Skip to main content
Download PDF
  • Systematic review update
  • Open access
  • Published:

Prevalence and risk factors of under-five mortality due to severe acute malnutrition in Africa: a systematic review and meta-analysis

Systematic Reviews volume 14, Article number: 29 (2025) Cite this article

Abstract

Background

Despite a global drop of under-five mortality by 59% between 1990 and 2019, it remains high in Low- and Middle- income Countries (LMICs)with a preponderance in Sub-Saharan Africa (SSA), Southern and Central Asia. Besides preterm and intrapartum complications, undernutrition contributes 45% of the deaths in these developing regions. In Africa, under-five mortality due to severe acute malnutrition (SAM) has stagnated at 10–40%, higher than WHO targets and the SDGs projections.

Methods

We searched MEDLINE (via PubMed), Scopus, Web of Science, Science direct, Google Scholar, Cochrane Library and Open Grey databases for literature reporting under-five mortality due to SAM in Africa from 2014 to 2024. Estimates of the primary and secondary outcomes were pooled using a random-effects meta-analysis due to the anticipated between study heterogeneity.

Results

Fifty-two out of 82 studies (63.4%) analyzed reported an overall under-five mortality of 11% (95%CI: 0.08–0.13). Diarrheal diseases, human immunodeficiency virus (HIV) and pneumonia were the three most frequently reported risk factors associated with mortality by 21 (40.1%), 20 (38.5%), and 14 (26.9%) studies, respectively. No significant regional variation was found.

Conclusion

Under-five mortality due to SAM in Africa is still high as reported in the included studies. There were no regional variations. Diarrheal diseases, HIV and pneumonia were the most frequently reported risk factors associated with under-five mortality due to SAM in Africa.

Peer Review reports

Introduction

According to UNICEF, a child born in SSA is on average 18 times more likely to die before their fifth birthday than their counterparts in other developed regions like Australia and New Zealand, whilst the risk of death for under-five in the highest-mortality country is 80 times that of the lowest-mortality country [1]. Overall, Under-five mortality declined by 60% from 93 deaths per 1000 live births between 1990 and 2022 to 37 deaths per 1000 live births in 2022. However, about 13,400 children under-five years still die daily from preventable causes which is unacceptably high [2]. This burden has remained prevalent mainly in the low- and middle-income regions of the world. More than 80% of the reported 5.2 million under-five deaths in 2019 were from SSA and Southern and central Asia [3]. Globally, Africa has the highest under-5 mortality rates. Data from the continent shows that 1 child in 13 dies before reaching five years of age, placing it 20 years behind the world average which achieved a 1 in 13 rate in 1999 [3]. Roser Max (2023) on his ‘Our World in Data’ web report, noted that amidst significant global improvements in childhood survival, for children up-to 15 years of age, from 50% to an impressive 96%, Africa, specifically SSA, still records the highest mortality rates of between 10 and 20% as compared to world regions with the lowest rates of between 0 and 5% [4]. This trend in under-five mortality in SSA is projected to even get worse if no interventions are put in place. Child population groups in low- and middle-income regions are growing and data already shows a worsening mortality trend in SSA from 31% in 1990 to 58% in 2021 [5]. This continues to diminish the possibility of achieving the Sustainable Development Goals (SDGs) Target 3.2 that aims to end preventable deaths of newborns and children under five years old by 2030 in all countries in the world. Since 1990, 163 out of 200 countries in the globe reduced their under-five mortality by half with 38 out of the 95 countries (40%) that reduced this mortality by two thirds being in the low- or lower-middle-income countries [6]. This suggests that focusing on the preventable causes of death in this age group can significantly reduce the mortality rates even in the resource-constrained regions of the world. In fact, the 2022 World Health Organization (WHO) report identified three African countries; Nigeria, DR Congo and Ethiopia among the five countries in the world where half of all the under-five deaths in 2020 occurred [7] representing West, Central and East African regions respectively.

Aside from preterm birth and intrapartum complications, acute malnutrition (undernutrition) has been found to underlie up to 45% of under-five mortality [8, 9]. Malnutrition is a term that incorporates both under and over nutrition. Undernutrition describes wasting, stunting, underweight, inadequate vitamins or minerals while over nutrition includes overweight, obesity, and resulting diet-related non-communicable diseases [10]. This review focused on children under five years old who are undernourished as it accounts for nearly half of their deaths in the LMICs [10]. Children with severe acute malnutrition are at a higher risk of death from infectious diseases like malaria, meningitis, diarrhea, pneumonia, tuberculosis and other infectious diseases as compared to their well-nourished counterparts. Severe acute malnutrition in these children is associated with chronic periods of ill-health with intermittent hospitalizations which often results in significant morbidity and mortality [9]. Diagnosis of malnutrition is made by assessing the child’s anthropometric measurements ( Mid Upper Arm Circumference (MUAC) and Weight-for-Height Z (WHZ) score) or by physically assessing for bilateral pitting oedema also known as “Kwashiorkor” or severe wasting also known as “Marasmus” [11]. As per WHO diagnostic criteria, a child between the ages of 6 to 59 months is diagnosed with SAM if their MUAC is < 115 mm or their WHZ score is calculated to be ≤ −3 SD. For moderate malnutrition, the MUAC cut off is 115 mm to 124 mm or a WHZ of > −3 SD to ≤ −2 SD [11]. The cause of malnutrition in children is usually multi-factorial and is one of the important preventable causes driving the high under-five mortality.

Rationale

Children under five years in Sub-Saharan Africa have been identified to carry the highest burden of the overall global under-five mortality. Despite the reported impressive decline of under-five mortality rates in other regions of the world by up to 59% in the preceding two decades in 2019, the mortality rates in this region have remained high. This study aimed to provide the current status of under-five mortality due to SAM in Africa by conducting a systematic review of the studies done in Africa from 2014 to 2024. The results also serve as a measure of child health in this region as well as gauge the achievement of the sustainable development goal (SDG)−3.2 which aims to end preventable deaths of under-five and lower the mortality to at least 25 per a thousand live births for all countries by 2030.

Methods

Protocol registration

Before searching the databases for articles and records, a protocol that described the research processes was developed. It stipulated the databases to be searched, study eligibility criteria and the methodology to be followed through to the final analysis. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to guide the reporting of the results of this systematic review and meta-analysis. The protocol for this review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform, registration number CRD42024504966.

