RESUMEN
BACKGROUND: Children of foreign-born parents with vulnerable legal status, limited economic rights and exclusion from national social interventions may be at higher risk for severe acute malnutrition (SAM). We evaluated the relationship between parent status (foreign-born vs. South African) and outcomes for children with SAM admitted to a rural regional hospital in the Western Cape, South Africa. METHODS: A retrospective cohort study was conducted including children <5 years admitted to Worcester Provincial Hospital during 2015-17 with SAM (WHO weight-for-height Z score <-3, presence of nutritional oedema, mid-upper-arm-circumference of <11.5 cm or visible severe wasting). Exposures, including parent status, and outcomes including in-hospital death were determined from hospital and regional dietician records. RESULTS: Of 95 children included, 31 (33%) were of foreign-born and 64 (67%) of South African parents. Median (interquartile range) age at admission was 12 (8-18) vs. 10 (8-13) months in children of South African vs. foreign-born parents with no difference in preterm birth, concurrent illnesses or admission duration. Age, HIV status and breastfeeding practices were no different in foreign-born compared to South African mothers. In-hospital deaths occurred in 3/64 (5%) and 6/31 (19%) children of South African vs. foreign-born parents (p = 0.01). Children of foreign-born compared to South African parents had an odds ratio of 4.88 (95% CI 1.13-21.06) for in-hospital SAM-associated mortality. CONCLUSION: In this rural setting, 33% of children admitted with SAM were of foreign-born parents and experienced in-hospital SAM-associated mortality at least four times higher than children of South African parents. This illustrates the extreme vulnerability of these children.
In some contexts children of foreign-born parents may experience vulnerable legal status putting them at higher risk for food insecurity and severe malnutrition in their early years of life, compared to children of native-born parents. In a rural region of the Western Cape of South Africa, we observed that children of foreign-born parents were four times more likely to die of malnutrition than children of South African parents. This was so even though these children did not display other expected risk factors for malnutrition such as being born preterm, not breastfeeding or being HIV-exposed. To achieve the Sustainable Developmental Goals, policy makers and healthcare systems will need to cater for all children in the country, including asylum seekers and children of foreign-born parents. The South African Constitution and Refugee Act are in support of this. However, the findings of this study illustrate the extent of vulnerability of children living in South Africa born to foreign-born parents and calls for an evaluation of the services made available to support their health and well-being.
