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

The Spectrum of Pathogens Associated with Infections in African Children with Severe Acute Malnutrition: A Scoping Review

Understanding the interplay between infections and severe acute malnutrition is critical in attaining good clinical outcomes when managing malnourished children. However, review studies describing the profile of the associated pathogens in the malnourished African paediatric population are sparse in the literature. We aimed to identify the spectrum of pathogens from studies reporting infections in severely malnourished African children, as well as the antibiotic resistance pattern and clinical outcomes. A systematic literature review of the PubMed database was conducted following PRISMA guidelines from January 2001 to June 2024. The search algorithm was ((marasmus) OR (kwashiorkor) OR (severe acute malnutrition) OR (protein energy malnutrition)) AND (Africa). For a more comprehensive retrieval, an additional search algorithm was deployed: ((HIV) OR (tuberculosis)) AND (severe acute malnutrition). We included 60 studies conducted between 2001 and 2024. Most of the studies were from East Africa (n = 45, 75%) and Southern Africa (n = 5, 8.3%). A total of 5845 pathogens were identified comprising 2007 viruses, 2275 bacteria, 1444 parasites, and 119 fungal pathogens. The predominant pathogens were HIV, Mycobacterium tuberculosis, and malaria parasites accounting for 33.8%, 30%, and 24.2% of pathogens identified. Antibiotic susceptibility testing was documented in only three studies. Fatality rates were reported in 45 studies and ranged from 2% to 56% regardless of the category of pathogen. This review affirms the deleterious effect of infections in malnourished patients and suggests a gross underdiagnosis as studies were found from only 17 (31.5%) African countries. Moreover, data on fungal infections in severely malnourished African children were nearly absent despite this population being at risk. Thus, there is an urgent need to prioritize research investigating African children with severe acute malnutrition for fungal infections besides other pathogens and improve the availability of diagnostic tools and the optimized usage of antibiotics through the implementation of antimicrobial stewardship programmes.

Determinants of recovery time from severe acute malnutrition among cholera-exposed and unexposed children in Ethiopia: a prospective cohort study

Background

There is a vicious interplay between severe acute malnutrition (SAM) and diarrheal diseases including cholera. The lack of sufficient evidence on the time to recovery and its determinants among children with cholera prompted this investigation. The study aimed to evaluate the time to recovery and determinants among children with severe acute malnutrition, comparing cholera-exposed and unexposed children.

Methods

A prospective cohort study was carried out from September 10, 2022, to February 21, 2023, among 224 children below 15 years. The study was conducted at cholera treatment centers and nearby communities in the Bale and Guji Zones of Oromia Regional state in Ethiopia. A structured questionnaire was used to obtain information and anthropometric measurements were conducted weekly. After checking all assumptions, a multivariable Cox Proportional Hazards model was used to identify independent determinants of time to recovery using an adjusted hazard ratio (AHR) with a 95% confidence interval (CI). Statistical significance was declared at p < 0.05.

Results

Nearly 80% of participants recovered from SAM with a recovery rate of 40/1000 person-week observation and a median time to recovery of 21 days [Inter Quartile Range14-28]. The recovery time from SAM for cholera-exposed children was delayed by 54% [ARR: 0.46, 95% CI: 0.30-0.69] compared to unexposed children. Similarly, the recovery time from SAM for food-insecured families was delayed by 39% [ARR: 0.61, 95% CI: 0.38-0.96] compared to food-secured families. Moreover, children with more than three meal frequencies per day had 1.61 times [ARR: 1.61, 95% CI: 1.04-2.50] higher probability of fast recovery from SAM, compared to children with less than three meals. Children from families with good attitudes toward nutrition had more than two times [ARR: 2.23, 95% CI: 1.45-3.41] higher probability of faster recovery from SAM than families with poor attitudes.

Conclusion

The study revealed that cholera exposure is one of the main determinants of prolonged recovery time for children with SAM. Food insecurity, meal frequency, and the attitude of parents toward children's dietary habits were determinants for the recovery of children from SAM. The findings imply the need for designing interventions to enhance child feeding during cholera illness, focusing on key determinants.

Time to recovery and its predictors among children aged 6-59 months having uncomplicated severe acute malnutrition attending an outpatient therapeutic program in Northeast Ethiopia: prospective cohort study

Introduction

There are insufficient data regarding the variables influencing recovery times, despite the accessible outpatient therapy program (OTP) bringing services for treating severe acute malnutrition (SAM) closer to the community. Therefore, this study aimed to identify the factors influencing the recovery duration in children with uncomplicated SAM between the ages of 6 and 59 months who were attending an OTP in North Wollo, northern Ethiopia.

Methods

From February 2021 to July 2021, 356 children, ages 6-59 months, enrolled in a facility-based prospective cohort study. An interviewer administered a semi-structured questionnaire once a week to acquire anthropometric measures. The data were imported into Stata version 14.2 for analysis from EPI data entry version 4.6.06. The time to recovery for each attribute was determined using a log-rank test, a survival curve, and a Kaplan-Meier estimate of the median time to recovery. The Cox Proportional-Hazards Model was used to identify independent predictors of recovery time; statistical significance was indicated at 95% CI and a p-value of 0.05.