Eligibility criteria

The eligibility (inclusion and exclusion) criteria of studies were defined in advance in the protocol. Observational studies published in the peer-reviewed literature were eligible for inclusion. Studies were included if they reported mortality related to SAM and /or its prevalence in children aged 0 to 59 months in Africa, had a sample size of 300 or more, were published between 2014 and 2024, and were in English. A sample size of 300 and above is usually considered a reliable rule-of-thumb when the researcher does not know the true effect size and it is often used to produce accurate results in prevalence studies [12].

Information sources

Literature was searched from the following electronic databases; MED-LINE (via PubMed), Cochrane Library (including the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and Scopus. The Open Grey database was searched for gray literature. A hand-search of reference lists of included studies was conducted to source additional studies.

Search strategy

A study search strategy was developed with the guidance of a health sciences subject matter librarian. Search strings were designed to be sensitive to terms and keywords related to SAM and under-five mortality outcomes. The search was restricted by applying filters to retrieve studies published from 2014 to 2024. A pilot of the search strategy was conducted in PubMed thereafter an optimized search strategy was adapted for other databases each time applying appropriate search syntaxes specific to each database.

Selection process

Search outputs retrieved from the databases were transferred to Microsoft Excel database for duplicate records removal. Two reviewers (JK and PK) independently screened titles and abstracts of every unique record retrieved from the search for eligible studies. Following title and abstract screening, full texts of potentially eligible studies were selected for full-text assessment. Discrepancies were resolved through discussion to reach a consensus. The screening process is as outlined in the PRISMA flow diagram, Fig. 1.

Fig. 1
figure 1

PRISMA flow diagram for included studies, databases searched, registers and other sources

Full size image

Data extraction process

After two reviewers independently screened titles, abstracts, and full texts of studies identified as eligible as per the protocol’s inclusion and exclusion criteria, the two reviewers (JK and PK) then independently extracted data from included studies and evaluated their quality. Data was then extracted into a pre-designed data extraction form in Microsoft Excel, cleaned and exported for analysis in STATA statistical software from Stata Corp, version 15.

Data items

Data items extracted included: (i) study characteristics; study title, author identification, year of publication, study design, study participants and sample characteristics, Place where the study was conducted, (ii) Study objectives and outcomes; study main findings, SAM prevalence and mortality rates reported, study limitations and study conclusion.

Risk of bias assessment

Studies meeting the inclusion criteria were assessed for quality using the Hoy quality Assessment tool [13]. The tool is appropriate for assessing the quality of studies reporting prevalence data. Two reviewers independently undertook the quality of studies assessments. Discrepancy in the quality of a study assessed by two reviewers was resolved through discussion before arriving at a consensus.

Effect measures

The prevalence of deaths due to SAM among under-five children were computed and a synthesis of the risk factors associated with under-five mortality due to SAM done.

Data synthesis methods

Pooling of the prevalence of mortality due to SAM among under-five children reported by different studies using random effects models due to high heterogeneity among the included studies was done. Heterogeneity was assessed in the meta-analysis using Higgins & Thompson’s I2 Statistic with significance defined at 10% α-level. I2 statistics of between 25% and less than 50% was considered low heterogeneity. I2 statistics of between 50% and less than 75% was considered moderate heterogeneity and I2 statistics of greater than 75% was considered substantial heterogeneity [14]. Results for the pooled estimates were presented in forest plots while results of individual studies are shown in tables.

Data analysis

Meta-analysis was conducted to pool primary and secondary outcomes reported by studies meeting the review’s inclusion criteria. Estimates were pooled using a random-effects meta-analysis due to the anticipated between study heterogeneity. The random-effects model assumed that the effect estimates followed a normal distribution, considering both within-study and between-study variation. Forest plots were generated to illustrate primary outcome findings graphically. Meta-analysis was performed using the metaprop command in STATA version 15.

Study selection process

From 3 databases searched, 2189 records were retrieved. 22 duplicate records were excluded after merging the records from the 3 databases. After duplicate title and abstract screening, 1939 records were excluded because they did not meet the review’s inclusion criteria. 220 articles were retrieved for full text screening. 8 articles were not found for retrieval. After full-text screening, 82 original research articles met the inclusion criteria and were included in the final analysis. The study selection process is summarized in a PRISMA flow diagram (Fig. 1).

Results

Characteristics of included studies

Included studies comprised of cohort and cross-sectional studies that were done in Africa. Fifty-eight studies (69.9%) were from East Africa, fourteen (16.9%) from West Africa, six studies (7.2%) from Southern Africa, three studies (3.6%) from Central Africa and two studies (2.4%) were multi-regional. Thirty-six studies (43.4%) were done in Ethiopia, six (7.2%) in Uganda, five (6.0%) in Nigeria while Tanzania, South Africa and Malawi contributed four (4.8%) studies each. A total of 52 out of the 82 screened studies (63.4%) reported mortality rates of children under-five due to SAM. Fifty-three studies (63.9%) were conducted in hospital while thirty studies (36.1%) were conducted in the community. 590,497 was the total sample size of all the included studies with the largest study comprising 189,195 participants (32.0%). The largest and smallest studies in the East African region had a sample size of 13,827 and 324 and a total sample size of 53,129. In West Africa, the largest study had 2224 participants and the smallest 377 participants with a total sample size of 6,107. In the Southern Africa region, the largest and smallest studies had 86,219, and 93 participants, respectively, with a total sample size of 95,027 (Tables 1).

Table 1 Characteristics of included studies
Full size table

Prevalence of under-five mortality due to SAM in Africa

The overall prevalence of under-five mortality was 11%; 95%CI: 0.08–0.13 (Fig. 2a). The largest and smallest studies had a sample size of 86,219 and 93 participants and a reported mortality rate of 11% and 6% respectively. Fifty-two studies that reported under-five mortality of children due to SAM in Africa were from four African regions (East, West, Southern and Central Africa). Thirty-one studies (37.8%) did not report data on mortality.

