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

Predictors of recovery from severe acute malnutrition among 6-59 months children admitted to a hospital

Background and aim

Severe acute malnutrition is a threat to child survival as mortality rates in children with severe malnutrition are nine times higher. Globally, about 19 million children are severely malnourished. This study looked at children aged 6-59 months admitted to hospital to see how quickly they recovered from severe acute malnutrition as well as what factors predicted their recovery.

Methods

The study included 543 systematically chosen children with severe acute malnutrition who were admitted to the stabilization center of a hospital. Data from the patient registry were gathered using a retrospective follow-up study design. In order to find predictors of recovery, the Cox proportional hazard model was applied.

Results

From 543 children, 425 (78.27%) were recovered. The median survival time was 8 days. Having grade II edema, grade III edema, and pneumonia were negatively associated with recovery. Similarly, taking ceftriaxone, cloxacillin, and being on a nasogastric tube were associated with poor recovery. Conversely, better recovery rates were linked to exclusive breastfeeding and vitamin A supplementation.

Conclusion

Both the recovery rate and the median survival time fell within acceptable bounds. To boost the recovery rate, efforts are needed to lessen comorbidities.

Predictors of nutritional recovery time in children aged 6–59 months with severe acute malnutrition in Sofala Province, Mozambique: survival analysis approach

Background

Malnutrition is a public health problem that affects physical and psychosocial well-being. It manifests as a rapid deterioration in nutritional status and bilateral edema due to inadequate food intake or illness.

Methods

This study is a retrospective cohort of 1208 children with severe acute malnutrition (SAM) in Sofala Province from 2018 to 2022. It includes hospitalized children aged 6–59 months with SAM and related complications. The dependent variable is recovery, and the independent variables include age, sex of the child, vomiting, dehydration, hypoglycemia, nutritional edema and anthropometry. Survival curves were plotted using the Kaplan–Meier method, and bivariable and multivariable Cox regression analyses were performed.

Results

The crude analysis revealed significant factors for nutritional recovery in children with SAM, including age, weight, height, malaria, diarrhea and dehydration. Children under 24 months had a 28% lower likelihood of recovery. Weight below 6.16 kg decreased the likelihood by 2%, and height above 71.1 cm decreased it by 20%. Conversely, malaria, diarrhea and dehydration increased the likelihood of recovery. However, after adjustment, only diarrhea remained a significant predictor of nutritional recovery.

Conclusion

This study found that diarrhea is a predictor of nutritional recovery in children with SAM.

Severe Acute Malnutrition among Children in Bale Zone Southeast Ethiopia: Treatment Outcome and its Determinant Factors

OBJECTIVE

To assess the treatment outcomes of severe acute malnutrition (SAM) and its associated factors in children aged 6-59 months in Bale zone, Southeast Ethiopia.

DESIGN

A multi-institutionally-based, retrospective cross-sectional study design was conducted, based on records from September 11, 2014 to September 11, 2017. Simple random sampling was used to select the records. A pretested extraction format was used to collect information from the logbook and patient records. Treatment outcome was dichotomized into recovery and censored. Bivariate and multivariable logistic regression analyses were used to analyze the data. Odds ratios with 95% CIs were calculated to determine the association between each independent variable and treatment outcome.

RESULTS

A total of 763 records were completed and reviewed. Of these, 711 (93.2%) were recovered from SAM. Provision of deworming treatment (aOR = 6.5; 95% CI: 2.8-15.1), education given to the mother/caregiver (aOR = 8.8; 95% CI: 4.2-18.4), age range 6-24 months (aOR = 0.37; 95% CI: 0.17-0.81), presence of anemia (aOR = 0.33; 95% CI: 0.14-0.78), and use of nasogastric (NG) tube (aOR = 0.42; 95% CI: (0.21-0.85) were associated with recovery from SAM.

CONCLUSIONS

Recovery rate of SAM children in this study was in line with international standards. Deworming, maternal education status, child's age, anemia, and NG tube use were associated with recovery. Attention should be given to deworming all children, disease control, and prevention of anemia and other comorbidities.

Impact of a simplified treatment protocol for moderate acute malnutrition with a decentralized treatment approach in emergency settings of Niger

Introduction

Of the 45.4 million children under five affected by acute malnutrition in the world, the majority (31.8 million) are affected by moderate acute malnutrition (MAM). Its treatment is particularly complex in emergency settings such as the Diffa region in Niger. This study aims to evaluate the effectiveness and coverage of a simplified treatment protocol with Community Health Workers (CHWs) as treatment providers.

Methods

This study is a non-randomized controlled trial. The control group (n = 181) received the standard protocol currently used in country, delivered by nursing staff only in health centres and health posts, while the intervention group (n = 483) received the simplified protocol which included nursing at health centres and CHWs at health post as treatment providers.

Results

The recovery rate was higher in the simplified protocol group (99.6% vs. 79.56%, p < 0.001) recording lower time to recover and higher anthropometric gain. Treatment coverage in the intervention group increased from 28.8% to 84.9% and reduced in the control group (25.3% to 13.6%). No differences were found in the recovery rate of children treated by CHWs and nursing staff.

Conclusion

The outcomes using the simplified protocol exceeded humanitarian requirements and demonstrated improvements compared to the standard protocol showing that the simplified protocol could be safely provided by CHWs in an emergency context. Further research in other contexts is needed to scale up this intervention.

Effect of ready-to-use therapeutic foods on time to recovery among children with severe acute malnutrition in Ethiopia: a prospective cohort study

BACKGROUND

The therapeutic feeding unit (TFU) provides comprehensive inpatient clinical care for children suffering from severe acute malnutrition (SAM) in three stages: stabilization, transition, and rehabilitation. During the transitional and rehabilitation phases, children receive either F-100 or ready-to-use therapeutic food (RUTF). Although both promote weight gain, RUTF is more energy dense than F-100. There is limited and contrasting evidence regarding their effect on recovery time. Therefore, this study aimed to assess the effect of RUTF on time to recovery among SAM children aged 6-59 months admitted to the TFU in Ethiopia.

METHODS

Health Facility-based prospective cohort study was conducted among 476 children treated in three hospitals and four health centers in the Sidama region from September 2021 to January 2022. A structured questionnaire adopted from the Ethiopian national protocol for the management of SAM was used for data collection. Data were entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. The Kaplan-Meir curve and log-rank test were used to compare time to recovery between children who received RUTF and F-100. Multivariable Cox proportional hazard analysis was conducted to assess the association between time to recovery and the type of therapeutic food, controlling for the confounding variables.

RESULTS

The median recovery time was significantly shorter in children receiving RUTF (7 days; 95% CI: 6.62-7.38) compared to F-100 (10 days; 95% CI: 8.94-11.06). Children below 24 months (AHR = 0.54, 95% CI: 0.42-0.69), dehydrated (AHR = 1.34, 95% CI: 1.07-1.75), edematous malnutrition (AHR = 1.29, 95% CI: 1.03-1.61), and anemic (AHR = 2.57, 95% CI: 1.90-3.48) during admission were associated with time to recovery.

CONCLUSIONS

Children who received RUTF recovered faster than children who received F-100. Administering RUTF to children below 24 months, who present with anemia and dehydration can improve their recovery rate and shorten their stay in the health facility.

Time to recovery from severe acute malnutrition and its predictors among under five children admitted to therapeutic feeding units of general and referral hospitals in Tigray, Ethiopia, 2020: a prospective cohort study

BACKGROUND

Across the globe, an estimated 16 million children under the age of 5 are affected by severe acute malnutrition. Children with severe acute malnutrition are nine times more likely to die than well-nourished children. In Ethiopia, 7% of children under five are wasted, and 1% of these are severely wasted. A prolonged hospital stay increases the incidence of hospital-acquired infections. The aim of this study was to assess the time to recovery and its predictors among children 6-59 months old with severe acute malnutrition admitted to therapeutic feeding units of selected general and referral hospitals in Tigray, Ethiopia.

METHODS

A prospective cohort study design was conducted among children aged 6-59 months admitted with severe acute malnutrition in selected hospitals in Tigray that have therapeutic feeding units. The data were cleaned, coded, entered into Epi-data Manager, and exported to STATA 14 for analysis.

RESULT

Among 232 children followed in the study, 176 have recovered from severe acute malnutrition with a recovery rate of 54 per 1000 person-days observation and the median time to recovery was 16 days with an inter-quartile range of 8. In a multivariable Cox Regression, feeding plumpy nut [AHR 0.49 (95% CI 0.2717216-0.8893736)] and failing to gain 5 gr/kg/day for three successive days after feeding freely on F-100 [AHR 3.58 (95% CI 1.78837-7.160047)] were found to have an association with time to recovery.

CONCLUSION

Despite the median time to recovery is shorter than what has been reported in a few studies, we can conclude that this could not let children avoid any possible hospital-acquired infections. The impact of staying in a hospital may also extend to the mother/caregiver in terms of the infection that they may acquire or the costs imposed on them.

Utilization of mid-upper arm circumference as discharge tool for children in outpatient therapeutic program, Ethiopia

Mid-upper arm circumference (MUAC) is simple to use and inexpensive in Ethiopia; both MUAC and target weight are employed, although the time to cure for MUAC is not indicated. The present study is aimed to determine cure time of MUAC for children in outpatient therapeutic program. A prospective cohort study was conducted among 414 severe acute malnourished under-five children admitted to selected health twenty-two posts from 1 February to 30 July 2021, in Oromia, Ethiopia. Data were coded, entered to Ep-data version 4.2 software, and transferred to SPSS for windows version 25 software for analysis. The Multivariate Cox Proportional Hazards model was used to fit independent determinants of time to cure. All tests were two-sided and statistical implications at P-values < 0⋅05. In the present study, the minimum week for a cure was 4 weeks, the maximum was 16 weeks and the overall time to cure severe acute malnutrition as measured by MUAC is judged to be 10 at 95 % CI (9⋅65-10⋅35). Families with six or more members are 2⋅16 times more at risk, children from homes with the lowest wealth index are at 1⋅4 times more risk, and children from food insecure families were 2⋅61 times more likely to require long-term treatment for MUAC. In the present study, the time to cure severe acute malnutrition by MUAC is determined as 10 weeks. Moreover, family size, low wealth index, and household food insecurity were risks to delay in cure time MUAC.