Results

With a recovery rate of 74.7%, the median recovery period was 56 days. Frequency of growth monitoring and promotion (GMP) service utilization [AHR = 1.622 (95% CI: 1.052-2.130)], cough [AHR = 0.385 (95% CI: 0.176-0.843)], maternal delivery at health center [AHR = 1.448 (95% CI: 1.023-2.050)], and maternal literacy [AHR = 1.445 (95% CI: 1.019-2.058)] were determinants of time to recovery.

Conclusion

The median recovery period was 56 days with a recovery rate of 74.7%. Regular utilization of GMP services, maternal delivery at the health center, and cough at admission were independent predictors for this study. As a result, there should be a greater emphasis on the importance of girls' (future mothers') education and nutrition counseling, particularly the integration of GMP service components into institutional delivery/for girls/women who have received little education on how to improve time to recovery and the success of the OTP.

Effects of Formula-100 therapeutic milk and Bregas Nutriroll ready-to-use therapeutic food on Indonesian children with severe acute malnutrition: A randomized controlled trial study

Severe acute malnutrition (SAM) is a global health concern that affects children and leads to delayed growth. The aim of this study was to compare the impact of F100 milk and Bregas Nutriroll, a local ready-to-use therapeutic food (RUTF), on SAM children. An unmasked, non-blinded, two-group, and simple randomized controlled trial was conducted. Indonesian children aged 12-59 months with SAM were randomly assigned to receive either F100 milk or Bregas Nutriroll. After eight weeks, the increase in the mean weight gain in both groups was assessed. The Bregas Nutriroll group (n=19) had a mean weight gain of 1.07±0.09 kg, while the F100 group (n=17) had a mean weight gain of 1.05±0.11 kg. The Bregas Nutriroll group had a slightly higher gain of mid-upper arm circumference (MUAC) than the F100 group (0.62±0.34 cm vs 0.50±0.37 cm). The gain of children's height of the Bregas Nutriroll group was 0.96±0.42 cm, while the F100 group was shorter at a mean of 0.81±0.44 cm. Statistically significant differences (p<0.001) in nutritional status were observed based on weight, MUAC, and height/length after F100 and Bregas Nutriroll interventions. The intervention with F100 increased hemoglobin (Hb) levels of 0.71±1.25 mg/dL, while the Bregas Nutriroll intervention led to an increase of 0.11±1.39 mg/dL. In conclusion, our study showed that community-based treatment with F100 milk or Bregas Nutriroll resulted in nutritional status in children with SAM. These findings suggested that both treatments could be effective in treating SAM in improving nutritional status and child health outcomes.

Micronutrient supplementation practices in relation to the World Health Organisation 2013 guidelines on management of severe acute malnutrition

In 2013, the World Health Organisation (WHO) updated the recommendations for micronutrient deficiency correction in hospitalised under-5 children with complicated severe acute malnutrition (SAM). This study aimed to describe the micronutrient deficiency correction practices in relation to WHO 2013 recommendations. Data from medical records of under-5 children admitted for SAM management at two hospitals in South Africa and three tertiary hospitals in Ghana were extracted. Micronutrient correction practices were compared to the WHO 2013 recommendations by considering the dosage, timing of micronutrient supplementation (vitamin A, iron and folic acid) and therapeutic feeds administered. In total, 723 medical records were included. Nearly half (48.3%) of the children received at least one of the studied micronutrients as a supplement. Vitamin A was supplemented in 27.4% of the children, while iron and folic acid were supplemented in 9.5% and 34.9%, respectively. Among the children who received vitamin A, 60.1% received the first dose on Day 1 of admission. Also, 46.4% of the iron-supplemented children received iron within the first week of admission. Vitamin A, iron and folic acid were administered within the dose range of 100,000-180,000 IU, 3.1-7.7 mg per kg per day, and 3-5 mg per day, respectively. Additionally, 71.7% of the children reportedly received therapeutic feeds that met WHO recommendations. The micronutrient deficiency correction practices regarding dose and timing differed from the 2013 WHO guidelines. Qualitative studies investigating the reasons for the disparities are recommended.

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.

Time to recovery and its predictors among under five children in outpatient therapeutic feeding programme in Borena zone, Southern Ethiopia: a retrospective cohort study

OBJECTIVES

This study aimed to assess the time to recovery and its predictors among 6-59 months aged children treated at an outpatient therapeutic feeding programme in Borena zone.

DESIGN

A retrospective cohort study.

SETTING

Facility based; 23 treatment sites included in this study.

PARTICIPANTS

Among the cohorts of 601 children aged 6-59 months enrolled from July 2019 to June 2021, records of 590 children were selected using systematic random sampling. Transfers and incomplete records were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES

Time to recovery was a main outcome while its predictors were secondary outcomes.