Fig. 2
figure 2

a Under-five mortality due to SAM in Africa. b Under-five mortality due to SAM in East Africa. c Under-five mortality due to SAM in West Africa. d Under-five mortality due to SAM in Southern Africa

Full size image

Prevalence of under-five mortality due to SAM by region

In East Africa, the overall mortality rate was 11%; 95%CI:0.07–0.15, with a mortality rate range of 2% and 46% (Fig. 2b). In West Africa, the overall mortality rate was 11%; 95%CI:0.05–0.18. The mortality rate range for this region was 2% to 29% (Fig. 2c). Finally, the Southern Africa region had an overall mortality rate of 13%; 95%CI:0.06–0.22. The mortality rate range for this region was 1% to 35% (Fig. 2d).

Risk factors of under-five mortality due to SAM

Of the 83 studies that were analyzed, 52 studies (62.7%) reported risk factors associated with under-five mortality due to SAM in Africa. Gastroenteritis or diarrheal diseases, HIV and pneumonia were the three most reported risk factors associated with mortality by 21 (40.1%), 20 (38.5%), and 14 (26.9%) studies, respectively. Other risk factors identified included severe anemia, sepsis, tuberculosis (TB), shock, malaria, reduced appetite/inability to feed/needing nasogastric tube feeding and dehydration in that order.

Discussion

The analysis found a prevalence of under-five mortality due to SAM across the continent of Africa of 11% (110 deaths per 1000 live births), which is still high.

In terms of the African regions, we did not find much difference in the mortality rates across the board, even though Southern Africa was at 13% while East Africa and West Africa were at 11% each. In this analysis there were no studies that were included from North Africa as most studies in this region are not published in English. Our analysis, however, found a high variability in the mortality rate range between studies of 1%- 46%. It is possible that this observed variability may have been due to the differences in the sample sizes of individual studies that ranged from 89,195 to 93 participants, the data sources- 30 studies (36.1%) were conducted in the community, while 53 (63.9%) were conducted in the hospital- and the different study follow up periods that ranged from 4 weeks to 16 years.

A similar variability was observed by Burke et al. (2016) in his study that reported only 8–15% mortality difference across country borders with an in-country difference accounting for 74–78% of the overall variation of under- five mortalities which points to local over national factors driving mortality patterns [15].

The most reported mortality risk factors included diarrhea, HIV, pneumonia, severe anemia, sepsis, tuberculosis, shock, malaria, reduced appetite/ inability to feed/needing nasogastric tube feeding and dehydration. These risk factors were similar to those reported by Karunaratne et al. in their systematic analysis of predictors of inpatient mortality among children hospitalized for SAM [16].

HIV was reported in studies published during the initial 7 years (2014- 2021) out of the 10 years of the review period (2014- 2024) which may be due to the reported decline of new HIV infections in Africa [17]. UNAIDS reported the same trend with new HIV infections reducing by up to 50% in some countries in Sub Saharan Africa since 2009 [18].

The trends for the other mortality risk factors remained the same over the review period. These trends were comparable with results from several other studies. Gebremichael et al. found the leading cause of death of children with SAM to be dehydration secondary to diarrhea (12 (30.8%) [19] while Adama et al. reported diarrhoeal disease as one of the determinants of mortality with the highest OR of 4.6(95%CI 2.6–8.2) [20]. Desta et al. also reported diarrhea as the commonest co-infection with SAM in children at 44.6% [21]. Abate et al. also reported diarrhoeal disease as being present in 14 of the 15 deaths in the study period [22]. Diarrhea was also reported as the most common clinical presentation by Kanan et al. [23].

Pediatric HIV was reported by Adama et al. as a determinant of mortality with an OR of 10.9(95%CI 5.6–21.5) [20]. Desyibelew et al. reported HIV/AIDSas one of the factors significantly associated with time to death in children with SAM [24]. Chane et al. identifies HIV infection as a predominant factor that compromised recovery rate and increased mortality rate [25]. Kerac et al. reported that mortality was greatest among HIV sero-positive children accounting for 62%(274/445) of the reported deaths [26] which was also reported by Dangarembizi et al. who found an almost fourfold higher mortality in HIV-positive compared with HIV-negative children [27].

Gavhi et al. found 1.6 times higher odds of dying for children who had lower respiratory tract infections (LRTIs) also known as Pneumonia (95% CI 1.3–2.0, p < 0.001) compared to those that had no LRTIs [28]. Harris et al. lists pneumonia second in the five leading causes of death [29].

Other risk factors of mortality listed in the studies that reported mortality in SAM children included age less than 24 months, children who had impaired consciousness, hypoglycaemia, convulsions, hypothermia, hypokalaemia, severe wasting and those that had a MUAC < 115mm. Intravenous fluid infusion, blood transfusion and not adhering to medical and nutritional therapies were also identified as factors that contributed to mortality reported by other studies [14, 28

This systematic review and meta-analysis sought to assess the current mortality rate of children under-five years with SAM in Africa and the associated risk factors. The high overall mortality of 11% that we found, falls in the same range as was reported by Nduhukire et al. of 10% to 40% in many facilities in Sub Saharan Africa [15]. This is despite the complete roll-out of the WHO guidelines [16] for management of children under-five years (6–59 months) with SAM whether admitted in hospital or being managed in the outpatient therapeutic clinic (OTP) clinics. The implementation of these guidelines aimed to lower the mortality rate associated with SAM to below 10% in a bid to achieve the Sustainable Development Goals (SDGs) Target 3.2; to end preventable deaths of newborns and children under five years old by 2030 in all countries in the world. This SDG also seeks to reduce the prevalence of wasting to < 5% by 2025 and < 3% by 2030 [17]. The result of this review reveals that the achievement of this goal may not be realizable in the remaining one year and six years’ time, respectively.

Strengths and limitations of the study

We conducted a comprehensive literature search including records from different databases to ensure robustness of the findings. A variety of the included studies were analytical with the ability to infer causality between the risk factors and SAM. However, the review included only records and articles published in the English language which might bias the regional representation and comparisons. Furthermore, some of the studies were retrospective and hence the quality of data only relied upon the available medical participant records which could have affected the outcomes.