Severe acute malnutrition’s recovery rate still below the minimum standard: predictors of time to recovery among 6- to 59-month-old children in the healthcare setting of Southwest Ethiopia

Background

Despite currently available, scientifically proven treatments and national guideline, the SAM recovery rate is still considerably behind expectations, and it continues to have a devastating impact on under-five children. Identifying predictors of time to recovery might help to reach the minimal criterion established by the WHO and the national Sphere which decreases child mortality. Therefore, the current study assessed time to recovery and its predictors among children aged 6–59 months admitted with SAM in the Healthcare Setting of Southwest Ethiopia, 2021.

Methods

An institutional-based multicenter retrospective follow-up study was conducted on 486 children aged 6 to 59 months admitted with SAM cases. Data were entered into Epi-Data version 4.6 and exported to Stata version 14 for further analysis. Cox–Snell residual plot was used to assess the final model’s overall goodness of fit. Finally, a significant predictor of time to recovery was identified using Weibull survival regression model, at 0.05 significance level.

Result

Overall, 68.72 (95% CI 64.8, 73) of the children recovered and 4.32% died. The overall incidence density was 3.35/100-person day. Independent predictors of time to recovery were, starting complementary feeding at six months (AHR = 1.44; 95%, CI 1.073, 1.935), pneumonia at baseline (AHR = 1.33, 95%, CI 1.049, 1.696), amoxicillin (AHR = 1.31, 95%, CI 1.021, 1.685), and folic acid supplementation (AHR = 1.82, 95% CI 1,237, 2.665).

Conclusion

The recovery from SAM at study area after a maximum of 60 days of treatment was below the accepted minimum standard. Complementary feeding, pneumonia, treated by amoxicillin, and folic acid supplementation were predictors of time to recovery. Therefore, providing folic acid and amoxicillin for those in need as well as the earliest possible treatment of concomitant conditions like pneumonia is highly recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41043-022-00331-9.

Time to Discharge and its Predictors among Children Aged 1-60 Months with Severe Acute Malnutrition Admitted to the Therapeutic Feeding Center in A Tertiary Hospital, North West Ethiopia

Background

Standard treatment of severe acute malnutrition with medical complication and/or failed appetite test is admission in therapeutic feeding centers for stabilization. Once stabilized, patients will be linked to Outpatient treatment program for rehabilitation. Information regarding time to discharge from inpatient therapeutic feeding centers is limited in Ethiopia. The main objective of this study was to assess the time to discharge and its predictors among children 1-60 months with Severe Acute Malnutrition admitted to University of Gondar Hospital.

Methods

Hospital Based retrospective follow up study was conducted in Gondar University Hospital among 282 children aged 1-60 months admitted to inpatient Therapeutic Feeding Center from June 2018 to December 2020. Participants were selected by Simple random sampling technique. Time to discharge from inpatient treatment was estimated using Kaplan-Meir procedure and Log Rank test was used to test observed difference between covariates. Identification of predictors for time to discharge was done by Stratified cox regression model.

Results

Overall 282 children were studied; 242 (85.8%) were discharged improved and 40 (14.2%) were censored. The median time to Discharge was 13 days (IQR: 9-18) and the Incidence of discharge was found to be 6.4 (95% CI: 5.6-7.2) per 100 person- day observations. Kwash-dermatosis (AHR=2.4, 95% CI: 1.17-4.8), Anemia (AHR=1.7, 95% CI: 1.1-2.6), pneumonia at admission (AHR=1.6, 95% CI: 1.01-2.63) and Hospital acquired infection (AHR=4.4, 95% CI: 2.4-8.2) were predictors of time to discharge.

Conclusion

Hospital stay at the stabilization center was prolonged. Pneumonia, anemia, kwash dermatosis and Nosocomial infections were significant predictors of time to discharge.

Time to recovery from severe acute malnutrition and its predictors among children aged 6–59 months at Asosa general hospital, Northwest Ethiopia. A retrospective follow up study

Background

Severe Acute Malnutrition (SAM) has become a major public health challenge in developing countries including Ethiopia, especially among the underprivileged population. Ethiopia is among the developing countries with the highest burden of acute malnutrition among under-five children. Though, plenty of studies were done on the magnitude of acute malnutrition among under-five children in Ethiopia, there is a limited evidence on time to recovery from SAM and its predictors among children aged 6–59 months in Ethiopia, particularly in the study area.

Objectives

The study was aimed to assess the time to recovery from SAM and its predictors among children aged 6–59 months at Asosa general hospital (AGH), Benishangul Gumuz, Ethiopia.

Methods

A Five years retrospective follow-up study design was employed among 454 children admitted with SAM in AGH from January 2015 to December 2019. The data were extracted from the patient medical records using checklist. The data were coded and entered into Epi-Data 3.1; then exported to STATA/SE-14 for analysis. Proportional Cox regression was performed to identify predictors of recovery time. A proportional hazard assumption was checked. Variables with AHR at 95% CI and P-value less than 0.05 in the multivariable Cox proportional regression was considered as significant predictors of recovery time.

Findings

Among the 454 included records of children with SAM, 65.4% (95%CI: 50.1, 69.2) of them were recovered at the end of the follow-up with a median recovery time of 15 IQR(11–18)days. The incidence rate of recovery was 5.28 per 100 child days’ observations. Being HIV Negative (AHR = 2.19: 95% CI 1.28, 3.73), Marasmic (AHR = 1.69: 95% CI 1.18, 2.42), and marasmic-kwashiorkor child (AHR = 1.60: 95% CI (1.09, 2.37) independently predicted recovery time.

Conclusions

Though the time to recovery from severe acute malnutrition was in the acceptable range, the proportion of recovery was found to be low in the study area compared to sphere standard. The prognosis of children with severe acute malnutrition was determined by the HIV status of the child and the type of malnutrition experienced. Further strengthening of malnutrition therapeutic centers and routine checkup of the nutritional status of HIV positive children should be emphasized to reduce child mortality and morbidity from under-nutrition.

Determinants of mortality among under-five children admitted with severe acute malnutrition in Addis Ababa, Ethiopia

BACKGROUND

Management of severe acute malnutrition (SAM) has been a program priority in Ethiopia, but it remains the leading cause of mortality in under-five children. Hence, this study aimed to identify the incidence density rate of mortality and determinants among under-five children with severe acute malnutrition in St. Paul's Hospital Millennium Medical College, 2012 to 2019.

METHODS

A retrospective cohort study was conducted and data were collected using a structured checklist from 673 charts, of which 610 charts were included in the final analysis. The Kaplan-Meier survival curve with Log-rank test was used to estimate the survival time. Bi-variable and multi-variable Cox proportional hazard regression models were fitted to identify determinants of death. Schoenfeld residuals test was used to check a proportional hazard assumption. Goodness of fit of the final model was checked using Nelson Aalen cumulative hazard function against Cox-Snell residual.

RESULTS

In this study, 61 (10%) children died making the incidence density rate of death 5.6 (95% CI: 4.4, 7.2) per 1000 child-days. Shock (Adjusted Hazard Ratio) [AHR] =3.2; 95% CI: 1.6, 6.3)), IV fluid infusion (AHR = 5.2; 95% CI: 2.4, 10.4), supplementing F100 (AHR = 0.12; 95%CI: 0.06, 0.23) and zinc (AHR = 0.45; 95% CI: 0.22, 0.93) were determinants of death.

CONCLUSION

The overall proportion of deaths was within the range put forth by the Sphere standard and the national SAM management protocol. Shock and IV fluid infusion increased the hazard of death, whereas F100 & zinc were found to decrease the likelihood death. Children with SAM presented with shock should be handled carefully and IV fluids should be given with precautions.

Predictors for time to recovery from sever acute malnutrition among under-five children admitted to therapeutic feeding unit at Dubti referral hospital, Afar region, Ethiopia

Background

Currently, about 165 million children are categorized under malnutrition and 51.5 million suffering from acute malnutrition in world wide. Hence, the objective of current study was to assess the recovery time and its predictors of children under five from severe acute malnutrition admitted to Therapeutic Feeding Unit at Dubti Referral Hospital, Afar region, Eastern Ethiopia.

Methods

Institutional based retrospective cohort study was conducted on 650 inpatient children with SAM admitted for therapeutic feeding unit whose treatment was from March to April/2017.

Results

The result in current investigation indicates that the average recovery time from SAM was found to be 21 days (95% CI; 21.23–25.77), p-value = 0.035). A Cox proportional hazard regression model revealed that Weight of a child at birth, gestational age of a child, working status of a child at admission birth order of a child, mother’s BMI, mother’s level of education, mother’s stature, mother’s occupation, mother’s age, mother’s marital status, mother’s nutritional status, house hold income in ETB, family size in HH, number of under-five children, the type of toilet used in HH, source of improved drinking water, type of cooking fuel, ownership of livestock, age and weight of a child at admission had statistically significant association with the variation of average recovery time of children from SAM.

Conclusion

Male children under severe acute malnutrition, rural children, children with different additional diseases and children who did not get mothers’ breast milk at least in the first six months after birth and children who did not get vaccination are groups at risk and needs intervention and special attention to be recovered with short period of time. Children from low income family, who did not get improved drinking water, without moderate cooking fuel and a child from larger families were groups at risk in recovery time from SAM.

Predictors of recovery in children aged 6-59 months with uncomplicated severe acute malnutrition: a multicentre study

OBJECTIVE

To identify predictors of recovery in children with uncomplicated severe acute malnutrition (SAM).

DESIGN

This is a secondary data analysis from an individual randomised controlled trial, where children with uncomplicated SAM were randomised to three feeding regimens, namely ready-to-use therapeutic food (RUTF) sourced from Compact India, locally prepared RUTF or augmented home-prepared foods, under two age strata (6-17 months and 18-59 months) for 16 weeks or until recovery. Three sets of predictors that could influence recovery, namely child, family and nutritional predictors, were analysed.

