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Victor A, Antônio BC, Gotine ARM, Mahoche M, Pedro Xavier S, Silva Rodrigues OA, Ferreira AJF, Rondó PH. Predictors of nutritional recovery time in children aged 6-59 months with severe acute malnutrition in Sofala Province, Mozambique: survival analysis approach. J Public Health (Oxf) 2024; 46:305-314. [PMID: 38609179 DOI: 10.1093/pubmed/fdae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/11/2023] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
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.
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Affiliation(s)
- Audêncio Victor
- School of Public Health, University of São Paulo (USP), Ave. Doutor Arnaldo, 715, 01246904, São Paulo, Brazil
- Department of Nutrition, Ministry of Health of Mozambique, Ave. Eduardo Mondlane 1008, Maputo, C.P. 264, Mozambique
| | - Bélio Castro Antônio
- Department of Nutrition, Ministry of Health of Mozambique, Ave. Eduardo Mondlane 1008, Maputo, C.P. 264, Mozambique
| | - Ana Raquel Manuel Gotine
- School of Public Health, University of São Paulo (USP), Ave. Doutor Arnaldo, 715, 01246904, São Paulo, Brazil
- Faculty of Health Sciences, Lúrio University, Bairro de Marrere, Rua No. 4250, CP 364, Nampula, Mozambique
| | - Manuel Mahoche
- School of Public Health, University of São Paulo (USP), Ave. Doutor Arnaldo, 715, 01246904, São Paulo, Brazil
| | - Sancho Pedro Xavier
- Institute of Collective Health, Federal University of Mato Grosso, Ave. Fernando Correia da Costa, nº 2367 - Bairro Boa Esperança, Cuiabá - MT - 78060-900, Brazil
| | - Osiyallê Akanni Silva Rodrigues
- Institute of Collective Health, Federal University of Bahia (UFBA), Basílio da Gama Street, Canela, Salvador - BA, 40110-040 Salvador, Bahia state, Brazil
| | - Andrêa J F Ferreira
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Building Tecnocentro, Rua Mundo, 121, Trobogy, Salvador, Bahia 41745-715 Brazil
- Center on Racism, Global Movements, and Population Health Equity, Drexel University Dornsife School of Public Health, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA
| | - Patrícia H Rondó
- School of Public Health, University of São Paulo (USP), Ave. Doutor Arnaldo, 715, 01246904, São Paulo, Brazil
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Andargie A, Zewdie S. Predictors of recovery from severe acute malnutrition among 6-59 months children admitted to a hospital. Front Public Health 2024; 12:1258647. [PMID: 38706552 PMCID: PMC11066272 DOI: 10.3389/fpubh.2024.1258647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
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.
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Affiliation(s)
- Assefa Andargie
- Division of Epidemiology and Biostatistics, Department of Public Health, Injibara University, Injibara, Ethiopia
| | - Segenet Zewdie
- Division of Social Pharmacy, Department of Pharmacy, Injibara University, Injibara, Ethiopia
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Victor A, Antônio BC, Gotine ARM, Mahoche M, Pedro Xavier S, Silva Rodrigues OA, Ferreira AJF, Rondó PH. Predictors of nutritional recovery time in children aged 6–59 months with severe acute malnutrition in Sofala Province, Mozambique: survival analysis approach. J Public Health (Oxf) 2024. [DOI: https:/doi.org/10.1093/pubmed/fdae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Abstract
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.