RESULTS

The median recovery time was 49 days (95% CI=49 to 52) with a recovery rate of 79.8% (95% CI=76.4 to 83.0). Absence of comorbidity (adjusted HR, AHR=1.72, 95% CI=1.08 to 2.73), referral way by trained mothers on screening (AHR=1.91, 95% CI=1.25 to 2.91), new admission (AHR=1.59, 95% CI=1.05 to 2.41) and adequate Plumpy'Nut provision (AHR=2.10, 95% CI=1.72 to 2.56) were significantly associated with time to recovery. It is also found that being from a distance ≥30 min to treatment site lowers a chance of recovery by 27% (AHR=0.73, 95% CI=0.60 to 0.89).

CONCLUSIONS

The findings showed that a time to recovery was within an acceptable range. Incidence of recovery is enhanced with early case detection, proper management, nearby service, new admissions, provision of adequate Plumpy'Nut and enabling mothers to screen their own children for acute malnutrition. However, we did not observe a statistically significant association among breastfeeding status, type of health facility, wasting type, vaccination and routine medications. Service providers should improve adherence to treatment protocols, defaulter tracing, community outreach and timely case identification.

Nutritional Recovery of Children With HIV and Severe Acute Malnutrition Attending an Outpatient Therapeutic Care Program

BACKGROUND

Despite significant morbidity and mortality from HIV and severe acute malnutrition (SAM) among children in sub-Saharan Africa, research is lacking in these children. We describe the proportion of children living with HIV with SAM achieving recovery, the factors associated with recovery, and time to recovery in an outpatient therapeutic care program.

SETTING AND METHODS

This is a retrospective observational study of children with SAM and HIV on antiretroviral therapy (6 months-15 years), enrolled in outpatient therapeutic care from 2015 to 2017 at a pediatric HIV clinic in Kampala, Uganda. SAM diagnosis and recovery by 120 days after enrollment were determined per World Health Organization guidelines. Cox-proportional hazards models were used to determine predictors of recovery.

RESULTS

Data from 166 patients were analyzed (mean age 5.4 years, SD 4.7). Outcomes showed 36.1% recovered, 15.6% were lost to follow-up, 2.4% died, and 45.8% failed. Average time to recovery was 59.9 days (SD 27.8). Patients 5 years or older were less likely to recover (crude hazard ratio [CHR] = 0.33, 95% CI: 0.18 to 0.58). In multivariate analysis, febrile patients were less likely to recover (adjusted hazard ratio = 0.53, 95% CI: 0.12 to 0.65). Patients with CD4 count of 200 or less at enrollment were less likely to recover (CHR = 0.46, 95% CI: 0.22 to 0.96).

CONCLUSIONS

Despite treatment with antiretroviral therapy for children living with HIV, we observed poor rates of recovery from SAM, below the international target of >75%. Moreover, patients 5 years and older, fever, or low CD4 at diagnosis of SAM may require more intense therapy or closer monitoring than their counterparts.

Treatment outcomes among children admitted stabilization centers in Eastern Ethiopia: retrospective study

Background

There is improved access to Sever Acute Malnutrition management in Ethiopia; however, studies have revealed an alarming rate of defaulters' poor recovery and deaths, emphasizing the importance of researching to identify major causes. As a result, the goal of this research is to identify treatment outcome determinants and associated factors in severely malnourished children aged 6-59 months admitted to public hospitals in Eastern Ethiopia's stabilization centers.

Methods

This study used an institutional-based retrospective cohort study design with 712 children aged 6 to 59 months. Data was gathered using a Sever Acute Malnutrition registration logbook and patient charts. Participants were chosen at random from their respective healthcare facilities based on population proportion. Epi-data was entered and analyzed using STATA version 14. To identify associated factors, the Cox proportional hazard Ratio was calculated, and a p-value of 0.05 at the 95% confidence interval was considered statistically significant.

Results

This study revealed that only 70.65% (95% CI = 67.19, 73.88) of the children were cured while 17.84% defaulted from the management and 5.90% died. Children who did not have tuberculosis (AHR = 1.58, 95%CI:1.04, 2.40), anemia (AHR = 1.31, 95% CI:1.03, 1.68), Kwash dermatosis (AHR = 1.41, 95%CI:1.04, 1.91), or on NG-tube (AHR = 1.71, 95%CI:1.41, 2.08) were more likely to be cured from SAM.

Conclusion

This study discovered that the cure rate is extremely low and the defaulter rate is extremely high. As a result, intervention modalities that address the identified factor are strongly recommended to accelerate the rate of recovery in Eastern Ethiopia.

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.

