Ionic Disorders Observed in Infants with Severe Wasting at the Yalgado Ouedraogo Teaching Hospital and the Charles de Gaulle Pediatric Teaching Hospital in Ouagadougou, Burkina Faso ()
1. Introduction
In Burkina Faso, according to the final report of the SMART 2020 survey, the prevalence of acute malnutrition, chronic malnutrition and severe wasting at the national level were respectively 9.1% (including 1.0% in severe form), 24.9% and 17.6% [2] .
Severe physio-pathological disorders (hydroelectrolytic disorders) are associated with emaciation. They are the subject of a medical emergency and require rapid and effective treatment. In Burkina Faso, these troubles are poorly studied. Thus, through this study, we propose to evaluate the factors associated with ionic disorders occurring in wasting in infants aged 6 to 24 months hospitalized at the Yalgado Ouedraogo Teaching Hospital (YO-TH) and at the Charles De Gaulle Pediatric Teaching Hospital (CDG PTH). These centers have a Center for Recovery and Nutritional Education (CRNE).
2. Patients and Methods
2.1. Type and Study Site
This was a cross-sectional study with a descriptive and analytical aim; the retrospective collection of which took place from January 1, 2016 to December 31, 2020. The study concerned all infants aged 6 to 24 months hospitalized in Teaching Hospitals Charles De Gaulle and Yalgado Ouedraogo suffering from severe emaciation (low weight/height ratio) and having carried out an extensive complete blood ionogram during hospitalization.
2.2. Data Analysis and Processing
The sociodemographic variables were age, sex, anthropometric data, place of residence and motive for consultation. The biological variables explored were sodium, potassium, chloride, calcium, magnesium, phosphorus, bicarbonate and total protein ions.
Data collected on a questionnaire were entered from Microsoft Office Excel 2013 software and analyzed with Epi-InfoTM 7 software in version 7.2.0. Bivariate regression analyses were performed to establish a statistical relationship between the variables. For bivariate analysis, measures of association such as Odds Ratio and p-value were performed. The significance level was p < 0.05. Before the beginning of the study, authorization to collect data was obtained from the management of CDG-PTH and YO-TH. Data confidentiality was maintained throughout the study.
3. Results
3.1. Socio-Demographic Characteristics
Our study included 125 at YO-TH and 146 at CDG-PTH (Figure 1).
In total, we included 271 infants aged 6 to 24 months in the study. The characteristics of the study population are presented in Table 1. The mean age of
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Figure 1. Distribution of infants with severe acute wasting by hospital center.
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Table 1. General characteristics of the study population.
the infants were 14.48 ± 5.44 months with 42.07% of them in the age range of [12 - 18] months. On admission to the hospital, the children had a mean weight of 6.22 ± 1.32 kg and a height of 0.73 ± 0.07 m. Children were from urban settings 56.46% and the main motives for consultation were fever (88.19%), vomiting (52.80%) and diarrhea (50.20%).
3.2. Ionic Disorders in Wasted Children
The mean values of blood ionogram parameters of severely malnourished children are presented in Table 2.
Electrolyte disturbances in severely emaciated children affected all 8 parameters of the blood ionogram (Figure 2). The major disorders were hyponatremia (65.68%), hypobicarbonataemia (55.35%), hypoprotidemia (41.33%) and hypokalaemia (32.47%) in infants aged 6 to 24 months.
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Table 2. Mean values of blood ionogram parameters in severely malnourished children.
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Figure 2. Frequency of ionic disorders in severely emaciated infants (N = 271).
3.3. Bivariate Analysis
In terms of factors associated with ionic disorders, we found that hypokalemia was statistically associated with diarrhea (OR = 3.44; 95% CI: 1.99 - 5.94, p-value = 0.000) (Table 3).
In addition, rural residence (urban or rural), was significantly associated with
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Table 3. Sociodemographic characteristics and reasons for consultation associated with hypokalemia in univariate.
hypochloremia in infants (OR = 2.07; 95% CI: 1, 18 - 2.64, p-value = 0.010) (Table 4).
4. Discussion
The aim of the present study was to investigate disturbances in blood ionograms in infants 6 to 24 months with severe wasting at YO-TH and CDG-PTH. The
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Table 4. Sociodemographic characteristics and reasons for consultation associated with hypochloremia in univariate analysis.
main limit in this study was the retrospective data collection with high risk of missing data. Despite this, we were able to include 271 emaciated infants.
The mean age of the infants was 14.48 ± 5.44 months and the 12 - 18-month age group was most affected by severe acute undernutrition (42.07%). This age group is also found in Mali with 49.4% [3] and in Burkina with 51.8% [4] . This high frequency of severe emanciation in this group could be explained by the fact that it is the weaning period for infants therefore food can be insufficient (quantitatively and qualitatively) to cover the growth needs, thus causing nutriments deficiencies and immunodeficiency with a high risk of infections which, in turn, aggravate undernutrition.
The major ionic disorders were hyponatremia (65.68%), hypobicarbonataemia (55.35%), hypoprotidemia (41.33%) and hypokalaemia (32.47%) in infants aged 6 to 24 months. The high frequency of hyponatremia, hypobicarbonatemia, hypoprotidemia and hypokalaemia is reported by several authors in Guinea [5] , India [6] [7] [8] [9] and in Pakistan [10] . Emaciated infants have profound physiological disturbances, particularly electrolyte imbalances and poor fluid distribution. This modification of the distribution of fluids influences the concentrations of several ions hence hyponatremia, hypokalemia, hypobicarbonatemia, hypoprotidemia [11] . Sodium, chloride and bicarbonate are the main ions contributing to the osmolality of extracellular fluid. Bicarbonate is the major ion that regulates the pH of extracellular fluid. The concentrations of individual ions influence the properties and behavior of excitable membranes such as nerve cells and the performance of many intracellular enzymes.
In undernutrition conditions, serum electrolytes do not reflect body content but only circulating concentration. Thus, high serum potassium leads to intracellular potassium deficiency while low serum sodium masks sodium overload, but correction of these disorders is important in the immediate treatment of life-threatening situations [12] . A reduction in bicarbonate levels occurred more often in infants with prolonged deterioration and undernutrition.
A significant association was found between hypokalemia and diarrhea. In severe acute malnutrition with diarrhea, there is a significant risk of fluid and electrolyte disturbances, especially with hyponatremia, hypokalemia and metabolic acidosis [13] . In infants, diarrhea continues to be a serious problem that can be fatal when added to undernutrition.
Place of residence was statistically associated with hypochloremia. Infants in the rural area were the most susceptible to hypochloremia. This could be explained by a deficit in chloride intake that could be observed in infants receiving chloride-deficient breastmilk substitutes or linked to excessive gastrointestinal and renal losses [14] .
5. Conclusion
This study demonstrated the extent of major fluid electrolyte disturbances in emaciated infants aged 6 to 24 months. Also, it showed the association of two factors, namely diarrhea and residence which were respectively associated with hypokalemia and hypochloremia. It is concluded that ionic disorders in emaciated infants become evident in the presence of diarrhea and vomiting.
Prospective cohort follow-up studies will shed more light on the factors associated with metabolic disorders in this 6-to-24-month age group.
Funding
This study did not receive any specific funding from public, commercial, or nonprofit funding agencies.
Acknowledgments
Realization of this work benefited from the invaluable support of several people, including of our elders by their accompaniments (Dr. F. Soudre, Dr. C. Yonaba, Dr. A. Kiba, Dr. R. Karfo, Dr. O. Da) and that our masters with their precious advice (Prof. Elie Kabre and Prof. Jean Sakande). May these people find here the expression of my greatest gratitude.