Conclusions

The under-five mortality rate of children who suffer from severe acute malnutrition in Africa is still high. This was observed across the regions with no regional variability in East, West and Southern Africa. This review identified diarrheal diseases/ gastroenteritis, HIV and pneumonia as the top three leading risk factors of under-five mortality due to SAM in Africa. More efforts need to be focused on this group of children in order to reduce this death rate especially by addressing the preventable causes including proper nutrition for children and optimal breastfeeding, full vaccination, encouraging good sanitation and PMTCT of HIV.

Data availability

Data generated from the review are included in this article whereas original data is publicly available in the included articles. Processed and unprocessed data extracted from included studies and used for the analyses are available upon request. Original articles are publicly accessible through the databases we searched.

Abbreviations

LRTIs:

Lower Respiratory Tract Infections

MAM:

Moderate Acute Malnutrition

MUAC:

Mid Upper Arm Circumference

OTP:

Outpatient Therapeutic Program PMTCT: Prevention of Mother-To-Child Transmission

SAM:

Severe Acute Malnutrition

WHZ:

Weight -for-Height Z score

References

  1. UNICEF. Levels and trends in child mortality - UNICEF DATA, https://data.unicef.org/resources/levels-and-trends-in-child-mortality-2024/.

  2. UNICEF. Child Mortality - UNICEF DATA, https://data.unicef.org/topic/child-survival/under-five-mortality/.

  3. WHO. Children: improving survival and well-being, https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality.

  4. Roser M. Mortality in the past: every second child died - Our World in Data, https://ourworldindata.org/child-mortality-in-the-past.

  5. Sharrow D, Hug L, You D, Alkema L, Black R, Cousens S, Croft T, Gaigbe-Togbe V, Gerland P, Guillot M, Hill K, Masquelier B, Mathers C, Pedersen J, Strong KL, Suzuki E, Wakefield J, Walker N. Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet Glob Heal. 2022;10:e195–206. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S2214-109X(21)00515-5.

    Article  CAS  Google Scholar 

  6. Alkema L, Chao F, You D, Pedersen J, Sawyer CC. National, regional, and global sex ratios of infant, child, and under-5 mortality and identification of countries with outlying ratios: A systematic assessment. Lancet Glob Heal. 2014;2:e521–30. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S2214-109X(14)70280-3.

    Article  Google Scholar 

  7. WHO: Child mortality (under 5 years). https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-under-5-mortality-in-2020.

  8. WHO. Child mortality (under 5 years), https://www.who.int/news-room/fact-sheets/detail/levels-and-trends-in-child-under-5-mortality-in-2020.

  9. Walson J. Childhood Acute Illness and Nutrition (CHAIN) Network: a protocol for a multi-site prospective cohort study to identify modifiable risk factors for mortality among acutely ill children in Africa and Asia The Childhood Acute Illness and Nutrition Network. 2019. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmjopen-2018-028454.

  10. WHO. Fact sheets - Malnutrition, https://www.who.int/news-room/fact-sheets/detail/malnutrition?gad_source=1&gclid=EAIaIQobChMI8tntusCyhgMV6ZWDBx0vrgtUEAAYASAAEgIJFPD_BwE#.

  11. WHO. Table 1, World Health Organization (WHO) classification of nutritional status of infants and children. 2017.

  12. Bujang MA, Adnan TH. Requirements for minimum sample size for sensitivity and specificity analysis. J Clin Diagn Res. 2016;10:YE01. https://doiorg.publicaciones.saludcastillayleon.es/10.7860/JCDR/2016/18129.8744.

  13. Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, Baker P, Smith E, Buchbinder R. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65:934–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jclinepi.2011.11.014.

    Article  PubMed  Google Scholar 

  14. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/SIM.1186.

    Article  PubMed  Google Scholar 

  15. Burke M, Heft-Neal S, Bendavid E. Sources of variation in under-5 mortality across sub-Saharan Africa: a spatial analysis. Lancet Glob Heal. 2016;4:e936–45. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S2214-109X(16)30212-1.

    Article  Google Scholar 

  16. Karunaratne R, Sturgeon JP, Patel R, Prendergast AJ. Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis. Am J Clin Nutr. 2020;112:1069. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/AJCN/NQAA182.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Maciej Serda, Becker, F.G., Cleary, M., Team, R.M., Holtermann, H., The, D., Agenda, N., Science, P., Sk, S.K., Hinnebusch, R., Hinnebusch A, R., Rabinovich, I., Olmert, Y., Uld, D.Q.G.L.Q., Ri, W.K.H.U., Lq, V., Frxqwu, W.K.H., Zklfk, E., Edvhg, L. V, Wkh, R.Q., Becker, F.G., Aboueldahab, N., Khalaf, R., De Elvira, L.R., Zintl, T., Hinnebusch, R., Karimi, M., Mousavi Shafaee, S.M., O ’driscoll, D., Watts, S., Kavanagh, J., Frederick, B., Norlen, T., O’Mahony, A., Voorhies, P., Szayna, T., Spalding, N., Jackson, M.O., Morelli, M., Satpathy, B., Muniapan, B., Dass, M., Katsamunska, P., Pamuk, Y., Stahn, A., Commission, E., Piccone, T.E.D., Annan, M.K., Djankov, S., Reynal-Querol, M., Couttenier, M., Soubeyran, R., Vym, P., Prague, E., World Bank, Bodea, C., Sambanis, N., Florea, A., Florea, A., Karimi, M., Mousavi Shafaee, S.M., Spalding, N., Sambanis, N., فاطمی, ح.: Synteza i aktywność biologiczna nowych analogów tiosemikarbazonowych chelatorów żelaza. Uniw Śląski. 2013;7:343–354. https://doiorg.publicaciones.saludcastillayleon.es/10.2/JQUERY.MIN.JS.

  18. UNAIDS. New HIV infections among children have been reduced by 50% or more in seven countries in sub-Saharan Africa | UNAIDS, https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2013/june/20130625prglobalplan.

  19. Gebremichael DY. Predictors of nutritional recovery time and survival status among children with severe acute malnutrition who have been managed in therapeutic feeding centers, Southern Ethiopia: Retrospective cohort study. BMC Public Health. 2015;15:1–11. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S12889-015-2593-5/TABLES/7.