A Systematic Review on the Optimal Dose and Duration of Ready-to-Use Therapeutic Food (RUTF) for 6-59-Month-Old Children with Severe Wasting or Oedema

The World Health Organisation (WHO) recommends that severe wasting and/or oedema should be treated with ready-to-use therapeutic food (RUTF) at a dose of 150-220 kcal/kg/day for 6-8 weeks. Emerging evidence suggests that variations of RUTF dosing regimens from the WHO recommendation are not inferior. We aimed to assess the comparative efficacy and effectiveness of different RUTF doses and durations in comparison with the current WHO RUTF dose recommendation for treating severe wasting and/or oedema among 6-59-month-old children. A systematic literature search identified three studies for inclusion, and the outcomes of interest included anthropometric recovery, anthropometric measures and indices, non-response, time to recovery, readmission, sustained recovery, and mortality. The study was registered with PROSPERO, CRD 42021276757. Only three studies were eligible for analysis. There was an overall high risk of bias for two of the studies and some concerns for the third study. Overall, there were no differences between the reduced and standard RUTF dose groups in all outcomes of interest. Despite the finding of no differences between reduced and standard-dose RUTF, the studies are too few to conclusively declare that reduced RUTF dose was more efficacious than standard RUTF.

Time to recovery from malnutrition and its predictors among human immunodeficiency virus positive children treated with ready-to-use therapeutic food in low resource setting area: A retrospective follow-up study

Background and Aim

Malnutrition is a serious public health issue and a frequent impact of human immunodeficiency virus (HIV) infection, which raises the risk of morbidity and mortality in affected people. Despite the World Health Organization's (WHO) support for the use of ready-to-use therapeutic foods (RUTF) to treat malnutrition, research on the length of time it takes for children with HIV infection to recover from malnutrition and the factors that predict it is lacking, particularly Ethiopia.

Methods

An institution-based retrospective follow-up study was carried out in the Amhara regional state referral hospitals in Northern Ethiopia. From 2013 to 2018, a total of 478 children who received RUTF treatments were chosen using a simple random sampling technique. To calculate the likelihood of recovery and the median recovery period, incidence and Kaplan-Meier survival analyses were performed. The Cox regression model was used to identify predictors of time to recovery from malnutrition. The multivariable model only included variables with a p value below 0.2. While factors were deemed to be substantially linked with the outcome variable if their p value was less than 0.05.

Results

The median recovery duration was 5 months (95% confidence interval [CI] = 4-5 months), and the nutritional recovery rate was 64.64% (95% CI = 60.2-68.9). Moderate acute malnutrition (adjusted hazard ratio [AHR] = 4.60, 95% [CI] = 2.85-7.43), WHO clinical stage I (AHR = 4.01, 95% CI = 1.37-11.77), absence of opportunistic infection (AHR = 1.76, 95% CI = 1.19-2.61), haemoglobin (Hgb) count above the threshold (AHR = 1.36, 95% CI = 1.01-1.85) and family size of 1-3 (AHR = 2.38, 95% CI = 2.38-5.00) were significantly linked to rapid recovery from malnutrition.

Conclusion

In comparison to the period specified by the national guideline (3 months for moderate and 6 months for severe acute malnutrition), the median time to recovery was lengthy. Acute malnutrition, clinical stage, opportunistic infection, Hgb count, and family size were statistically associated with early recovery from malnutrition.

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.

Predictors of time to recovery and non-response during outpatient treatment of severe acute malnutrition

Background

Every year, over 4 million children are treated for severe acute malnutrition with varying program performance. This study sought to explore the predictors of time to recovery from and non-response to outpatient treatment of SAM.

Methods

Children with weight-for-height z-score (WHZ) <-3 and/or mid-upper arm circumference (MUAC) <115 mm, without medical complications were enrolled in a trial (called MANGO) from outpatient clinics in Burkina Faso. Treatment included a weekly ration of ready-to-use therapeutic foods. Recovery was declared with WHZ ≥-2 and/or MUAC ≥125 mm, for two weeks without illness. Children not recovered by 16 weeks were considered as non-response to treatment. Predictors studied included admission characteristics, morbidity and compliance during treatment and household characteristics. Cox proportional hazard models were fitted and restricted mean time to recovery calculated. Logistic regression was used to analyse non-response to treatment.

Results

Fifty-five percent of children recovered and mean time to recovery was eight weeks while 13% ended as non-response to treatment. Independent predictors of longer time to recovery or non-response included low age, being admitted with WHZ <-3, no illness nor anaemia at admission, illness episodes during treatment, skipped or missed visits, low maternal age and not practising open defecation. Eighty-four percent of children had at least one and 59% at least two illness episodes during treatment. This increased treatment duration by 1 to 4 weeks. Thirty-five percent of children missed at least one treatment visit. One missed visit predicted 3 weeks longer and two or more missed visits 5 weeks longer treatment duration.

Conclusions

Both longer time to recovery and higher non-response to treatment seem most strongly associated with illness episodes and missed visits during treatment. This indicates that prevention of illnesses would be key to shortening the treatment duration and that there is a need to seek ways to facilitate adherence.