SETTING

Rural and urban slum areas of three states of India, namely Rajasthan, Delhi and Tamil Nadu.

PARTICIPANTS

In total, 906 children (age: 6-59 months) were analysed to estimate the adjusted hazard ratio (AHR) using the Cox proportional hazard ratio model to identify various predictors.

RESULTS

Being a female child (AHR: 1·269 (1·016, 1·584)), better employment status of the child's father (AHR: 1·53 (1·197, 1·95)) and residence in a rental house (AHR: 1·485 (1·137, 1·94)) increased the chances of recovery. No hospitalisation (AHR: 1·778 (1·055, 2·997)), no fever, (AHR: 2·748 (2·161, 3·494)) and ≤ 2 episodes of diarrhoea (AHR: 1·579 (1·035, 2·412)) during the treatment phase; availability of community-based peer support to mothers for feeding (AHR: 1·61 (1·237, 2·097)) and a better weight-for-height Z-score (WHZ) at enrolment (AHR: 1·811 (1·297, 2·529)) predicted higher chances of recovery from SAM.

CONCLUSION

The probability of recovery increases in children with better WHZ and with the initiation of treatment for acute illnesses to avoid hospitalisation, availability of peer support and better employment status of the father.

Time to nutritional recovery and its determinants among children aged 6 to 59 months with severe acute malnutrition admitted to stabilization centers of WagHimra Zone, Northeast Ethiopia

Severe acute malnutrition is a life-threatening condition that contributes to over half of under five deaths in developing countries. Urgent and specialized treatment to improve the time to recovery and recovery rate is very important. However, data regarding time to nutritional recovery is limited in Ethiopia. Hence, this study aimed to determine the average time to recovery and its determinants among children aged 6 to 59 months admitted with SAM to the stabilization centers of Wag Himra zone, northeast Ethiopia. A retrospective cohort study was conducted on 501 patients charts of children with severe acute malnutrition (SAM) admitted to stabilization centers (SCs) from September 2014 to August 2017. The charts were selected using the systematic random sampling technique. Data were extracted from the charts of each child using a pretested standard checklist and entered using Epi data version 3.1 and analyzed by STATA 14. A Cox proportional-hazard regression analysis was carried out to identify determinants of time to recovery. Any statistical test was considered significant at P-values < 0.05. In this study, the overall recovery rate from SAM was 80.4% (95% Confidence Interval [CI]: 76, 84) with the median nutritional recovery time of 11 (Inter Quartile Range [IQR]: 8-18) days. Patients aged 6-23 months (Adjusted Hazard Ratio [AHR] = 0.74, 95%CI: 0.60, 0.92), and had pneumonia (AHR = 0.44; 95% CI: 0.32, 0.59), anemia (AHR = 0.65; 95% CI: 0.52, 0.81) and vomiting (AHR = 0.63, 95% CI: 0.49, 0.82) at admission were less likely to recover quickly compared to those who did not have these conditions or were in other age categories, whereas edematous malnourished children (AHR = 2.85; 95% CI: 2.28, 3.56) were positively and significantly associated with early recovery. The median nutritional recovery time fell within the recommended international standards. However, the length of stay was significantly longer among children with severe wasting, aged 6-23 months, and had vomiting, pneumonia, and anemia at admission than their counterparts. Therefore, interventions should focus on young children with severe wasting, pneumonia, vomiting, and anemia to prevent prolonged stay in the SCs without recovery. Retrospectively registered.

A cohort analysis of survival and outcomes in severely anaemic children with moderate to severe acute malnutrition in Malawi

INTRODUCTION

Moderate to severe acute malnutrition (SAM/MAM) and severe anaemia are important and associated co-morbidities in children aged less than five years. Independently, these two morbidities are responsible for high risk of in-hospital and post-discharge deaths and hospital readmissions. The primary objective of this study is to investigate the risk of death among severely anaemic children with moderate to severe acute malnutrition compared to children with severe anaemia alone.

METHODS

This was a retrospective analysis of data collected from a large prospective study that was investigating severe anaemia in children aged less than 5 years old. The study was conducted at Queen Elizabeth Central Hospital in Blantyre and Chikhwawa district hospital in southern Malawi. Children aged less than five years old; with severe anaemia were screened and enrolled. Each child was followed up for eighteen months at one, three, six, twelve and eighteen months after enrolment. Data were analysed using STATA 15.

RESULTS

Between July 2002 and July 2004, 382 severely anaemic children were enrolled in the main study. A total of 52 children were excluded due to missing anthropometric data. Out of the 330 included, 53 children were moderately to severely malnourished and 277 were not. At the end of the 18-month follow period, 28.3% of children with MAM/SAM died compared to 13% of children without MAM/SAM (RR 2.1, CI 0.9-4.2, p = 0.03). Similarly, children with moderate to severe malnutrition reported a significantly higher number of malaria infection cases (33.9%) compared to children with severe anaemia alone (27.9%, p = 0.02). However, the number of hospitalizations and recurrence of severe anaemia was similar and not statistically significant between the two groups (RR 0.8 (0.4-1.4), p = 0.6 and RR 1.1 (0.3-2.8), p = 0.8).

CONCLUSION

Among children with severe anaemia, those who also had moderate to severe malnutrition had a twofold higher risk of dying compared to those who did not. It is therefore crucial to investigate acute malnutrition among severely anaemic children, as this might be treatable factor associated with high mortality.

Can Sever Acute Malnourished children be effectively rehabilitated physically, biochemically and developmentally at nutritional rehabilitation centers: A follow up study from Ujjain

Background

Under-nutrition has got serious and lasting impact on health, development, society and economy. It may result in poor growth, development of child and can cause increase mortality, morbidity, health care cost, low productivity and economic growth. Nutritional rehabilitation is one of key intervention to address the under nutrition. It is questionable that nutritional intervention has potential to improve multiple domains.

Methods

Follow up study evaluated the multi-domain impact of nutritional interventions on 204 admitted Severe Acute Malnutrition (SAM) children. Data was analyzed with SPSS version 20.

Results

Significant positive changes were observed in physical, biochemical, developmental domains. Macnemar, paired t- test, co relation, z test were applied for data analysis.

Conclusion

Nutritional intervention was found to be effective in improving selected physical, biochemical and developmental parameters. After discharge rate of improvement in anthropometric parameters was less. Actual quantification of recovery especially in biochemical and developmental parameters due to nutritional intervention is difficult.

Determinants of Mortality Among Severely Malnourished Children in Northern Nigeria

Objectives

Severe Acute Malnutrition is a significant cause of mortality in children under the age of 5 years in low-resource settings, including Northern Nigeria. The study aimed to determine the associations between selected risk factors and mortality outcomes in children admitted with SAM in a facility in Katsina State, Northern Nigeria.

Methods

A prospective observational cohort of 201 children aged 6 to 59 months who were admitted with severe acute malnutrition (SAM) in stabilization centers in Katsina State, Northern Nigeria between May 18, 2021, and July 20, 2021, (63 days) were assessed followed up. Outcomes were analyzed using Kaplan-Meir analysis to estimate time to death, and Cox proportional-hazard regression model was used to determine predictors of mortality.

Results

The log-rank test showed significant differences in the probability of death between categories of diarrheal status (log-rank statistic = 9.760, P = .021) and presence of existing disease (comorbidity) (log-rank statistic = 5.338, P = .021). The study identified that severely malnourished children admitted with comorbidities showed significant association with time to event (death) (AHR: 4.109, 95% CI: 1.51, 32.60). The estimated mean time until death was 57.9 days (±3.0) for children without comorbidities and 20.1 (±3.0) days for children with comorbidities. The median survival time was 18 days for children with comorbidities.

Conclusion

The presence of comorbidities was significantly associated with mortality. Severely malnourished children with comorbidities had 4 times higher mortality risk than severely malnourished children admitted without comorbidities. Clinicians and health workers should give due emphasis to the early detection and effective management of comorbidities in children with severe acute malnutrition.

Predictors of undesirable treatment outcomes of severe acute malnutrition among inpatient children in Addis Ababa, Ethiopia: a retrospective cohort study

Background

In 2018, malnutrition contributed to 45% of all global cause of child death. These early child deaths were due to conditions that could either be prevented or treated with basic interventions. Hence, this study intended to provide a quantitative estimate of factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM).

Methods

We studied a retrospective cohort of 304 children aged 6–59 months with complicated SAM admitted to Yekatit 12 Hospital Medical College from 2013 to 2016. We extracted data from hospital records on nutritional status, socio-demographic factors and medical conditions during admission. The analysis was carried out using SPSS version 20. The Kaplan-Meier estimator was employed to analyze the recovery rate of the children treated for SAM and multivariable Cox regression was used to determine factors that predict inpatient undesirable treatment outcomes.

Result

From a total of 304 children 6–59 months with SAM, 133 (51.4%) were boys. Marasmus was the most common type (132 (51%)) of severe acute malnutrition. The recovery, death and defaulter rate were 70.4, 12.2 and 8.2% respectively. The main predictors of undesirable treatment outcomes were found to be the presence of HIV antibody (AHR = 3.208; 95% CI: [1.045–9.846]) and sepsis (AHR = 7.677, 95% CI: [2.320–25.404]).

Conclusion

The study revealed that the overall treatment outcomes were below the SPHERE standard recommendation. The main predictors of undesirable treatment outcomes among inpatient children treated for SAM were HIV and sepsis. Intervention to reduce undesirable treatment outcomes should focus on comorbidities, especially HIV and sepsis.

Treatment outcomes of severe acute malnutrition and predictors of recovery in under-five children treated within outpatient therapeutic programs in Ethiopia: a systematic review and meta-analysis

Background

Severe acute malnutrition affects around 17 million under-five children in the world, of which the highest burden is accounted by Sub-Saharan Africa where Ethiopia is found. Though there are few individual, inconsistent and inconclusive studies, there is no nationally representative study on treatment outcomes of SAM in outpatient therapeutic feeding programs of Ethiopia. This study aimed at estimating the pooled treatment outcomes and predictors of recovery rate among under- five children with SAM in Ethiopia.

