urban Rural 77(60.2%) 51(39.8%) 1.85(1.18-2.90) 0.008 1.61(0.79-3.28) 0.193
    184(73.6%) 66(26.4%) 1   1  
MUAC at admission in mm 233(75.6%)75(24.4%0.22(0.13-0.37)00.69(0.25-1.87)0.462
  Not indicated 28(40.0%) 42(60.0%) 1   1  
Admission status New 191(71.3%) 77(28.7%) 0.56(0.32-0.98) 0.041 0.77(0.32-1.84) 0.55
  Repeat 31(72.1%) 12(27.9%) 0.54(0.24-1.23) 0.142 0.71(0.21-2.36) 0.573
  Return P defaulter 39(58.2%) 28(41.8%) 1   1  
Appetite test at admission Pass 24(50.0%) 24(50.0%) 2.55(1.38-4.71) 0.003 0.72(0.28-1.87) 0.497
  Fail 237(71.8%) 93(28.2%) 1   1  
Shock Yes 256(71.3%) 103(28.7%) 6.96(2.44-19.82) 0 4.35(1.12-16.91) 0.034
  No 5(26.3%) 14(73.7%) 1   1  
Immunization status fully immunized 168(65.6%) 88(34.4.4%) 0.91(0.49-1.69) 0.765 2.61(1.01- 6.77) 0.048
  up to date            
  not yet immunized 60(85.7%) 10(14.3%) 0.29(0.12-0.69) 0.006 0.55(0.17-1.75) 0.313
    33(63.5%) 19(36.5%) 1   1  
Child who had given ReSoMal No 186(64.6%) 102(35.4%) 2.74 (1.49-5.02) 0.001 1.19(0.56-2.59) 0.644
  Yes 75(83.3%) 152(16.7%) 1   1  
Failure to treatment No 14(3.7%) 86(22.8%) 0.58 (0.30-1.12) 0.103 0.69(0.25-1.92) 0.48
  Yes 36(9.5%) 242(64.0%) 1   1  
TB No 252(68.5%) 116(31.5%) 4.14 (0.52-33.08) 0.18 2.14(0.24-18.72) 0.492
  Yes 9(90.0%) 1(10.0%) 1   1  
Types of IV medication Blood 8(80.0%) 2(20.0%) 0.06(0.00-0.92) 0.043 0.06(0.00- 1.15) 0.062
  Iv fluid 52(74.3%) 18(25.7%) 0.09(0.00-0.83) 0.033 0.29(0.02-3.88) 0.348
  IV antibio 200(68.3%) 93(31.7%) 0.12(0.01-1.05) 0.056 0.13(0.01-1.58) 0.109
  Others 1(20.0%) 4(80.0%) 1   1  

Table 4: Factors associated with hypoglycaemia under five SAM children who was admitted East Gojjam public hospitals from 2018 to 2021, Ethiopia, 2022. (n=378).

Key 1= Reference

* Statistically significant by COR at p-value ≤0.25

**Statistically significant by AOR at p-value <0.05

Discussion

In this study, a total of 378 sampled retrospective data records were reviewed, and the prevalence of hypoglycemia was 13.2% (95% CI: 0.1- 0.17). The study is lower than the study conducted in India (21.9%).

Again, there was retrospective bias, and only 27% of patients had a blood glucose recorded in this system within 4 hours of admission WHO standards. In our study, 50 of 378 (13.2%) SAM patients were admitted to three hospitals, including the East Gojjam Zone Public Hospital, for a retrospective study. A study conducted in Kenya examined the utility of the WHO protocol for a retrospective study of children with SAM and discovered a prevalence of hypoglycemia of 13.6%, This might be due to differences, in hospital facilities; skills of professionals, adherence to management protocol, the severity of cases, and comorbidity attributed to these variations.

The magnitude of hypoglycemia with SAM in our study was 13.2%, which is higher than the previous study in Ethiopia, Children with SAM who had hypoglycemia made up 8.8% of those admitted to the Gedo Zone. The prevalence of hypoglycemia in SAM patients with comorbid pneumonia was 35 (9.3%) in this study, 14.3% in the previous study in Ethiopia and in Malawi 7 out of 176 (4%) SAM patients were recorded to have hypoglycemia in the first 24 hours of admission based on an electronic medical records database. The other study showed a retrospective analysis of case notes, relying on hypoglycemia being recognized and tested for; the prevalence of hypoglycemia was therefore likely underestimated based on observational data ranging from 1.3% to31%.