Time to recovery and its predictors among children aged 6–59 months with severe acute malnutrition admitted to outpatient therapeutic program in Southwest Ethiopia: retrospective cohort study

Background

Outpatient therapeutic program (OTP) brings the services for the management of Severe Acute Malnutrition (SAM) closer to the community by making services available at decentralized treatment points within the primary health care setting. Despite the available interventions to tackle nutritional problems, there is scarce information on time to recovery and its predictors. Therefore, the aim of this study was to estimate time to recovery and identify its predictors among children aged 6–59 month with SAM admitted to OTP in Bench Sheko zone Southwest Ethiopia.

Methods

A retrospective cohort study was conducted on 588 children who had been managed for SAM under OTP, from September 01, 2018, to August 30, 2019, in 4 public health centers in Bench Sheko zone. A total of 1301 children’s card were eligible from them 588 children’s cards were selected by simple random sampling methods. Data was entered into EPI- data version 4.4.2 and exported to SPSS version 20 for analysis. Kaplan Meir estimate median time to recovery and survival curve was used to compare the time to recovery using a log-rank test among different characteristics. Cox Proportional Hazard Model was used to identify significant predictors of time to recovery. Association was summarized by using adjusted hazard ratio (AHR) and statistical significance was declared at 95% CI, and P-value < 0.05.

Result

Recovery rate was 54.4% with the median recovery time 49 days with an Interquartile range of 21 days. The independent predictors of nutritional recovery time were: newly admitted (AHR = 1.52, 95% CI: 1.17, 2.98),had no diarrhea (AHR = 1.9, 95% CI: 1.52, 2.42), had no cough (AHR = 1.4, 95% CI: 1.13, 1.74) had no blood stool (AHR = 1.55, 95% CI: 1.14, 2.10) had no malaria (AHR = 1.75, 95% CI: 1.32, 2.32), and took deworming (AHR = 1.4, 95% CI: 1.01–1.61).

Conclusion and recommendation

In the current study recovery rate and the median time of recovery is by far below the standard. Cough, diarrhea, malaria, deworming and admission status were independently associated with recovery time. Health professionals should give attention for early detection and management of co-morbidities. Minster of health should give refreshment community based management of acute malnutrition training for health workers to follow the national guideline strictly.

Incidence and predictors of severe acute malnutrition mortality in children aged 6-59 months admitted at Pawe general hospital, Northwest Ethiopia

Background

Severe acute malnutrition (SAM) is defined as a weight-for-height < -3z scores of the median WHO growth standards, or visible severe wasting or the presence of nutritional edema. SAM related mortality rates in under-five children are well documented in Ethiopia but data on their predictors are limited. We aimed to document factors associated with SAM related mortality to inform better inpatient management.

Methods

A facility-based retrospective cohort study was conducted among children admitted due to SAM at Pawe General Hospital, Northwest Ethiopia, from the 1^st of January 2015 to the 31^st of December 2019. Data from the records of SAM children were extracted using a standardized checklist. Epi-Data version 3.2 was used for data entry, and Stata version 14 was used for analysis. Bi-variable and multivariable Cox regression analyses were conducted to identify predictors of mortality. Variables with P<0.05 were considered significant predictors of mortality.

Results

Five-hundred sixty-eight SAM cases were identified of mean age was 27.4 (SD± 16.5) months. The crude death rate was 91/568 (16.02%) and the mean time to death was determined as 13 (±8) days. Independent risk factors for death were: (i) vomiting AHR = 5.1 (1.35–21.1, p = 0.026), (ii) diarrhea AHR = 2.79 (1.46–5.4, p = 0.002), (iii) needing nasogastric therapy AHR = 3.22 (1.65–6.26, p = 0.001), (iv) anemia AHR = 1.89 (1.15–3.2, p = 0.012), and (v) being readmitted with SAM AHR = 1.7 (1.12–2.8, p = 0.037).

Conclusion

SAM mortality was high in under-five children in our setting. The identified risk factors should inform treatment and prevention strategies. Improved community health education should focus on healthy nutrition and seeking early treatment. Inpatient mortality may be reduced by stricter adherence to treatment guidelines and recognizing early the key risk factors for death.

The effect of timely initiation of complementary feeding and vitamin A supplementation on acute malnutrition among children aged 6-59 months attending Hamusit Health Centre, Northwest Ethiopia, 2021: A cross-sectional study

INTRODUCTION

Acute malnutrition is a nutritional deficiency that results either from inadequate energy or protein intake. It is more prevalent in low- and middle-income countries. Even though efforts have been carried out at the global and national level, the burden is still intolerable and it attracts the attention of the government and researchers. Hence, this study aims to assess the magnitude of acute malnutrition and its associated factors among under-five children who attended Hamusit Health Centre from 1st September to 30th January 2021.

MATERIALS AND METHODS

This institution-based cross-sectional study was conducted from 1st September to 30th January on 404 randomly selected under-five children who visited the health centre. Samples were selected using a simple random sampling technique, and the data were obtained using a pre-tested standardized questionnaire. For data entry and analysis, Epi-info 7 and SPSS 21 applications were used, respectively. Bivariable and multivariable binary logistic regression were used to identify associated factors at a 95% confidence interval. Significance was considered at p-value<0.05.