    Article  Google Scholar 

  20. Adama ZW, Ella CW, Bengaly MD, Angèle Z, Virginio P, Ludovic KK, Alfred TS. Determinants of mortality in children under five years of age with severe acute malnutrition admitted to the Yalgado Ouédraogo Teaching Hospital (Burkina Faso). Int J Child Heal. 2016. https://mail.lifescienceglobal.com/pms/index.php/ijchn/article/view/3689.

  21. Shitaye Desta K. Citation: Desta KS. A survival status and predictors of mortality among children aged 0–59 months with severe acute malnutrition admitted to stabilization center at Sekota Hospital Waghemra Zone. J Nutr Disord Ther. 2015;5:160. https://doiorg.publicaciones.saludcastillayleon.es/10.4172/2161-0509.1000160.

  22. Abate HK, Kidane SZ, Feyessa YM, Gebrehawariat EG. Mortality in children with severe acute malnutrition. Clin Nutr ESPEN. 2019;33:98–104. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/J.CLNESP.2019.07.001.

    Article  PubMed  Google Scholar 

  23. Kanan SO, Swar MO. Prevalence and outcome of severe malnutrition in children less than five-year-old in Omdurman Paediatric Hospital, Sudan. Sudan J Paediatr. 2016. https://pubmed.ncbi.nlm.nih.gov/27651550/.

  24. Desyibelew HD, Baraki AG, Dadi AF. Mortality rate and predictors of time to death in children with severe acute malnutrition treated in Felege-Hiwot Referral Hospital Bahir Dar, Northwest Ethiopia. BMC Res Notes. 2019;12. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S13104-019-4467-X.

  25. Mekonnen TC, Oljira L, Chane T, Atomesa GE, Agedew E. Treatment outcome and associated factors among under-five children with severe acute malnutrition admitted to therapeutic feeding unit in Woldia hospital. researchgate.net. 2014; 4:6. https://doiorg.publicaciones.saludcastillayleon.es/10.4172/2155-9600.1000329.

  26. Kerac M, Bunn J, Chagaluka G, Bahwere P, Tomkins A, Collins S, Seal A. Follow-up of post-discharge growth and mortality after treatment for severe acute malnutrition (FuSAM study): a prospective cohort study. PLoS One. 2014;9. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0096030.

  27. Bwakura-Dangarembizi, M., Dumbura, C, B.A.-T.A. journal of, 2021, undefined: Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia. Elsevier. 2021. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ajcn/nqaa346.

  28. Gavhi F, Kuonza L, Musekiwa A, Villyen Motaze N. Factors associated with mortality in children under five years old hospitalized for Severe Acute Malnutrition in Limpopo province, South Africa, 2014–2018: A cross-sectional analytic study. PLoS ONE. 2020;15: e0232838. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0232838.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Harris C, Mills R, Seager E, Blackstock S, Hiwa T, Pumphrey J, Langton J, Kennedy N. Paediatric deaths in a tertiary government hospital setting. Malawi Paediatr Int Child Health. 2019;39:240–8. https://doiorg.publicaciones.saludcastillayleon.es/10.1080/20469047.2018.1536873.

    Article  PubMed  Google Scholar 

  30. Adal T, Kote M, Healthc, B.T.-J.B.A. 2016, undefined: Incidence and predictors of mortality among severe acute malnourished under five children admitted to Dilla University Referal hospital: a retrospective. Res J Biol Agric Heal. 2016. https://www.researchgate.net/publication/311717386_Incidence_and_Predictors_of_Mortality_among_Severe_Acute_Malnourished_Under_Five_Children_Admitted_to_Dilla_University_R.

  31. Wagnew F, Tesgera D, Mekonnen M, Abajobir AA. Predictors of mortality among under-five children with severe acute malnutrition, northwest ethiopia: An institution based retrospective cohort study. Arch Public Heal. 2018;76:1–10. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S13690-018-0309-X.

    Article  Google Scholar 

  32. Gebremichael M, A.B.-O.A.L. 2014, undefined: Treatment outcomes and associated risk factors of severely malnourished under five children admitted to therapeutic feeding centers of Mekelle City, Northern. Acad. Gebremichael, AM Bezabih, M Tsadik. Open Access Libr. Journal, 2014•academia.edu. 2014. https://doiorg.publicaciones.saludcastillayleon.es/10.4236/oalib.1100446.

  33. Yohannes T, Laelago T, Ayele M, Tamrat T. Mortality and morbidity trends and predictors of mortality in under-five children with severe acute malnutrition in Hadiya zone, South Ethiopia: A four-year retrospective review of hospital-based records (2012-2015). BMC Nutr. 2017;3. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S40795-017-0135-5.

  34. Admasu A, Tadesse E, Moshago T, Mekonnen N. Survival status and its associated factors among under-five children admitted with complicated severe acute malnutrition in hospitals of Wolaita zone. South Ethiop Retrosp Cohort Study. 2017. https://www.researchgate.net/publication/345757391_Survival_Status_and_Its_Associated_Factors_among_Under-_Five_Children_Admitted_with_Complicated_Severe_Acute_Malnutrition_in_Hospitals_of_Wolaita_Zone_South_Ethiopia_Retrospective_Cohort_StudySurvival.

  35. Girum T, Kote M, Tariku B, Bekele H. Survival status and predictors of mortality among severely acute malnourished children 5 years of age admitted to stabilization centers in Gedeo Zone: a a retrospective cohort study. Therapeutics Clin Risk Manag. 2017:101–10. https://doiorg.publicaciones.saludcastillayleon.es/10.2147/TCRM.S119826.

  36. Donatus E, Nwadiaro E. A study of malnutrition-dependent factors among under-five children in Ekureku community, Abi local government area of cross river state, Nigeria. Artic. British J Med Med Res. 2017;21:1–10. https://doiorg.publicaciones.saludcastillayleon.es/10.9734/BJMMR/2017/30204.

  37. Wagnew F, Tesgera D, Mekonnen M, Abajobir AA. Predictors of mortality among under-five children with severe acute malnutrition, northwest ethiopia: An institution based retrospective cohort study. Arch Public Heal. 2018:76:1–10. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S13690-018-0309-X.

  38. Darsene H, Geleto A, Gebeyehu A, Meseret S. Magnitude and predictors of undernutrition among children aged six to fifty nine months in Ethiopia: A cross sectional study. Arch Public Heal. 2017:75. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S13690-017-0198-4.