Methods

Electronic databases (PubMed, Medline (EBSCOhost), EMBASE (Elsevier), CINAHL (EBSCOhost), web of science, Scopus, Science Direct and Food Science and Technology Abstracts (FSTA)), and grey literature sources (Google scholar, Mednar, World Cat and google) were used to retrieve articles. The random effect model was used to estimate the pooled treatment outcomes. Hazard ratios were used to determine the predictors of recovery rate. Cochran’s Q, I², and univariate Meta regression were done for heterogeneity. Begg’s & Egger’s tests were used for publication bias.

Results

Nineteen articles with a total number of 23,395 under-five children with SAM were used for this meta-analysis. The pooled recovery, death, defaulter and non-recovery rates were 70% (95% CI: 64, 76), 2% (95% CI: 1, 2), 10% (95%CI: 7, 12), 15% (95% CI: 10, 20), respectively. Diarrhea (HR = 0.8, 95% CI: 0.75, 0.94), no edema (HR = 0.41, 95% CI: 0.33, 0.50) and amoxicillin (HR = 1.81, 95% CI: 1.18, 2.44) were independent predictors of recovery rate of children with SAM in Ethiopia. Publication year was found to be the potential source of heterogeneity between included studies.

Conclusion

The treatment outcomes of children with SAM from outpatient therapeutic feeding programs of Ethiopia are lower than the sphere guidelines, WHO and national recommendations. Diarrhea and no edema antagonized the recovery rate of children, while amoxicillin enhanced the recovery rate of children from SAM. Community health workers need to be trained. Especial attention should be given while treating children with diarrhea and severe wasting. Community mobilization is also recommended to improve community awareness about the therapeutic foods.

Time to Cure and Predictors of Recovery Among Children Aged 6-59 Months with Severe Acute Malnutrition Admitted in Jimma University Medical Center, Southwest Ethiopia: A Retrospective Cohort Study

Purpose

Treatment at a stabilization center is an important intervention to avert the huge burden of mortality for children with complicated severe acute malnutrition (SAM). Despite the improvement in hospital coverage and the development of standardized WHO treatment guidelines, recent reviews indicated a wide range in recovery rate (34-88%) due to several context-specific factors. This study aimed to estimate time to recovery and to determine predictors of time to recovery among children aged 6-59 months with severe acute malnutrition.

Patients and Methods

An institution-based retrospective cohort study design was used among 375 children aged 6-59 months admitted to Jimma University Medical Center, Jimma, Ethiopia from September 2015 to September 2017. All eligible children were enrolled and assessed using a pretested questionnaire. Kaplan-Meir estimates and survival curves were used to compare the time to recovery using log rank test among different characteristics. Cox proportional hazard model was used to identify significant predictors of time to recovery. A p-value less than 0.05 was declared statistically significant.

Results

The rate of recovery was 4.06 per 100 person days. Median time of recovery for our cohort of SAM children's was 19 days (95% CI: 17.95-20.05). Independent predictors of time to recovery were play stimulation (AHR=1.93, 95% CI: 1.23-3.03), vaccination status (AHR=2.26, 95% CI: 1.12-4.57), tuberculosis (AHR= 0.48, 95% CI: 0.27-0.87), malaria (AHR=0.34,95% CI:0.13-0.88), use of amoxicillin (AHR=1.54, 95% CI: 0.008-2.34), deworming (AHR=1.8, 95% CI: 1.18-2.73), and shock (AHR=0.18, 95% CI: 0.05-0.59).

Conclusion

The findings of this study showed that the average length of stay on treatment and median time for recovery are within the sphere standard. Psychosocial stimulation, appropriate provision of routine medication and management of medical co-morbidity are needed to promote fast recovery.

Length of stay to recover from severe acute malnutrition and associated factors among under-five years children admitted to public hospitals in Aksum, Ethiopia

Background

Severe acute malnutrition is defined by <70% weight for length/height, by visible severe wasting, by the presence of pitting edema, and in children 6 to 59 months of age, mid upper arm circumference <110 mm. Severe acute malnutrition remains to be a worldwide problem, claiming lives of millions of children, especially in sub-Saharan Africa and south Asia. Though the Ethiopian national guideline states the total length of stay in therapeutic feeding units should not be more than four weeks, there is huge difference, varying from 8 to 47 days of stay. Therefore, the objective of this study was to assess length of stay to recover from severe acute malnutrition and associated factors among under five children hospitalized to the public hospitals in Aksum Town.

Methods

Sample size was calculated using STATA version 12.0. A retrospective cohort study was conducted using pretested questionnaire in the public hospitals in Aksum on children aged 0–59 months. Cleaned data was entered to Epi info version 7.1.4 and then exported into SPSS version 21 for analysis. Bivariable and multivariable analyses were performed using Kaplan Meier and Cox regression models. During bivariable analysis, variables with p-value < 0.05 were selected for multivariable analysis to identify independent factors associated with length of stay.

Results

A total of 564 participants enrolled to the study. The rate of recovery was 56% with median length of stay of 15 days (95% CI: 14.1, 15.9). The independent predictors of length of stay to recovery were presence of diarrhea at admission (AHR = 0.573, 95% CI: 0.415–0.793), being HIV positive (AHR = 0.391, 95% CI: 0.194–0.788), palmar pallor (AHR = 0.575, 95% CI: 0.416–0.794), presence of other co-morbidities at admission (AHR = 0.415, 95% CI: 0.302–0.570) and not being treated with plumpy nut (AHR = 0.368, 95% CI: 0.262–0.518).

Conclusions

Length of stay is in the acceptable range of the international and national set of standards. Nevertheless, the recovery rate was lower compared to the Sphere standard. Presence of diarrhea, palmar pallor, HIV other co-morbidities and not treated with plumpy nut were found independent protective factors for recovery from sever acute malnutrition.

Time to Recovery and Its Predictors among Children 6-59 Months Admitted with Severe Acute Malnutrition to East Amhara Hospitals, Northeast Ethiopia: A Multicenter Prospective Cohort Study

Background

Malnutrition has been among the most common public health problems in the world, especially in developing countries including Ethiopia. Even though the Ethiopian government launched stabilization centers in different hospitals, there are limited data on how long children will stay in treatment centers to recover from severe acute malnutrition. This study aimed to assess the time to recovery and its predictors among children 6-59 months with severe acute malnutrition admitted to public hospitals in East Amhara, Northeast Ethiopia.

Methods

Institution-based, prospective cohort study was conducted in seven public hospitals in East Amhara and a total of 341 children were included in the study. The results were determined by Kaplan-Meier procedure, log-rank test, and Cox-regression to predict the time to recovery and to identify the predictors of recovery time. Variables having P value ≤0.2 during binary analysis were entered into multivarable Cox proportional hazards regression analysis. P value <0.05 was considered statistically significant.

Results

The nutritional recovery rate was 6.9 per 100 person-days with a median nutritional recovery time of 11 days (an interquartile range of 6). The independent predictors like using NG tube for feeding (AHR = 0.44, 95% CI: 0.27-0.71), not entering phase 2 on day 10 (AHR = 0.19, 95% CI: 0.12-0.29), and being admitted to referral hospitals (AHR = 0.52 95% CI: 0.37-0.73) were associated with longer periods of nutritional recovery time.

Conclusion

Both the recovery rate and the recovery time were within the acceptable minimum standards. But, special attention has to be given to children who failed to enter phase 2 on day 10, for those who needed NG tube for feeding, and for those admitted to referral hospitals during inpatient management.

Recovery rate and its predictors among children with severe acute malnutrition in Addis Ababa, Ethiopia: A retrospective cohort study

INTRODUCTION

Malnutrition is a public health problem in under-five children in several parts of the world even after decades of the implementation of management protocols. An estimated 17 million children under the age of five years are living with severe acute malnutrition and the majorities are found in Asia and Africa, including Ethiopia.

OBJECTIVE

The main objective of this study was to determine the recovery rate and its predictors among under-five children who were admitted to St. Paul's Hospital Millennium Medical College from 2012 to 2019.

METHODS

An institution based retrospective cohort study was employed at St. Paul's Hospital Millennium Medical College from May 20, 2019 to June 28, 2019. Data were collected by reviewing children's' medical records using a structured checklist. A total of 534 charts were selected using a simple random sampling method and 515 of them were used for the final analysis. Ep-info version 7 software was used for data entry and STATA Version 15 for analysis. The Kaplan Meier failure estimate with Log-rank test was used to determine the survival estimates. Bi-variable and multivariable Cox proportional hazards regression model were fitted to identify predictors of mortality. Finally, variables with p-values less than 0.05 in the multivariable Cox regression were considered as independent predictors. The proportional hazards assumption was checked using the Schoenfeld residuals test and the final model fitness was checked using the Cox-Snail residual test.

RESULT

In this study, a total of 515 subjects were followed for 8672 child-days and 79% of the subjects recovered from SAM with the median time of 17 days. The incidence density rate of recovery was 46 per 1000 child-days. Tuberculosis (AHR(Adjusted Hazard Ratio) 0.44 & 95% CI: 0.32, 0.62), pale conjunctiva (AHR,0.67 & 95% CI: 0.52, 0.88), IV fluid infusion (AHR, 0.71 & 95 CI: 0.51, 0.98), feeding F100 (AHR, 1.63 & 95% CI:1.04,2.54), Vitamin A supplementation (AHR, 1.3 & 95% CI:1.07, 1.59) and bottle feeding (AHR, 0.79 & 95CI%: 0.64-0.98) were the independent predictors of time to recovery from SAM.

CONCLUSION

In conclusion, the recovery rate was relatively higher than the Sphere standard and the national SAM management protocol. Co-morbidities and the treatments given were the main determinants of recovery of children. Co-morbidities must be managed as early as possible and the treatments given during the SAM management process need to be given with precaution.