RESULTS

The present research involved a total of 404 children aged 6-59 months. The magnitude of acute malnutrition in this study was 14.4%. Children aged 6-23 months [AOR: 2.92; 95%CI (1.46, 5.85)], vitamin A supplementation [AOR: 0.49; 95%CI (0.25, 0.95)], not timely initiation of complementary feeding [AOR: 2.02; 95%CI (1.06, 3.82)] and children with diarrhea prior to two weeks of the survey [AOR: 2.47; 95% CI (1.28, 4.87)] were significantly associated with acute malnutrition.

CONCLUSION

A significant number of children aged 6-59 months were affected by acute malnutrition. Younger children, vitamin A supplementation, not timely initiation of complementary feeding, and children with diarrhoea were other factors associated with acute malnutrition.

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.

Mortality in relation to profiles of clinical features in Ghanaian severely undernourished children aged 0-59 months: an observational study

Severe acute malnutrition (SAM) is associated with a complex pattern of various clinical conditions. We investigated how risk factors cluster in children with SAM, the relationship between clusters of risk factors and mortality as well as length of stay in children with SAM. A prospective observational study design was used. Data were extracted from medical records of 601 infants and children aged 0-59 months admitted and treated for SAM in three Ghanaian referral hospital between June 2013 and June 2018. Among the 601 medical records extracted, ninety-nine died. Three clusters of medical features clearly emerged from data analyses. Firstly, an association was defined by eye signs, pallor, diarrhoea and vomiting with gastrointestinal infections and malaria. In this cluster, pallor and eye signs were related to 2- to 5-fold increased mortality risk. Secondly, HIV, oedema, fast pulse, respiratory infections and tuberculosis; among those features, HIV increased child mortality risk by 2-fold. Thirdly, shock, convulsions, dermatitis, cold hands and feet, weak pulse, urinary tract infections and irritability were clustered. Among those features, cold hands and feet, dermatitis, convulsions and shock increased child mortality risk in a range of 2- to 9-fold. Medical conditions and clinical signs in children diagnosed with SAM associate in patterns and are related to clinical outcomes.

Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study

BACKGROUND

Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers.

METHODS

A facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance.

RESULTS

Out of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition.

CONCLUSION

The overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.

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.

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.

Treatment outcome of Severe Acute Malnutrition and associated factors among under-five children in outpatient therapeutics unit in Gubalafto Wereda, North Wollo Zone, Ethiopia, 2019

BACKGROUND

In Ethiopia, uncomplicated severe acute malnutrition is managed through the outpatient therapeutic program at health posts level. This brings the services for the management of Severe Acute Malnutrition closer to the community by making services available at decentralized treatment points within the primary health care settings. So far, evidence of the treatment outcome of the program is limited.

OBJECTIVE

The main aim of this study was to determine the magnitude of treatment outcomes of severe acute malnutrition and associated factors among under-five children at outpatient therapeutic feeding units in Gubalafto Wereda, Ethiopia, 2019.

METHODS

This was a retrospective cohort study conducted on 600 children who had been managed for Severe Acute Malnutrition (SAM) under Outpatient Therapeutic Program (OTP) in Gubalafto Wereda from April to May/2019. The children were selected using systematic random sampling from 9 health posts. The structured, pre-tested, and adapted questionnaire was used to collect the data. The data was entered by using EPI-data Version 4.2 and exported to SPSS version 24.0 for analysis. Bivariate and Multivariate regression was also carried out to determine the association between dependent and independent variables.

RESULTS

A total of 600 records of children with a diagnosis of severe acute malnutrition were reviewed. Of these cases of malnutrition, the recovery rate was found to be 65%. The death rate, default rate, and medical transfer were 2.0, 16.0, and 17.0 respectively. Immunized children had 6.85 times higher odds of recovery than children who were not immunized (AOR = 6.85 at 95% CI (3.68-12.76)). The likelihood of recovery was 3.78 times higher among children with new admission than those with re-admission (AOR = 3.78at 95% CI ((1.77-8.07))). Likewise, children provided with amoxicillin were 3.38 times recovered than their counterparts (AOR = 3.38 at 95% CI ((1.61-7.08))). SAM treatment in OTP is beneficial because of its local access for most severe cases since children reach early before developing complications as a result fatalities will be reduced.

CONCLUSIONS

The recovery rate and medical transfer were lower than the sphere standard. Presence of cough, presence of diarrhea admission category, provision of amoxicillin, and immunization status were factors identified as significantly associated with treatment outcome of severe acute malnutrition. The impact on increasing the recovery rates of children treated using the OTP service indicates the potential benefits of increasing the capacity of such services across a target region on child mortality/recovery. Timely intervention is another benefit of a more local service like OTP. Building capacity of OTP service providers and regular monitoring of service provision based on the management protocol was recommended.

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.

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.