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Affiliation(s)
- Audêncio Victor
- School of Public Health, University of São Paulo (USP) , Ave. Doutor Arnaldo, 715, 01246904, São Paulo , Brazil
- Department of Nutrition, Ministry of Health of Mozambique , Ave. Eduardo Mondlane 1008, Maputo, C.P. 264 , Mozambique
| | - Bélio Castro Antônio
- Department of Nutrition, Ministry of Health of Mozambique , Ave. Eduardo Mondlane 1008, Maputo, C.P. 264 , Mozambique
| | - Ana Raquel Manuel Gotine
- School of Public Health, University of São Paulo (USP) , Ave. Doutor Arnaldo, 715, 01246904, São Paulo , Brazil
- Faculty of Health Sciences, Lúrio University , Bairro de Marrere, Rua No. 4250, CP 364, Nampula , Mozambique
| | - Manuel Mahoche
- School of Public Health, University of São Paulo (USP) , Ave. Doutor Arnaldo, 715, 01246904, São Paulo , Brazil
| | - Sancho Pedro Xavier
- Institute of Collective Health, Federal University of Mato Grosso , Ave. Fernando Correia da Costa, nº 2367 - Bairro Boa Esperança, Cuiabá - MT - 78060-900 , Brazil
| | - Osiyallê Akanni Silva Rodrigues
- Institute of Collective Health, Federal University of Bahia (UFBA) , Basílio da Gama Street, Canela, Salvador - BA, 40110-040 Salvador, Bahia state , Brazil
| | - Andrêa J F Ferreira
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation , Building Tecnocentro, Rua Mundo, 121, Trobogy, Salvador, Bahia 41745-715 Brazil
- Center on Racism , Global Movements, and Population Health Equity, , Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104 , USA
- Drexel University Dornsife School of Public Health , Global Movements, and Population Health Equity, , Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104 , USA
| | - Patrícia H Rondó
- School of Public Health, University of São Paulo (USP) , Ave. Doutor Arnaldo, 715, 01246904, São Paulo , Brazil
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Chandra J, Kumar P. Anemia in Severe Acute Malnutrition: Ten Steps of Management Need to be Fine-Tuned. Indian J Pediatr 2023; 90:1061-1064. [PMID: 37436578 DOI: 10.1007/s12098-023-04742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Jagdish Chandra
- Department of Pediatrics, PGIMSR and ESIC Model Hospital, Basaidarapur, New Delhi, India.
- B-1007, Sea Show CGHS, Plot 14, Sector 19B, Dwarka, New Delhi, 110075, India.
| | - Praveen Kumar
- Department of Pediatrics, LHMC and KSCH, New Delhi, India
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Kitesa GY, Berhe TT, Tedla GW, Sahile AT, Abegaz KH, Shama AT. Time to recovery and its predictors among under five children in outpatient therapeutic feeding programme in Borena zone, Southern Ethiopia: a retrospective cohort study. BMJ Open 2023; 13:e077062. [PMID: 37709317 PMCID: PMC10503381 DOI: 10.1136/bmjopen-2023-077062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
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.
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Affiliation(s)
- Gutu Yonas Kitesa
- Department of Public Health Nutrition, Addis Ababa Medical and Business College, Addis Ababa, Ethiopia
| | - Trhas Tadesse Berhe
- Department of Public Health, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
- Department of Public Health, Frontieri Consult Plc, Addis Ababa, Ethiopia
| | | | | | - Kedir Hussein Abegaz
- Department of Public Health,Biostatistics and Health Informatics, Madda Walabu University, Robe 247, Ethiopia
- Department of Biostatistics, Faculty of Medicine, Near East University, Near East Avenue, Nicosia 99138, Turkey
| | - Adisu Tafari Shama
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Braxton ME, Larson KL, Melendez CR. Understanding Time-to-Recovery among Guatemalan Children before and during COVID-19. GLOBAL PEDIATRICS 2023; 5:100066. [PMID: 37366518 PMCID: PMC10286525 DOI: 10.1016/j.gpeds.2023.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Purpose To understand malnutrition recovery at a Guatemalan Nutrition Rehabilitation Center (NRC) before and during the COVID-19 pandemic. Design and Methods A retrospective chart review was conducted on-site in November 2022. The NRC is located on the outskirts of Antigua, Guatemala. They manage the care of 15-20 children at a time, providing food, medicine, and health assessments. A total of 156 records were included (126 prior to the onset of COVID; 30 after the onset of COVID). Descriptive variables collected were age, gender, severity of malnutrition, height, weight, amoxicillin, multivitamins, nebulizer/bronchodilator, and zinc. Principal Results There was no significant difference in time-to-recovery between COVID cohorts. Mean time-to-recovery was 5.65 weeks, or 39.57 days (SD = 25.62, 95% CI [35.5, 43.7]) among all recovered cases (n =149). The cohort admitted after the onset of COVID-19 (March 1, 2020) had a significantly higher weight gain and discharge weight. In the total sample, amoxicillin was the only significant predictor variable for recovery time; with children receiving it being more likely to recover in >6 weeks. The few differences between cohorts was possibly attributed to the sample after the onset of COVID-19. These records had minimal sociocultural data. Major Conclusions Conducting a family needs assessment on admission could identify sociocultural factors that may facilitate nutritional recovery, such as housing conditions and potable water access. Further research is needed to more fully understand the complexities that the COVID-19 pandemic has had on childhood malnutrition recovery.