  39. Leidman E, Tromble E, Yermina A, Johnston R, Isokpunwu C, Adeniran A, Bulti A. Acute malnutrition among children, mortality, and humanitarian interventions in conflict-affected regions — Nigeria, October 2016–March 2017. MMWR Morb Mortal Wkly Rep. 2019;66:1332–35. https://doiorg.publicaciones.saludcastillayleon.es/10.15585/MMWR.MM6648A4.

  40. Acevedo P, García Esteban MT, Lopez-Ejeda N. Gómez A, Marrodán MD. Influence of malnutrition upon all-cause mortality among children in Swaziland. Endocrinol Diabetes y Nutr. 2017;64:204–10. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/J.ENDINU.2017.01.008.

  41. Lugangira K, Kazaura M, Kalokola F. Morbidity and mortality of children aged 2-59 months admitted in the Tanzania Lake Zone’s public hospitals: A cross-sectional study. BMC Res Notes. 2017;10. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S13104-017-2818-Z.

  42. Endris N, Asefa H, Dube L. Prevalence of malnutrition and associated factors among children in rural Ethiopia. BioMed Res Int. 2017. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2017/6587853.

  43. Awoke A, Ayana M, Gualu T. Determinants of severe acute malnutrition among under five children in rural Enebsie Sarmidr District, East Gojjam Zone, North West Ethiopia, 2016. BMC Nutr. 2018;4. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S40795-018-0211-5.

  44. Nabukeera-Barungi N, Grenov B, Lanyero B, Namusoke H, Mupere E, Christensen VB, Michaelsen KF, Mølgaard C, Rytter MJ, Friis H. Predictors of mortality among hospitalized children with severe acute malnutrition: a prospective study from Uganda. Pediatric Res. 2018. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s41390-018-0016-x.

  45. Guesh G, Degu G, Abay M, Beyene B, Brhane E, Brhane K. Survival status and predictors of mortality among children with severe acute malnutrition admitted to general hospitals of Tigray, North Ethiopia: A retrospective cohort study. BMC Res Notes. 2018:11. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S13104-018-3937-X.

  46. Bilan Mohamed A, Abdirashid Adam Y, Mohamed Abdullahi A, Abdirisaq Ali A, Ibrahim nor F, Mohamed Abdulah A, Abdirashid Adan Y. Prevelance of malnourished children under five years at benadir region. 2018. https://www.researchgate.net/publication/326623325_PREVELANCE_OF_MALNOURISHED_CHILDREN_UNDER_FIVE_YEARS_AT_BENADIR_REGION.

  47. Gachau S, Irimu G, Ayieko P, Akech S, Agweyu A, English M. Prevalence, outcome and quality of care among children hospitalized with severe acute malnutrition in Kenyan hospitals: A multi-site observational study. PLoS One. 2018:13. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0197607.

  48. Fitzgerald E, Mlotha-Mitole R, Ciccone EJ, Tilly AE, Montijo JM, Lang HJ, Eckerle M. A pediatric death audit in a large referral hospital in Malawi. BMC Pediatr. 2018:18. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S12887-018-1051-9.

  49. Willcox ML, Kumbakumba E, Diallo D, Mubangizi V, Kirabira P, Nakaggwa F, Mutahunga B, Diakité C, Dembélé E, Traoré M, Daou P. Circumstances of child deaths in Mali and Uganda: a community-based confidential enquiry. The Lancet Glob Health. 2018. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S2214-109X(18)30215-8.

  50. Nigatu G, Assefa Woreta S, Akalu TY, Yenit MK. Prevalence and associated factors of underweight among children 6-59 months of age in Takusa district, Northwest Ethiopia. Int J Equity Health. 2018:17. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S12939-018-0816-Y.

  51. Bamford L, Barron P, Kauchali S, Dlamini N. Inpatient case fatality rates improvements in children under 5: Diarrhoeal disease, pneumonia and severe acute malnutrition. South African Med J. 2018;108:33–7. https://doiorg.publicaciones.saludcastillayleon.es/10.7196/SAMJ.2018.v108i3.12772.

  52. Grellety E, Golden MH. Severely malnourished children with a low weight-for-height have a higher mortality than those with a low mid-upper-arm-circumference: I. Empirical data demonstrates Simpson’s paradox. Nutr J. 2018:17. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S12937-018-0384-4.

  53. Abate BB, Tilahun BD, Kassie AM, Kassaw MW. Treatment outcome of Severe Acute Malnutrition and associated factors among under-five children in outpatient therapeutics unit in Gubalafto Wereda, North Wollo Zone, Ethiopia, 2019. PLoS One. 2020;15:e0238231. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0238231.

  54. Desyibelew HD, Baraki AG, Dadi AF. Mortality rate and predictors of time to death in children with severe acute malnutrition treated in Felege-Hiwot Referral Hospital Bahir Dar, Northwest Ethiopia. BMC Res Notes. 2019:12. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S13104-019-4467-X.

  55. Nambuusi BB, Ssempiira J, Makumbi FE, Kasasa S, Vounatsou P. The effects and contribution of childhood diseases on the geographical distribution of all-cause under-five mortality in Uganda. Parasite Epidemiol Control. 2019. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.parepi.2019.e00089.

  56. Dapi Nzefa L, Monebenimp F, Äng C. Undernutrition among children under five in the Bandja village of Cameroon, Africa. South African J Clin Nutr. 2019;32:46–50. https://doiorg.publicaciones.saludcastillayleon.es/10.1080/16070658.2018.1448503.

  57. Boah M, Azupogo F, Amporfro DA, Abada LA. The epidemiology of undernutrition and its determinants in children under five years in Ghana. PLoS One. 2019:14. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0219665.

  58. Gebre A, Reddy PS, Mulugeta A, Sedik Y, Kahssay M. Prevalence of malnutrition and associated factors among under-five children in pastoral communities of Afar Regional State, Northeast Ethiopia: a community. J Nutr Metab. 2019. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2019/9187609.

  59. Humbwavali JB, Giugliani C, Nunes LN, Dalcastagnê SV, Duncan BB. Malnutrition and its associated factors: A cross-sectional study with children under 2 years in a suburban area in Angola. BMC Public Health. 2019;19. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S12889-019-6543-5.