Recovery rate and determinants of severe acute malnutrition children treatment in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Severe acute malnutrition affects more than 20 million children. Africa is pointed out as a region where the problem is highly prevalent. There were individual studies on the recovery rate and its determinants among children with severe acute malnutrition in Ethiopia. But, there is no national pooled estimate. Therefore, this systematic review and meta-analysis aimed to estimate the recovery rate and determinants among children with severe acute malnutrition admitted to the therapeutic feeding unit in Ethiopia.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed in this study. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, and EMBASE. The statistical analysis was conducted using STATA version-11 software. The pooled prevalence was estimated with 95% confidence intervals using a random-effects model.

RESULT

A total of 12 studies were included with 2658 participants in the analysis. The overall pooled estimated recovery rate among children with severe acute malnutrition admitted to the inpatient therapeutic feeding unit in Ethiopia was 72.02 % (CI, 64.83, 79.22%). In the subgroup analysis, the highest estimate (80.29%) was observed in studies conducted in Oromia regional state, while 68.63% was observed in studies Southern Nation Nationality of people region 68.63%. Children who had no congestive heart failure were 4.88 times (OR, 4.88; 95% CI, 2.246, 10.586) more likely to recover than their counterparts.

CONCLUSION

The recovery rate among severe acute malnourished children on the therapeutic feeding unit in Ethiopia lied within the international minimum sphere. Hence, health care providers shall strengthen the management of severe acute malnutrition and management other co-morbidities like congestive heart failure.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019119124.

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.

Mortality rate and predictors of time to death in children with severe acute malnutrition treated in Felege-Hiwot Referral Hospital Bahir Dar, Northwest Ethiopia

Objectives

This study aimed to determine mortality rate, time to death and factors affecting the time to death among children with severe acute malnutrition admitted to therapeutic feeding unit of Felege Hiwot Referral Hospital, Bahirdar.

Result

A total of 401 children with severe acute malnutrition who were admitted to therapeutic feeding units from September 2012 to January 2016 were included in the study. The incidence of death rate was 8.47% (95% CI 6.11%, 11.65%). The median time to death was 3 days (Inter Quartile Range of 4 days). Children’s of age > 24 months (AHR = 0.27; 95% CI 0.1, 0.73), fully vaccinated status (AHR = 0.16; 95% CI 0.07, 0.36), HIV infection (AHR = 3.82; 95% CI 1.3, 11.15) and congestive heart failure (AHR = 6.98; 95% CI 2.42, 20.09) were significant predictors of mortality among children admitted for severe acute malnutrition.

Treatment outcomes and factors affecting time-to-recovery from severe acute malnutrition in 6-59 months old children admitted to a stabilization center in Southern Ethiopia: A retrospective cohort study

BACKGROUND

Despite improving access to Severe Acute Malnutrition (SAM) management, information on the quality of the service, as measured by timely recovery, is scare. This study is designed to assess treatment outcomes and factors affecting time-to-recovery from SAM in children 6-59 months admitted to a stabilizing center in Hawassa University Comprehensive Specialized Hospital (HU-CSH), Southern Ethiopia.

METHODS

Institutional-based retrospective cohort study was conducted on 420 randomly selected children aged 6-59 months. The children were managed at the hospital from July, 2015 to June, 2017. Pre-tested structured questionnaire was used to extract data from medical records. Data were analyzed using Kaplan Meir (KM) curve, Log rank test and Cox-Proportional hazards model. The outputs of the bivariable and multivariable Cox model are presented using Adjusted Hazard Ratio (AHR) with the respective 95% Confidence Intervals (CIs).

RESULTS

After a maximum of 59 days treatment 69.3% of the children recovered and 10.8% died. The mean (±SD) weight gain rates was 12.7 (±8.9) g/kg/days. The overall incidence density rate of recovery was 3.8 per 100 person-days. The overall median (IQR) time of recovery was 17(10, 24) days. F-100 intake (AHR = 0.502, 95%, CI: 0.29-0.86), Tuberculosis infection (AHR = 1.38, 95% CI: 1.00-1.91) and provision of special medication (IV fluid, IV antibiotic and blood transfusion) (AHR = 0.72, 95% CI: 0.52-0.99) at admission were found to be significant predictors of time-to-recovery from SAM.

CONCLUSION

The overall recovery from complicated SAM children admitted at HU-CSH after a maximum of 59 days treatment was low (69.4%) and a very high proportion of children (10.8%) end up in death. Therefore, HU-CSH should give special focus for those children present with medical comorbidities during admission.

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.

Sub-national prevalence survey of tuberculosis in rural communities of Ethiopia

Background

Tuberculosis is a major public health problem with varying prevalence in different settings. National prevalence surveys provide evidence for planning and decision making. However, they lack the capacity to estimate subnational magnitude that affected the capacity to make selected intervention based on the prevalence. Ethiopia is among high TB burden countries with estimated prevalence of 108 per 100,000 population varying by regions. We aimed to study sub national prevalence of smear-positive TB in rural communities of southern Ethiopia.