Children admitted between the ages of 0 and 6 months were 3 times more likely than those admitted between the ages of 6 and 59 months to develop hypoglycemia. This might be because the ages of 0 and 6 months of life are extremely important for the growth and development of children. And it is a time when most malnutrition cases occur because it is a transition time from exclusive breastfeeding to complementary feeding.

Children who had shock were 5 times more likely than those who did not have shock to develop hypoglycemia among SAM. This finding was similar with previously conducted studies in Ethiopia Gedeon Zone and Mozambique of which shock was identified as the main determinant of death. This is because children with SAM are highly at risk of shock secondary to severe infections and diarrheal diseases, which can cause either hypovolemic or septic shocks. Besides, severe sepsis and diarrheal diseases in malnourished children might be associated with low cardiac reserves, leading to shock, which leads to death. Another possible explanation for the high fatality rate among children who got IV fluids is that the IV fluids prescribed to the children throughout the research period may not have adequately corrected their shock. This would be consistent with a study that compared the use of half-strength Darrow's solution with the use of the isotonic solution in children with SAM and reported inadequate shock correction in all study arms, leading to a decision to end the trial early.

Children who had been fully immunized were 3 times more likely than those who did not have yet been immunized to develop hypoglycemia among SAM. Malnourished children consequently stand to gain a great deal from vaccination, but given that it is the most prevalent immunodeficiency in the world, they may not be able to respond to immunizations as well as they could. Given that recurrent infections contribute to the pathophysiology of the illness, immunization may be essential for preventing malnutrition. The 10 greatest evidence-based nutrition-specific interventions are thought to minimize stunting by just 20%, highlighting the necessity for additional strategies, including as infection control, to prevent growth failure in infancy. However, it is difficult to pinpoint the specific contribution of vaccination. Multi-sectorial interventions have proven the most successful in lowering the prevalence of stunting. Immunizations against one disease are unlikely to have a large impact on growth; rather, it is becoming more and more obvious that a combination of therapies is required to combat malnutrition.

This study revealed that children with SAM are at risk of hypoor hyperglycemia, and hypoglycemia relates to clinical outcomes like mortality. Give emphasis to screening hypoglycemia in SAM patients with regard to treating and preventing hypoglycemia. As this is a hospital-based secondary data analysis, further prospective studies are needed to identify the prevalence of hypoglycemia and risk factors for severe acute malnutrition in children.

Abbreviations

DMCSH: Debre Markos Compressive Specialized Hospital, MRN: Medical registered number, MG/DL: Milligram per deciliter, RBS: Random blood sugar, RCT: randomize control trial, SAM: Sever acute malnutrition, SC: Stabilize centre, SPSS: Statistical package for social science, and WHO: World Health Organization

Availability of data and materials

The data and other documents used in this study are available from the corresponding author.

Competing Interests

The authors declare that they have no conflict of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author’s contribution

YG, AT, YG , EM and DB: conceptualization, methodology, data entry, data cleaning, data analysis, writing the original draft, validation, tool evaluation, methodology, reviewing, and editing. Finally, all authors approved the manuscript.

Acknowledgment

We would like to thank Debre Markos University, the College of Health Science, and the Department of Pediatrics and Child Health Nursing for their support in the preparation of this study. Hospital employees who allow any data collection from the hospitals recorded review. Finally, thank you, data collectors and supervisors.

Ethical consideration

The study was conducted after receiving ethical approval from the research and ethics committee of the Debre Markos University Department of Pediatrics and Child Health Nursing. Before actual data collection, permission was taken from Debre Markos Referral Hospital, Lumamie Primary Hospital, and Bichena Primary Hospital's chief executive officer. In addition to that, written informed consent was obtained from the study participant. Finally, the outcome was communicated to the clinician so that the patient could be treated. They were given the chance to ask any questions about the study and were free to refuse or stop the questionnaire at any time they wanted.

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Citation: Ashebir YG, Godie Y, Tadesse A, Mihretu E, Birhanu D (2023) Prevalence and Associated Factors of Hypoglycemia among Sever Acute Malnourished Children Who Admitted in East Gojjam Zone Public Hospitals from 2018 to 2021, Northwest Ethiopia, 2022. Multi-Center Retrospective Cross Sectional Study. J Paediatr Med Sur 7: 237. DOI: 10.4172/jpms.1000237

Copyright: © 2023 Ashebir YG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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