  60. Harris C, Mills R, Seager E, Blackstock S, Hiwa T, Pumphrey J, Langton J, Kennedy N. Paediatric deaths in a tertiary government hospital setting, Malawi. Paediatr Int Child Health. 2019;39:240–248. https://doiorg.publicaciones.saludcastillayleon.es/10.1080/20469047.2018.1536873.

  61. Mwangome M, Ngari M, Bwahere P, Kabore P, McGrath M, Kerac M, Berkley JA. Anthropometry at birth and at age of routine vaccination to predict mortality in the first year of life: A birth cohort study in BukinaFaso. PLoS One. 2019:14. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0213523.

  62. Ngwalangwa F, Phiri CHA, Dube Q, Langton J, Hildenwall H, Baker T. Risk factors for mortality in severely ill children admitted to a tertiary referral hospital in Malawi. Am J Trop Med Hyg. 2019. https://doiorg.publicaciones.saludcastillayleon.es/10.4269/ajtmh.19-0127.

  63. Wete AT, Zerfu TA, Anbese AT. Magnitude and associated factors of wasting among under five orphans in Dilla town, southern Ethiopia: 2018: a cross-sectional study. BMC Nutr. 2019;5. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S40795-019-0295-6.

  64. Gavhi F, Kuonza L, Musekiwa A, Villyen Motaze N. Factors associated with mortality in children under five years old hospitalized for Severe Acute Malnutrition in Limpopo province, South Africa, 2014-2018: A cross-sectional analytic study. PLoS One. 2020;15:e0232838. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0232838.

  65. Banga D, Baren M, Ssonko NV, Sikakulya FK, Tibamwenda Y, Banga C, Ssebuufu R. Comorbidities and factors associated with mortality among children under five years admitted with severe acute malnutrition in the nutritional unit of Jinja Regional Referral Hospital, Eastern Uganda. Int J Pediatr. (United Kingdom). 2020:2020. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2020/7809412.

  66. Abate HK, Kidane SZ, Feyessa YM, Gebrehawariat EG. Mortality in children with severe acute malnutrition. Clin. Nutr. ESPEN. 2019;33:98–104. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/J.CLNESP.2019.07.001.

  67. Ashine YE, Ayele BA, Aynalem YA, Yitbarek GY. Time to Death and its predictor among children under five years of age with severe acute malnutrition admitted to inpatient stabilization centers in North Shoa Zone, Amhara Region, Ethiopia. Nutr Diet Suppl. 2020;12:167–77.https://doiorg.publicaciones.saludcastillayleon.es/10.2147/NDS.S249045.

  68. Adimasu Kebede M, Abebe Fenta F, Bimerew Getahun M. Determinants of treatment outcomes of severe acute malnutrition among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study. 2020. https://doiorg.publicaciones.saludcastillayleon.es/10.21203/RS.3.RS-30080/V1.

  69. Kambale RM, Ngaboyeka GA, Ntagazibwa JN, Bisimwa MHI, Kasole LY, Habiyambere V, Kubuya VB, Kasongo JK, André E, van der Linden D. Severe acute malnutrition in children admitted in an Intensive Therapeutic and Feeding Centre of South Kivu, Eastern Democratic Republic of Congo: Why do our patients die? PLoS One. 2020;15:e0236022. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0236022.

  70. Arab M, Arab Abdilahi M, Mawlid Nur A, Dahir Jibril A. Prevalence of acute malnutrition and associated factors among under-five children in Gursum District, Somali Region, Ethiopia. Sci J Public Health. 2020;8:123–9. https://doiorg.publicaciones.saludcastillayleon.es/10.11648/j.sjph.20200804.15.

  71. Mdimu EL, Massaga JJ, Sembuche SL, Abade AM, Leyna GH. Risk factors associated with under nutrition among children aged 6-59 months in Ngorongoro, Arusha region, Tanzania: a case-control study, 2017. ajol.info. 37. 2017. https://doiorg.publicaciones.saludcastillayleon.es/10.11604/pamj.2020.37.315.21726.

  72. Carboo JA, Asare H, Nel E, Ricci C, Lombard M, Dolman R. Treatment outcomes and determinants of mortality in children aged 0-59 months diagnosed with complicated severe acute malnutrition in two referral hospitals in Ghana. Vulnerable Child Youth Stud. 2020;15:329–43. https://doiorg.publicaciones.saludcastillayleon.es/10.1080/17450128.2020.1800157.

  73. Bitew ZW, Ayele EG, Worku T, Alebel A, Alemu A, Worku F, Yesuf A. Determinants of mortality among under-five children admitted with severe acute malnutrition in Addis Ababa, Ethiopia. Nutr J. 2021;20:1–15. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S12937-021-00750-0/TABLES/4.

  74. Kassaw A, Amare D, Birhanu M, Tesfaw A, Zeleke S, Arage G, Kefale D. Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study. BMC Pediatr. 2021;21:1–10. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S12887-021-02651-X/TABLES/4.

  75. Oumer A, Mesfin L, Tesfahun E, Ale A. Predictors of death from complicated severe acute malnutrition in east ethiopia: Survival analysis. Int J Gen Med. 2021;14:8763–73. https://doiorg.publicaciones.saludcastillayleon.es/10.2147/IJGM.S337348.

  76. Kitila FL, Petros RM, Jima GH, Desalegn T, Sorsa A, Massey IY, Zhang C, Yang F. Under-five mortality and associated factors in southeastern Ethiopia. PLoS One. 2021;16. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0257045.

  77. Mann DM, Swahn MH, McCool S. Undernutrition and malaria among under-five children: findings from the 2018 Nigeria demographic and health survey. Pathog Glob Health. 2021;115:423–33. https://doiorg.publicaciones.saludcastillayleon.es/10.1080/20477724.2021.1916729.

  78. Bwakura-Dangarembizi M, Dumbura C. Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia. Elsevier; 2021. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ajcn/nqaa346.

  79. Muwanguzi E, Oboi JE, Nabbamba A, Wanyama R. Treatment outcome and associated factors for severely malnourished children (1–5 years) admitted to Lacor Hospital and Gulu Regional Referral Hospital in Uganda. J Nutr Sci. 2021;10:1–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1017/jns.2021.11.