Diarrhoeal children with concurrent severe wasting and stunting compared to severe wasting or severe stunting

OBJECTIVE

Children with both severe wasting and severe stunting (SWSS) represent an extreme form of malnutrition and are prone to develop severe infection. The study aims to demonstrate clinical features and aetiology of diarrhoea among children with SWSS compared to those with either severe wasting (SW) or severe stunting (SS), which may help in early identification of high-risk children.

METHODS

Data were extracted from the database of the diarrhoeal disease surveillance system (DDSS) of Dhaka Hospital, icddr,b from 2008 to 2017. Among 14 403 under-five diarrhoeal children, 149 had concurrent SWSS (WLZ/WHZ ˂-3 with LAZ/HAZ ˂-3), 795 had SW (WLZ/WHZ ˂-3 but LAZ/HAZ ≥-3) alone, and 1000 had only SS (LAZ/HAZ ˂-3 but WLZ/WHZ ≥-3).

RESULTS

In logistic regression analysis after adjusting for potential confounders, dehydrating diarrhoea and slum dwelling were independently associated with SWSS vs. SW (P < 0.05). When compared with SS, dehydration and maternal illiteracy were independently associated with SWSS (P < 0.05). In comparison with SW or SS, SWSS less often included infection with rotavirus (P < 0.05). Dehydration was independently associated with SW vs. SS after adjusting for potential confounders (P < 0.05).

CONCLUSION

Children with SWSS more often presented with dehydrating diarrhoea (69%) than children who had either SW (55%) or SS (43%). However, SWSS patients less frequently presented with rotavirus-associated diarrhoeal illnesses. This result underscores the importance of early detection and prompt management of dehydrating diarrhoea in children with concomitant severe wasting and severe stunting to reduce morbidity and mortality in these children, especially in poor settings.

Survival status and mortality predictors among severely malnourished under 5 years of age children admitted to Minia University maternity and children hospital

BACKGROUND

Though effective treatment programs for severely malnourished children are available, mortality rate among children with acute malnutrition continue to rise and little is known about its long-term outcomes and potential predictors of its in-hospital and post-discharge mortality. The aim of this study was to assess the survival status and predictors for mortality in severely malnourished children admitted to Minia University Maternity and Children Hospital.

METHODS

A retrospective cohort study which included 135 children under 5 years of age who were admitted to the nutrition rehabilitation ward with severe acute malnutrition (SAM) during the period from January to December 2018. Data were collected from the inpatient's hospital records and the children's parents/guardians were interviewed using a detailed structured questionnaire that inquired about demographic and socioeconomic variables. The logistic and Cox regressions were used to assess the factors associated with the SAM's mortality.

RESULTS

A total of 135 children were enrolled into the study. Death rate during hospitalization was 9.6%. The survival rate at the end of the fourth week of admission was 82.4%. There were 6.7% post-discharge deaths among 104 alive discharged children which occurred within 8 weeks after discharge. The adjusted HRs (95% CIs) for total SAM deaths were 1.57 (1.10-2.99) in children < 12 vs ≥ 12 months old; 4.79 (2.23-6.10) in those with WAZ < -3SD, 2.99 (1.16-4.66) in those with edema at admission and 3.44 (1.07-9.86) in children with complications. The respective ORs (95%CIs) for in-hospital SAM deaths in the same groups of children were 2.64 (1.22-6.43), 8.10 (2.16-11.67), 3.04 (1.70-6.06) and 3.71 (1.59-6.78). The main predictor for the SAM's post-discharge mortality was illiteracy of mothers; the adjusted HR (95%CI) was 7.10 (1.58-31.93; p = 0.01).

CONCLUSIONS

Age, WAZ, edema and complications at admission were predictors for both in-hospital and total SAM mortality, while mother's education contributed to the early post-discharge mortality. The identification of predictors for mortality is an important preliminary step for interventions aiming to reduce morbidity and mortality.

The recovery rate from severe acute malnutrition among under-five years of children remains low in sub-Saharan Africa. A systematic review and meta-analysis of observational studies

Background

Globally, Severe Acute Malnutrition (SAM) has been reduced by only 11% over the past 20 years and continues to be a significant cause of morbidity and mortality. So far, in Sub-Saharan Africa, several primary studies have been conducted on recovery rate and determinants of recovery from SAM in under-five children. However, comprehensive reviews that would have a shred of strong evidence for designing interventions are lacking. So, this review and meta-analysis was conducted to bridge this gap.

Methods

A systematic review of observational studies published in the years between 1/1/2000 to 12/31/2018 was conducted following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement. Two reviewers have been searched and extracted data from CINAHL (EBSCO), MEDLINE (via Ovid), Emcare, PubMed databases, and Google scholar. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with fair to good quality were included in the final analysis. The review presented the pooled recovery rate from SAM and an odds ratio of risk factors affecting recovery rate after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD42019122085.

Result

Children with SAM from 54 primary studies (n = 140,148) were included. A pooled rate of recovery was 71.2% (95% CI: 68.5–73.8; I² = 98.9%). Children who received routine medication (Pooled Odds ratio (POR):1.85;95% CI: 1.49–2.29; I² = 0.0%), older age (POR: 1.99;95% CI: 1.29–3.08; I² = 80.6%), and absence of co-morbidity (POR:3.2;95% CI: 2.15–4.76; I² = 78.7%) had better odds of recovery. This systematic review and meta-analysis suggestes HIV infected children had lower recovery rate from SAM (POR; 0.19; 95% CI: 0.09–0.39; I² = 42.9%) compared to those non-infected.

Conclusion

The meta-analysis deciphers that the pooled recovery rate was below the SPHERE standard, and further works would be needed to improve the recovery rate. So, factors that were identified might help to revise the plan set by the countries, and further research might be required to explore health fascilities fidelity to the WHO SAM management protocol.

Time to Recovery from Severe Acute Malnutrition and Its Predictors among Admitted Children Aged 6-59 Months at the Therapeutic Feeding Center of Pawi General Hospital, Northwest Ethiopia: A Retrospective Follow-Up Study

Background

Ethiopia is one of the countries in sub-Saharan Africa with the highest rates of severe acute malnutrition. Early recovery is a performance indicator for severe acute malnourished children for the therapeutic feeding. Despite the available interventions to tackle nutritional problems, there is scarce information on time to recovery and its determinants among children with SAM in Ethiopia.

Objective

The study is aimed at assessing time to recovery from severe acute malnutrition and its predictors among admitted children aged 6-59 months at the therapeutic feeding center of Pawi General Hospital, northwest Ethiopia, from January 2013 to December 2017.

Methods

An institution-based retrospective follow-up study was conducted among 398 children aged 6-59 months. The data were collected by using data extraction sheet. The data were cleaned and entered using EpiData version 4.2.0.0 and exported to Stata version 14 statistical software for further analysis. Kaplan-Meier survival curve was used to estimate median nutritional recovery time after initiation of inpatient treatment, and log-rank test was used to compare time to recovery between groups. The Cox proportional regression model was used to identify the predictors of recovery time. Adjusted hazard rate with its 95% CI was reported to show strength of relationship.

Results

The recovery rate was 5.3 per 100 person-day observations, and the median recovery time was 14 days (95% CI: 13-15). The lower chance of early recovery was found among children who were not fully vaccinated (AHR: 0.73 (95% CI: 0.56, 0.96)), while high chance of recovery was found among children who had no anemia (AHR: 1.66 (95% CI: 1.23, 2.23)), TB (AHR: 2.03 (95% CI: 1.11, 3.71)), and malaria infection (AHR: 1.54 (95% CI: 1.09, 2.17)) at admission. Conclusion and Recommendation. The overall nutritional recovery rate was below the accepted minimum standard. Children not fully vaccinated and children without malaria, anemia, and TB comorbidities at admission had a higher chance of recovering early from severe acute malnutrition. Hence, treating comorbidities is vital for prompt nutritional recovery.

Time to recovery from severe acute malnutrition and its predictors: a multicentre retrospective follow-up study in Amhara region, north-west Ethiopia

OBJECTIVES

This study aimed to determine the time to recovery from severe acute malnutrition (SAM) and its predictors in selected public health institutions in Amhara Regional State, Ethiopia.

DESIGN

An institution-based retrospective follow-up study was conducted using data extracted from 1690 patient cards from September 2012 to November 2016.

SETTING

Selected government health institutions in the Amhara region, Ethiopia.

PARTICIPANTS

Children treated in therapeutic feeding units for SAM were included.

OUTCOME MEASURES

Time to recovery from SAM.

RESULTS

One thousand and fifty children have recovered from SAM, 62.13% (95% CI 59.8% to 64.5%). The median time to recovery was 16 days (IQR=11-28). Female gender (adjusted HR (AHR)=0.81, 95% CI 0.67 to 0.98), oedematous malnutrition (AHR=0.74 95% CI 0.59 to 0.93), pneumonia (AHR=0.66, 95% CI 0.53 to 0.83), tuberculosis (AHR=0.53, 95% CI 0.36 to 0.77), HIV/AIDS (AHR=0.47, 95% CI 0.28 to 0.79), anaemia (AHR=0.73, 95% CI 0.60 to 0.89) and receiving vitamin A (AHR=1.43, 95% CI 1.12 to 1.82) were notably associated with time to recovery.

CONCLUSIONS

The time to recovery in this study was acceptable but the proportion of recovery was far below the minimum standard. Special emphasis should be given to the prevention and treatment of comorbidities besides the therapeutic feeding. Supplementing vitamin A would also help to improve the recovery rate.