Methods

This cross-sectional study, enrolled community members aged over 14 years who had cough of at least two weeks duration. Two sputum samples were collected and examined by using smear microscopy.

Results

38,304 eligible people were enumerated (10,779 from Hadiya, 10,059 from Gurage and 17,466 from Sidama) and indentified 960 presumptive cases. 16, 14 and 14 smear-positive pulmonary TB cases were identified respectively. The point prevalence of smear-positive TB were 148 per 100,000 population (95% CI: 91–241) in Hadiya, 139 per 100,000 population (95% CI: 83–234) in Gurage and 80/100,000 population (95%CI: 48–135) in Sidama zone. Gurage zone had the highest prevalent to notified cases of seven to one.

Conclusions

The prevalence of smear positive TB varies by districts and is high in rural southern Ethiopia compared to the estimated national prevalence. More TB patients remain missed and unreached, impacting negatively on health outcomes. TB case finding approaches should be revisited and innovative approaches and tools to identify missing people with TB should be scaled up.

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.

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.

Determinants of severe acute malnutrition among under five children in rural Enebsie Sarmidr District, East Gojjam Zone, North West Ethiopia, 2016

Background

Severe acute malnutrition is one of the major public health problems in developing countries having a devastating effect on the lives of many children under 5 years of age. In Ethiopia, there has been isolated studies conducted on malnutrition with no study attempting to identify the determinants of severe acute malnutrition in the rural district of Enebsie Sarmidr.This study intends to identify the determinants of severe acute malnutrition in rural district located in North West Ethiopia.

Methods

A Community based un matched case -control study was carried on 311 (64 cases and 247 controls) children aged between birth–59 months with their respective mothers or care takers from March 1–30/ 2016. Odds Ratio along with 95% confidence interval was estimated to identify determinants of severe acute malnutrition using the multivariable logistic regression.

Results

The response rate was 97.8%. Severe acute malnutrition was significantly associated with age groups birth-24 months (AOR = 2.64, 95% CI 1.17–5.95), late initiation of breast feeding greater than an hour after birth (AOR = 4.26, 95% CI 1.74–10.42), nonexclusive breast feeding (AOR =5.81, 95% CI 1.80–18.79), diarrheal disease in the preceding 2 weeks before SAM (AOR = 7.98, 95% CI 2.57–24.74), febrile illnesses preceding 2 weeks before SAM (AOR = 2.87 95% CI 1.13–7.63), decreased or maintained mealing of the mother compared to the regular during pregnancy or lactation (AOR = 8.15, 95% CI 3.70–17.98) and birth interval less than 2 years (AOR = 3.34, 95% CI 1.55–7.20) after controlling other variables effect.

Conclusion

A child’s age, late initiation of breast feeding, nonexclusive breast feeding, diarrheal diseases and febrile illnesses preceding 2 weeks before SAM, decreased or maintained mealing compared to the regular during pregnancy and lactating of the mother and narrow birth interval were identified as determinants of SAM. Therefore, collaborative efforts are needed to improve promotion of better child caring practices specifically, child and maternal feeding practices and prevention and treatment of acute illnesses.

The impact of rickets on growth and morbidity during recovery among children with complicated severe acute malnutrition in Kenya: A cohort study

The effects of rickets on children recovery from severe acute malnutrition (SAM) are unknown. Rickets may affect both growth and susceptibility to infectious diseases. We investigated the associations of clinically diagnosed rickets with life‐threatening events and anthropometric recovery during 1 year following inpatient treatment for complicated SAM. This was a secondary analysis of clinical trial data among non‐human immunodeficiency virus‐infected Kenyan children with complicated SAM (2–59 months) followed for 1 year posthospital discharge (ClinicalTrials.gov ID NCT00934492). The outcomes were mortality, hospital readmissions, and growth during 12 months. The main exposure was clinically diagnosed rickets at baseline. Of 1,778 children recruited, 230 (12.9%, 95% CI [11.4, 14 .6]) had clinical signs of rickets at baseline. Enrolment at an urban site, height‐for‐age and head circumference‐for‐age z scores were associated with rickets. Rickets at study enrolment was associated with increased mortality (adjusted Hazard Ratio [aHR] 1.61, 95% CI [1.14, 2.27]), any readmission (aHR 1.37, 95% CI [1.09, 1.72]), readmission for severe pneumonia (aHR 1.37, 95% CI [1.05, 1.79]), but not readmission with diarrhoea (aHR 1.05, 95% CI [0.73, 1.51]). Rickets was associated with increased height gain (centimetres), adjusted regression coefficient 0.19 (95% CI [0.10, 0.28]), but not changes in head circumference, mid‐upper arm circumference, or weight. Rickets was common among children with SAM at urban sites and associated with increased risks of severe pneumonia and death. Increased height gain may have resulted from vitamin D and calcium treatment. Future work should explore possibility of other concurrent micronutrient deficiencies and optimal treatment of rickets in this high‐risk population.