  80. Compaoré E, Kiemdé M, T.S.-C.N. 2021, undefined: Discontinuation of healthcare and factors associated to mortality among severe acute malnourished children under five years in healthcare and nutritional care. ElsevierEWR Compaoré, MEW Kiemdé, T Souho, O Ouedraogo, V Pietra, K Agbokou, N ZagreClinical Nutr. ESPEN, 2021•Elsevier. 2021. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.clnesp.2021.02.013.

  81. Kebede D, Merkeb Y, Worku E, Aragaw H. Prevalence of undernutrition and potential risk factors among children under 5 years of age in Amhara Region, Ethiopia: evidence from 2016 Ethiopian Demographic and Health Survey. J Nutr Sci. 2021;10:e22. https://doiorg.publicaciones.saludcastillayleon.es/10.1017/jns.2021.17.

  82. Feleke S, Egata G, Mesfin F, Yilak G, Molla A. Undernutrition and associated factors in orphan children aged 6–59 months in Gambella Southwest, Ethiopia: A community-based cross-sectional study. BMJ open. 2021;11:45892. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmjopen-2020-045892.

  83. Adedokun ST, Yaya S. Factors associated with adverse nutritional status of children in sub-Saharan Africa: Evidence from the Demographic and Health Surveys from 31 countries. Mater Child Nutr. 2021;17. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/mcn.13198.

  84. Asare H, Carboo J, Nel ED, Dolman RC, Conradie C, Lombard MJ, Ricci C. Mortality in relation to profiles of clinical features in Ghanaian severely undernourished children aged 0–59 months: an observational study. Br J Nutr. 2021. https://doiorg.publicaciones.saludcastillayleon.es/10.1017/S0007114520003396.

  85. Kiarie J, Karanja S, Busiri J, Mukami D, Kiilu C. The prevalence and associated factors of undernutrition among under-five children in South Sudan using the standardized monitoring and assessment of relief and transitions (SMART) methodology. BMC Nutr. 2021;7. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S40795-021-00425-3.

  86. Mandla N, Mackay C, Mda S. Prevalence of severe acute malnutrition and its effect on under-five mortality at a regional hospital in South Africa. South African J Clin Nutr. 2022;35:149–54. https://doiorg.publicaciones.saludcastillayleon.es/10.1080/16070658.2021.2001928.

  87. Kebede F, Kebede T, Negese B, Abera A, Fentaw G, Kasaw A. Incidence and predictors of severe acute malnutrition mortality in children aged 6–59 months admitted at Pawe general hospital, Northwest Ethiopia. PLoS One. 2022;17. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0263236.

  88. Anato A. Severe acute malnutrition and associated factors among children under-five years: A community based-cross sectional study in Ethiopia. 2017. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.heliyon.2022.e10791.

  89. Shifera N, Endale A, Debela D, Yosef T. Acute malnutrition and its contributing factors among children under-five years in rural kebeles of Shashemene Oromia, Ethiopia. Front Nutr. 2022;9. https://doiorg.publicaciones.saludcastillayleon.es/10.3389/FNUT.2022.1053928/FULL.

  90. Okidi L, Ongeng D, Muliro PS, Matofari JW. Disparity in prevalence and predictors of undernutrition in children under five among agricultural, pastoral, and agro-pastoral ecological zones of Karamoja sub-region, Uganda: a cross sectional study. BMC Pediatr. 2022;22. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S12887-022-03363-6.

  91. Ndlovu S, David-Govender C, Tinarwo P, Naidoo K. Changing mortality amongst hospitalised children with Severe Acute Malnutrition in KwaZulu-Natal, South Africa, 2009 – 2018. BMC Nutr. 2022;8. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/S40795-022-00559-Y.

  92. Sturgeon J, Mufukari W, Tome J, … C.D.-E. journal of, 2023, undefined: Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia. nature.comJP Sturgeon, W Mufukari, J Tome, European J. Clin. Nutr. 2023•nature.com. 2023. https://doiorg.publicaciones.saludcastillayleon.es/10.1038/s41430-023-01320-9.

  93. Wutor BM, Osei I, Galega LB, Ezeani E, Adefila W, Hossain I, Sarwar G, Mackenzie G. Verbal autopsy analysis of childhood deaths in rural Gambia. PLoS One. 2023;18. https://doiorg.publicaciones.saludcastillayleon.es/10.1371/JOURNAL.PONE.0277377.

Download references

Acknowledgements

The author would like to thank Dr. Sonal Katyal (PhD) for her unreserved assistance, timely guidance and valuable comments.

Availability of data and materials

The data used is publicly available as published articles.

Funding

This research didn’t receive any grant from any funding agency in the public, commercial or not-for- profit sectors.

Author information

Authors and Affiliations

  1. Clinical Trials Department, Kenya Medical Research Institute (KEMRI)-Wellcome Trust, P.O. Box 43640 – 00100, Nairobi, Kenya

    Joshua Wambua

  2. Faculty of Pharmaceutical Sciences, James Lind Institute, Geneva, Switzerland

    Joshua Wambua & Anahita Ali

  3. Bill and Joyce Cummings Institute of Global Health, University of Global Health Equity (UGHE), Butaro, Rwanda

    Jean Baptiste Ukwizabigira & Paul Kuodi

  4. Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel

    Paul Kuodi

Authors
  1. Joshua Wambua
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Anahita Ali
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Jean Baptiste Ukwizabigira
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Paul Kuodi
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

JK prepared the protocol, extracted the evidence from the source articles, provided the critical interpretation of the results and led the writing and editing of the manuscript. PK led the literature searches, contributed to the methodology and critical evaluation of the results. PK, AA and JB reviewed and provided feedback on the manuscript throughout its development. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Joshua Wambua.

Ethics declarations

Ethics and approval consent to participate

Ethics and approval consent to participate were not relevant as the data used was publicly available.

Consent for publication

Not applicable.

Competing interests

The author declares that there is no competing interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wambua, J., Ali, A., Ukwizabigira, J.B. et al. Prevalence and risk factors of under-five mortality due to severe acute malnutrition in Africa: a systematic review and meta-analysis. Syst Rev 14, 29 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13643-024-02740-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13643-024-02740-9

Keywords

Systematic Reviews

ISSN: 2046-4053