B. Alé F, Álvarez JL, Vargas A, Guerrero S. Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes

Severe acute malnutrition (SAM) affects over 16.6 million children worldwide. The integrated Community Case Management (iCCM) strategy seeks to improve essential health by means of nonmedical community health workers (CHWs) who treat the deadliest infectious diseases in remote rural areas where there is no nearby health center. The objective of this study was to assess whether SAM treatment delivered by CHWs close to families' locations may improve the early identification of cases compared to outpatient treatment at health facilities (HFs), with a decreased number complicated cases referred to stabilization centers, increased anthropometric measurements at admission (closer to the admission threshold) and similarity in clinical outcomes (cure, death, and default). The study included 930 children aged 6 to 59 months suffering from SAM in the Kita district of the Kayes Region in Mali; 552 children were treated by trained CHWs. Anthropometric measurements, the presence of edema, and other medical signs were recorded at admission, and the length of stay and clinical outcomes were recorded at discharge. The results showed fewer children with edema at admission in the CHW group than in the HF group (0.4% vs. 3.7%; OR = 10.585 [2.222-50.416], p = 0.003). Anthropometric measurements at admission were higher in the CHW group, with fewer children falling into the lowest quartiles of both weight-for-height z-scores (20.2% vs. 31.5%; p = 0.002) and mid-upper arm circumference (18.0% vs. 32.4%; p<0.001), than in the HF group. There was no difference in the length of stay. More children in the CHW group were cured (95.9% vs. 88.7%; RR = 3.311 [1.772-6.185]; p<0.001), and there were fewer defaulters (3.7% vs. 9.8%; RR = 3.345 [1.702-6.577]; p<0.001) than in the HF group. Regression analyses demonstrated that less severe anthropometric measurements at admission resulted in an increased probability of cure at discharge. The study results also showed that CHWs provided more integrated care, as they diagnosed and treated significantly more cases of infectious diseases than HFs (diarrhea: 36.0% vs. 18.3%, p<0.001; malaria: 41.7% vs. 19.8%, p<0.001; acute respiratory infection: 34.8% vs. 25.2%, p = 0.007). The addition of SAM treatment in the curative tasks that the CHWs provided to the families resulted in earlier admission and more integrated care for children than those associated with HFs. CHW treatment also achieved better discharge outcomes than standard community treatment.

Recovery time from severe acute malnutrition and associated factors among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

OBJECTIVES

Recovery time from severe acute malnutrition (SAM) is often a neglected topic despite its clinical impact. Although a few studies have examined nutritional recovery time, the length of hospitalization in those studies varied greatly. Therefore, the aim of this study was to determine the recovery time from SAM and to identify predictors of length of hospitalization among under-5 children.

METHODS

A retrospective cohort study was conducted among 423 under-5 children with SAM who had been admitted to Yekatit 12 Hospital. Kaplan-Meier analysis was used to estimate time to nutritional recovery, and Cox proportional hazard regression analysis was performed to determine independent predictors.

RESULTS

The nutritional recovery rate was 81.3%, and the median recovery time was 15.00 days (95% confidence interval [CI], 13.61 to 16.39). Age, daily weight gain per kilogram of body weight, vaccination status, and the existence of at least 1 comorbidity (e.g., pneumonia, stunting, shock, and deworming) were found to be significant independent predictors of nutritional recovery time. The adjusted hazard ratio (aHR) for nutritional recovery decreased by 1.9% for every 1-month increase in child age (aHR, 0.98; 95% CI, 0.97 to 0.99).

CONCLUSIONS

The overall nutritional recovery time in this study was within the Sphere standards. However, approximately 13.0% of children stayed in the hospital for more than 28.00 days, which is an unacceptably large proportion. Daily weight gain of ≥8 g/kg, full vaccination, and deworming with albendazole or mebendazole reduced nutritional recovery time. Conversely, older age, pneumonia, stunting, and shock increased nutritional recovery time.

Time to recovery and determinants of severe acute malnutrition among 6-59 months children treated at outpatient therapeutic programme in North Gondar zone, Northwest Ethiopia: a prospective follow up study

BACKGROUND

Despite the available interventions to tackle nutritional problems, there is scarce information on time to recovery and its determinants among children with SAM in Ethiopia.

OBJECTIVE

This study was aimed at finding the time to recovery and determinants among 6-59 months children with severe acute malnutrition treated at an outpatient therapeutic programme in North Gondar zone, northwest Ethiopia.

METHODS

Facility based prospective follow up study was conducted from March 24 to May 24, 2017. A total of 408 children with the age of 6-59 months were included in the study. Structured interviewer administered questionnaire was used. Anthropometric measurements were conducted every week. The median time of recovery, Kaplan Meier (KM) curve, and log rank test were computed. Both bi-variable and multivariable Cox regression model was fitted. To establish an association between time to recovery and its determinants 95% confidence interval (CI) and p-value < 0.05 were used. Proportional hazard assumption was checked graphically and using Schoenfeld residual test.

RESULTS

Out of 389 children, 254 (65.3%) recovered. The median time to recovery was 38.5 ± IQR of 14 days. Children with diarrhoea AHR = 0.81 with 95% CI (0.73, 0.99), children taken amoxicillin AHR = 2.304 with 95% CI (1.68-3.161), and had vomiting at admission AHR = 0.430 with 95% CI (0.205, 0.904) were significant predictors of time to recovery.

CONCLUSIONS AND RECOMMENDATIONS

The overall time to recovery has not met the minimum sphere international standard which was lower than 75%. It is advisable to give emphasis to patients with diarrhoea and vomiting.

A meta-analysis of inpatient treatment outcomes of severe acute malnutrition and predictors of mortality among under-five children in Ethiopia

BACKGROUND

Severe forms of malnutrition have drastic effects on childhood morbidity and mortality in sub-Saharan countries, including Ethiopia. Although few studies have previously estimated treatment outcomes of severe acute malnutrition (SAM) in Ethiopia, the findings were widely varied and inconsistent. This study thus aimed to pool estimates of treatment outcomes and identify predictors of mortality among children with SAM in Ethiopia.

METHODS

A systematic review was carried out to select 21 eligible articles from identified 1013 studies (dating from 2000 to 2018) that estimated treatment outcomes and predictors of mortality among SAM children. Databases including PubMed, CINHAL, Web of Sciences; Cochrane, Psych INFO and Google Scholar were comprehensively reviewed using medical subject headings (MESH) and a priori set criteria PRISMA guideline was used to systematically review and meta-analyze eligible studies. Details of sample size, magnitude of effect sizes, including Hazard Ratio (HRs) and standard errors were extracted. Random-effects model was used to calculate pooled estimates in Stata/se version-14. Cochran's Q, I2, and meta-bias statistics were assessed for heterogeneity and Egger's test for publication bias.

RESULT

Twenty-one studies were included in the final analysis, which comprised 8057 under-five children with SAM in Ethiopia. The pooled estimates of treatment outcomes, in terms of death, recovery, defaulter and transfer out and non-response rates were 10.3% (95% CI: 8.3, 12.3), 70.5% (95% CI: 65.7, 72.2), 13.8% (95% CI: 10.8, 16.9) and 5.1% (95% CI: 3.3, 6.9), respectively. Diarrhea (HR: 1.5, 95% CI: 1.1, 2.2), dehydration (HR: 3.1, 95% CI: 2.3, 4.2) and anemia (HR: 2.2, 95% CI: 1.5, 3.3) were statistically significant predictors of mortality among these children. No publication bias was detected.

CONCLUSION

Treatment outcomes in under-five children with SAM are lower than the World Health Organization (WHO) standard, where mortality is being predicted by comorbidities at admission. Children with SAM need to be treated for diarrhea, dehydration and anemia at the primary point of care to reduce mortality.

An overview of the case fatality of inpatient severe acute malnutrition in Ethiopia and its association with human immunodeficiency virus/tuberculosis comorbidity-a systematic review and meta-analysis

Background

Mortality of children with severe acute malnutrition (SAM) is a devastating problem in Ethiopia. This study estimated the pooled case fatality ratio of SAM among children <5 y of age and its association with comorbidity.

Methods

An electronic search was carried out using the database of MEDLINE/PubMed through the HINARI Programme, Google Scholar and Google for grey literature. A random effects model was used to estimate the pooled case fatality ratio of SAM and the hazard ratio (HR) of human immunodeficiency virus (HIV)/tuberculosis (TB) comorbidity using Stata/SE version 14.

Results

A total of 13 studies were included in the meta-analysis. The overall case fatality ratio of SAM among children <5 y of age in Ethiopia was 11.3% (95% confidence interval [CI] 8.8-13.7) with the I2 heterogeneity test (I2=89.5%). Furthermore, the HR of SAM children was 3.4 (95% CI 1.91-6.06) in HIV and 2.08 (95% CI 1.2-3.61) in TB comorbidity as compared with their counterparts without comorbidity.

Conclusions

In the aggregate, the pooled case fatality ratio was unacceptably high in Ethiopia. The case fatality ratio of SAM children is higher in HIV and TB comorbidity. Therefore, escalation of the existing nutritional strategies and early case detection of comorbidity are strongly recommended to mitigate the case fatality ratio of SAM.

Survival Status and Its Determinants among Under-Five Children with Severe Acute Malnutrition Admitted to Inpatient Therapeutic Feeding Centers in South Wollo Zone, Amhara Region, Ethiopia

Background

Under nutrition is one of the leading causes of morbidity and mortality in under-five children in developing countries including Ethiopia. In Ethiopia, many children with severe acute malnutrition (SAM) are treated at inpatient therapeutic feeding centers. However, the survival status and its determinants are not well understood. Therefore, the aim of this study was to estimate the survival status and its determinants among under-five children with severe acute malnutrition admitted to inpatient therapeutic feeding centers (ITFCs).

Methods

A record review was conducted on 414 under-five children who were admitted with severe acute malnutrition to ITFCs in South Wollo Zone, northeast Ethiopia, between September 11, 2014, and January 9, 2016. Data were entered into Epi-Info version 7.2 and analyzed using SPSS version 20. Life table analysis was used to estimate cumulative proportion of survival. The relationship between time to recovery and covariates was determined using Cox-proportional hazards regression model. p < 0.05 was used to declare presence of significant association between recovery time and covariates.

Results

Of the total children recorded, 75.4% of children were recovered and discharged, 10.3% were defaulters, 3.4% died, 7.4% were nonresponders, and 3.4% were unknown. The mean (±standard deviation) time to recovery was 12 (±5.26) days, whereas the median time to recovery was 11 (interquartile range of 8–15) days. Children's breastfeeding status at admission (AHR: 1.42, 95% CI: 1.10, 1.83) and children without comorbidities at admission (AHR: 1.44, 95% CI: 1.03, 2.00) had statistically significant effect on time to recovery from SAM.

Conclusion

All treatment responses in this study were within the recommended and acceptable range of global standards. Policy makers, health facilities, and care providers may need to focus on the importance of breastfeeding especially for those under two years of age and give emphasis for cases with comorbidities.

Treatment cure rate and its predictors among children with severe acute malnutrition in northwest Ethiopia: A retrospective record review

BACKGROUND

More than 29 million that is an estimated 5%, under-five children suffer from severe acute malnutrition (SAM) globally, with a nine times higher risk of mortality than that of well-nourished children. However, little is known regarding outcomes and predictors of SAM in Ethiopia. Therefore, this study aims to determine treatment cure rate and its predictors among children aged 6-59 months with SAM admitted to a stabilization center.

METHODOLOGY

A retrospective record review was employed in SAM children at the University of Gondar Comprehensive Specialized Hospital (UOGCSH) from 2014 to 2016. SAM defined as weight for height below -3 z scores of the median World Health Organization (WHO) growth standards or presence of bilateral edema or mid upper arm circumference < 115mm for a child ≥6months age. All SAM patients with medical complication(s) or failure to pass appetite test are admitted to the malnutrition treatment center for inpatient follow-up. Data were extracted from a randomly selected records after getting ethical clearance. Data were cleaned, coded and entered to Epi-info version-7, and analyzed using STATA/se version-14. Descriptive statistics and analytic analyses schemes including bivariable and multivariable Cox proportional hazards model were conducted.

RESULT

Among a total of 416 records recruited for this study, 288 (69.2%) SAM children were cured at the end of the follow up, with a median cure time of 11 days. Kwash-dermatosis (AHR (Adjusted Hazard Ratio): 1.48(95% CI: 1.01, 2.16)), anemia (AHR: 1.36(95% CI: 1.07, 1.74)), tuberculosis (AHR: 1.6(95% CI: 1.04, 2.43)) and altered body temperature at admission (AHR: 1.58(95% CI: 1.04, 2.4) were independent predictors of time to cure.

CONCLUSION

The cure rate in SAM children was low relative to sphere standard guideline. Prognosis of SAM largely depends on the presence of other comorbidities at admission. Available intervention modalities need to address coexisting morbidities to achieve better outcomes in SAM children.

Time-to-recovery from severe acute malnutrition in children 6-59 months of age enrolled in the outpatient treatment program in Shebedino, Southern Ethiopia: a prospective cohort study

BACKGROUND

In Ethiopia uncomplicated severe acute malnutrition (SAM) is managed at health posts level through the outpatient therapeutic program (OTP). Yet, evidence on the treatment success rate of the program is scarce. This study determines the treatment outcomes and predictors of time-to-recovery among children 6-59 months of age with SAM managed at the health posts level in Shebedino district, Southern Ethiopia.

METHODS

This was a prospective cohort study that enrolled 216 children with SAM identified through a campaign conducted in May 2015 and treated over eight weeks at 25 health posts of the district. The average time-to-recovery was estimated using Kaplan-Meier survival curve and the independent predictors of the recovery were determined using multivariable Cox-proportional hazard model. The outputs of the analyses are presented via adjusted hazard ratio with 95% confidence intervals (AHR, CI).

RESULTS

At the end of the eight weeks of treatment 79.6% (95% CI: 74.2-85.0%) of cases recovered from SAM with a weight gain rate of 5.4 g/kg/day. The median time-to-recover was 36 days. The analysis indicated, maternal illiteracy (0.54, 0.38-0.78), severe household food insecurity (0.47, 0.28-0.79), walking for more than 1 h to receive the treatment (0.69, 0.50-0.96), diarrhoea co-morbidity (0.63, 0.42-0.91) and practicing sharing of ready to use therapeutic food (RUTF) (0.53, 0.32-0.88) were associated with slower propensity of recovery from SAM. Children who were enrolled with marasmus diagnosis showed lower recovery than children with kwashiorkor (0.30, 0.18-0.51).

CONCLUSION

The median time-to-recover was 36 days. Discouraging sharing of RUTF, appropriate management of diarrhoea in SAM cases and improving access to OTP sites can help to improve the treatment outcome for SAM.

Co-morbidity, treatment outcomes and factors affecting the recovery rate of under -five children with severe acute malnutrition admitted in selected hospitals from Ethiopia: retrospective follow up study

BACKGROUND

In spite of the availability of guidelines for the management of severe acute malnutrition (SAM) in Ethiopia, high comorbidity and poor treatment outcomes are still observed in therapeutic feeding centers among under -five children with SAM. The aim of this study was to assess comorbidity, treatment outcomes and factors affecting the recovery rate of children aged 1-59 months with SAM admitted into Therapeutic Feeding Centers (TFCs).

METHODS

A total of 413 records of children with SAM admitted in three selected hospitals from July 2013 to July 2015 G.C were retrospectively reviewed. Descriptive analysis was used to compare performance indicator values with SPHERE project reference standards (the minimum standard to be attained during nutritional therapy). Cox-proportional hazard regression analysis was performed to estimate the predictors of recovery rate at p-value < 0.05.

RESULT

The mean age of children was 16 months (95% CI, 15.0, 17.0). Out of 413 children with SAM, 231 (55.9%) recovered, 24 (5.8%) died and 16.3% were defaulted from TFCs. The mean weight gain (in gram per weight of kilogram per day) for recovered children was 15.61 g/kg/day (95% CI, 14.15, 17.07). The overall median recovery time for these children was 12 days (95% CI, 11.22, 12.78). Moreover, most (77.5%) of children admitted with SAM were marasmic followed by Kwash (16%). Pneumonia (54.8%), diarrhea (41.8%) and rickets (21.4%) were co-morbidities which affected SAM children. A child being admitted at Mehal Meda Hospital (Adjusted Hazard Ratio (AHR) = 2.01; 95% CI: 1.34, 2.91), edematous form of malnutrition (AHR = 0.59; 95% CI: 0.39, 0.90) and being a child infected with pneumonia (AHR = 0.71; 95% CI: 0.51, 0.98) were predictors of nutritional recovery rate.

CONCLUSION

Under five pneumonia, diarrhea and rickets were co-morbidities that should be prevented. Recovery rate was poor when compared to SPHERE project reference value (which is > 75%). Predictors, namely presence of pneumonia and edematous form of malnutrition reduced nutritional recovery rate. Whereas, being admitted at Mehal Meda Hospital improved recovery rate. Therefore, hospitals should work in collaboration with health extension workers to prevent co-morbidities and strengthen screening and referral of malnutrition cases at community level. Moreover, Zonal Health Department and District Health Offices should facilitate experience sharing among health facilities.

The role of dietary diversity in the response to treatment of uncomplicated severe acute malnutrition among children in Niger: a prospective study

Background

Community-based treatment of severe acute malnutrition (SAM) has proven to be safe and cost-effective, although identifying additional factors that can increase recovery and decrease treatment failure may improve program effectiveness. We examine the association of dietary diversity and clinical and program treatment outcomes among children treated for uncomplicated SAM in Niger.

Methods

Two thousand four hundred twelve children were enrolled in a randomized trial of routine amoxicillin in the treatment of uncomplicated SAM from 2012 to 2014. All children received ready to use therapeutic food (RUTF) and standard clinical care. Child dietary diversity was assessed using a 7-day food frequency questionnaire and 8-food group diet diversity score. We assessed the association of dietary diversity at admission with nutritional recovery, hospitalization, and death at program discharge and 12 weeks, and weight and height gain.

Results

Food groups most commonly consumed by children in seven days preceding SAM treatment were cereals, roots and tubers (N = 2364, 99.5%) and vitamin A rich fruits and vegetables (N = 2253, 94.8%). Egg (N = 472, 19.9%) and dairy (N = 659, 27.7%) consumption was low. Mean (SD) diet diversity score was significantly lower in the lean vs. non-lean season [2.7 (1.1) vs. 2.9 (1.0)]. There was no evidence that dietary diversity increased nutritional recovery at discharge (RR: 1.02, 95% CI: 1.00, 1.04) or 12 weeks (RR: 0.98, 95%CI: 0.94, 1.02). No significant association was found with risk of hospitalization or death, or weight and height gain. Egg consumption was protective against death at discharge (RR: 0.53, 95% CI: 0.39, 0.70) and 12 weeks (RR: 0.66, 95% CI: 0.45, 0.96). Vitamin A rich fruits and vegetable consumption was associated with greater risk of mortality in children at discharge (RR: 1.30, 95% CI: 1.08, 1.56) and 12 weeks (RR: 1.19, 95% CI: 1.03, 1.36).

Conclusions

We did not find evidence that dietary diversity influenced nutrition recovery or response to treatment for children with uncomplicated SAM in Niger. It is feasible consumption of nutrient-dense foods like eggs may be important for recovery from SAM. There is need for continued research to further elucidate drivers of nutritional recovery from acute malnutrition in different settings.

Trial registration

Trial registration number: ClinicalTrials.gov NCT01613547. Registered May 26, 2012.

Management of severe acute malnutrition by cow milk in resource constraints settings: experience of the Nutritional Centre of the University Clinics of Graben

Background

Severe acute malnutrition is defined as a weight for height z-score < − 3 standard deviation. Since 2000, joint efforts of the World Health Organization and United Nations Children’s Fund allowed to standardize the management of acute malnutrition by improving outcome and preventing complications with the introduction of therapeutic milk and ready-to-use therapeutic foods. However, in the Democratic Republic of Congo, many health facilities face therapeutic milk shortage while managing severe acute malnutrition. At the University Clinics of Graben, cow milk with porridge made of maize, soybean, vegetal oil and sugar is used during stockouts periods. This study was carried out to analyse the efficiency and safety of this treatment compared to the conventional one in SAM patients.

Methods

This study is based on the experience of the University Clinics of Graben in eastern Democratic Republic of Congo whose nutritional centre is often confronted with stockouts in nutritional supplements. During a three months shortage in 2015, patients received cow milk alternating with preparations made from sugar-maize-soybean- vegetal oil. The study compared the evolution of these children with those who had previously been treated with the WHO conventional preparations by analysing weight changes, oedema resolution, gastrointestinal tolerability and clinical outcome over 21 days. Data were analysed with SPSS 20. We used the ANOVA, Chi-square test, odd ratio and p-value to compare the differences.

Results

Seventy-nine patients had received cow milk while fifty-seven were submitted to classical therapeutic milk. There was no significant difference between the two groups regardless the type of malnutrition in terms of weight changes, oedema resolution, gastrointestinal tolerability and clinical outcome over 21 days.

Conclusion

Cow milk alternately with sugar-maize-soybean- vegetal oil preparations is an acceptable alternative in case of stockouts in conventional therapeutic milk in these settings.

Recovery time and associated factors of severe acute malnutrition among children in Bahir Dar city, Northwest Ethiopia: an institution based retrospective cohort study

Background

Malnutrition commonly affects all groups in a community, but infants and young children are the most vulnerable. Worldwide, nearly 24 million under five children experience severe acute malnutrition (SAM) which contributes to one million child deaths yearly and 19 million severely wasted children are living in developing countries. While the treatment of severe acute malnutrition (SAM) is well established, achieving desired outcomes has proven to be challenging. There is limited evidence showing the success of treatments in the study area. Therefore, this study aimed to determine recovery time from severe acute malnutrition and identify predictors among children of 6-59 months of age.

Methods

Facility based retrospective cohort study was conducted among 401 children 6-59 months of age who have been treated for SAM. Both descriptive and analytic analyses were executed. The results were determined using Kaplan-Meier procedure, log-rank test and Cox-regression. Variables having P-value ≤0.2 during binary analysis were entered into multivariate analysis. P value < 0.05 was considered as statistically significant.

Results

The recovery rate was 51.9% and the median recovery time was 16 days (95%CI: 14.233-17.767). Controlling for other factors; having anemia at admission, no plumpy nut provision, failing to enter in to phase 2 on day 10 and a weight gain of more than 8 g/kg/day were significant predictors of recovery time.

Conclusions

Nutritional recovery rate was far outside of the accepted minimum international standard while median recovery time ranged in the accepted minimum international standard. Children had a lower chance of recovering early when they had anemia at admission, not provided plumpy nut, failed to enter phase 2 on day 10 and failed to gain more than 8 g/kg/day. Therefore, efforts should be strengthened to facilitate early recovery of children by considering the identified predictors of recovery time.

Changes in susceptibility to life-threatening infections after treatment for complicated severe malnutrition in Kenya

Background

Goals of treating childhood severe acute malnutrition (SAM), in addition to anthropometric recovery and preventing short-term mortality, include reducing the risks of subsequent serious infections. How quickly and how much the risk of serious illness changes during rehabilitation are unknown but could inform improving the design and scope of interventions.

Objective

The aim of this study was to investigate changes in the risk of life-threatening events (LTEs) in relation to anthropometric recovery from SAM.

Design

This was a secondary analysis of a clinical trial including 1778 HIV-uninfected Kenyan children aged 2-59 mo with complicated SAM, enrolled after the inpatient stabilization phase of treatment, and followed for 12 mo. The main outcome was LTEs, defined as infections requiring rehospitalization or causing death. We examined anthropometric variables measured at months 1, 3, and 6 after enrollment in relation to LTEs occurring during the 6 mo after each of these time points.

Results

Over 12 mo, there were 823 LTEs (257 fatal), predominantly severe pneumonia and diarrhea. At months 1, 3, and 6, 557 (34%), 764 (49%), and 842 (56%) children had a weight-for-height or -length z score (WHZ) ≥-2, respectively, which, compared with a WHZ <-3, was associated with lower risks of subsequent LTEs [adjusted HRs (95% CIs): 0.50 (0.40, 0.64), 0.30 (0.23, 0.39), and 0.23 (0.16, 0.32), respectively]. However, children with a WHZ ≥-2 at 1, 3, and 6 mo still had 39 (95% CI: 32, 47), 26 (95% CI: 22, 32), and 15 (95% CI: 12, 20) LTEs/100 child-years of observation during the following 6 mo. WHZ at study enrollment predicted subsequent WHZ but not the risk of LTEs. Changes in height-for-age z score did not predict LTEs.

Conclusions

Anthropometric response was associated with a rapid and substantial reduction in risk of LTEs. However, reduction in susceptibility lagged behind anthropometric improvement. Disease events, together with anthropometric assessment, may provide a clearer picture of the effectiveness of interventions. Robust protocols for detecting and treating poor anthropometric recovery and addressing broader vulnerabilities that complicated SAM indicates may save lives. This trial was registered at www.clinicaltrials.gov as NCT00934492.

Children with oedema recover better than those with severe wasting in outpatient therapeutic program at Boloso Sore district, Southwest Ethiopia

Objectives

Severely undernourished young children clinically present with a typical nutritional oedema or none-oedematous. However, research evidence is limited on how these types predict treatment outcomes in Ethiopia. This study was aimed to compare oedematous and none-oedematous children for their treatment outcomes in Boloso Sore district in Southwest Ethiopia.

Results

The overall recovery rate was 396 (68%). From oedematous children; 235 (79.9%) recovered, 18 (6.1%) transferred, 6 (2.0%) defaulted, 3 (1.0%) died, and 32 (11%) remained none-respondents. The treatment outcomes among the none-oedematous children were 161 (55.9%), 12 (4.2%), 4 (1.4%), 3 (1.0%), and 108 (37.5%) in similar order. Treatment outcomes of severely undernourished children in the two arms were statistically different (Χ² = 5.82, P < 0.016). Severely malnourished children with oedema were 2.3 times highly likely to recover as compared to those without it (adjusted hazard ratio = 2.3 at 95% confidence interval: 1.79, 2.82). We documented that oedematous children in the study area had a better likelihood of recovery as compared to those with severe wasting. We recommend targeted community outreach activities on severe acute malnutrition focusing on the types.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3232-x) contains supplementary material, which is available to authorized users.

Survival status and factors associated with treatment outcome of severely malnourished children admitted to Ayder referral hospital: a cross-sectional study

Background

Severe acute malnutrition remains the major cause of morbidity and mortality for children under five years of age in developing countries. The prevalence of wasting, underweight and stunting has remained high in Ethiopia and even unacceptably higher in Tigray region. The objective of the study is to assess the survival status and treatment outcome of patients with severe acute malnutrition and to identify contributing factors for poor treatment outcome.

Methods

An institutional-based cross-sectional study was conducted on 195 patients, selected using systematic random sampling technique, from 24-Mar-2015 to 7-Jun-2015 in Ayder Referral Hospital. Logistic regression was carried out to identify factors associated with treatment outcome. Rates of mortality associated with the disease were determined using Kaplan-Meier survival analysis. A Log Rank, Breslow, and Tarone-Ware test were employed for the overall comparisons of the survival curves. Statistical significance was declared at p – value <0.05.

Result

Out of 195 children admitted with SAM, the cure, death, defaulter, non-respondent and transferred-out rates were 22.1%, 3.6%, 43.6%, 9.2% and 21.5% respectively. Overall, 43.6% of the children were recovered from their disease. The mean length of stay of a ‘recovered’ child in the hospital was 21.56 ±1.27 days (95% CI: 19.04–24.09 days). Free from acute febrile illness (AOR = 4.20, 95% CI: 1.10–16.09, p < 0.036) and usage of deworming medications (AOR = 0.36, 95% CI: 0.14–0.93, p < 0.036) were significantly associated with positive and negative treatment outcomes respectively. Children with >70% of weight for height (WFH) and mid-upper arm circumference (MUAC) of >12 cm at admission had a better treatment outcome than children with WFH of ≤ 70% (p < 0.038) and MUAC of ≤ 12 cm (p < 0.090). Treatment using ready-to-used therapeutic food (RUTF) provided a longer all-cause mortality protection than the treatment using F-75 and F-100 (p < 0.010).

Conclusion

The cure rate in this study was found to be sub-optimal. Absence of acute febrile illness and deworming medication use were factors contributing to good treatment outcome. A WFH of >70%, MUAC of ≥ 12 cm and treatment using RUTF provided a longer all-cause mortality protection.

Recovery rate and associated factors of children age 6 to 59 months admitted with severe acute malnutrition at inpatient unit of Bahir Dar Felege Hiwot Referral hospital therapeutic feeding unite, northwest Ethiopia

BACKGROUND

Despite numerous advances made in improving child health and the clinical management protocols for treating severe acute malnutrition at treatment centers, evidences concerning the treatment outcomes are scarce. Therefore, this study was conducted to assess the recovery rate and associated factors of severely acute malnourished children of age 6 to 59 months admitted to inpatient therapeutic feeding unit at Felege Hiwot Referral Hospital.

METHODS

We conducted a hospital-based cross-sectional study including 401 severely malnourished children who were admitted from September 2012 to January 2016. Bivariable and a Multivariable logistic regression model were fitted to identify factors associated with recovery rate. Adjusted Odds ratio with its 95% CI was reported and P-value less than 0.05 was considered as significant.

RESULTS

Fifty eight percent (58.4%) (95%CI: 53.1-64.1) of admitted children were recovered with a mean recovery time of 18 (±6.3) days. Being female, children who were fully and partially vaccinated, who had better MUAC measurement, who stayed longer in the hospital, and children who took routine vitamin-A supplementation had better recovery rate. However, children who had co-morbidity at admission, had human immune virus (HIV) and Tuberculosis (TB) infection, and who had edema were less likely to recover.

INTERPRETATION

Recovery rate was low as compared to international SPHERE cutoff points (> 75% recovery rate). Interventions that could address the outlined factors would be helpful to improve treatment recovery rate of admitted children.