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Affiliation(s)
- Morgan E Braxton
- Arizona State University, 550 North 3rd Street, Phoenix, AZ 85004-0698
| | - Kim L Larson
- East Carolina University, 2205 W 5th St, Greenville, NC 27834
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Braxton ME, Melendez CR, Larson KL. A Feasibility Study to Examine Clinical Variables of Childhood Malnutrition in Guatemala. HISPANIC HEALTH CARE INTERNATIONAL 2023:15404153221150452. [PMID: 36617794 DOI: 10.1177/15404153221150452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Guatemala is the country with the highest rate of malnutrition in Latin America and fifth highest worldwide. The objective of this pilot study was to determine the feasibility of examining clinical variables of malnutrition among a subset of children at a Guatemalan Nutrition Rehabilitation Center (NRC). Methods: The study was conducted using a secondary dataset of children admitted and discharged at the NRC in 2018. A total of 42 cases were reviewed. The 12 clinical variables were age, gender, height, weight, nutrition status, referral, diet, secondary diagnoses, medications, supplements, discharge disposition, and time-to-discharge. Results: The two major findings were (a) the lack of access to height and weight at discharge and (b) the inability to verify time-to-recovery. Mean age of participants was 23 months (SD = 12.9). All children were discharged home; median time-to-discharge was 48 days. The Kaplan-Meier analyses indicated that children <2 had slower time-to-discharge (51 days), compared to those older than age 2 (32 days); though not statistically significant. Conclusion: Findings of this study provide valuable data to inform ways NRC leadership can better report child health outcomes. International community-academic partnership could contribute to understanding malnutrition and time-to-recovery.
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Affiliation(s)
| | | | - Kim L Larson
- 3627East Carolina University, Greenville, NC, USA
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Tsegaye A, Lencha B, Kumsa K. Predictors of time to recovery from uncomplicated severe acute malnutrition among 6-59 months children treated in out patient treatment in health posts of Nagele Arsi district: a retrospective cohort study. BMC Pediatr 2022; 22:712. [PMID: 36514008 PMCID: PMC9746122 DOI: 10.1186/s12887-022-03767-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Access to outpatient therapeutic feeding programs (OTP) for all children who have uncomplicated severe acute malnutrition (SAM) remains a global public health priority. Identifying predictors that determine time-to-recovery from severe acute malnutrition optimize therapeutic success. However, reliable evidence on the determinants of time to recovery at health posts was not available in Nagele Arsi district of South Ethiopia. OBJECTIVE This study was aimed to identify determinants of time-to-recovery from uncomplicated SAM among children aged (6-59) months treated at an OTP in health posts of Nagele Arsi district, Southern Ethiopia. METHODS Institutional based retrospective cohort study was conducted among 357 children treated in Negele Arsi district from July1, 2018 to June 30, 2020. The children were selected using simple random sampling from 20 health posts. SAM treatment outcomes were compared against international SPHERE standards. The average time-to-recovery was estimated using Kaplan-Meier survival curve and the independent predictors of time to recovery were determined using multivariable Cox-proportional hazard model. The strength of the association was done using adjusted hazard ratio (AHR) with 95% confidence intervals. Statistical significance was declared at p value < 0.05. The results were presented by text, tables and figures. RESULT A total of 284 (79.6%) children recovered during follow up. The mean weight gain for recovered children was 4.7 + 2.4 g/kg/day. The median time-to-recovery was 44 days 95% CI (42.7-45.3). Children who received Amoxicillin, AHR =2.574, 95% CI (1.879-3.525); de-wormed, AHR = 1.519, 95% CI (1.137-2.031); received Vitamin A, AHR = 2.518, 95% CI, (1.921-3.301) and new admissions, AHR = 1.823, 95%CI, (1.224-2.715) were more likely to recover. However, those who admitted with non-edema, AHR = 0.256, 95% CI, (0.189-0.346); had cough at admission, AHR = 0.513, 95 CI, (0.366-0.719) and had diarrhea at admission AHR = 0.5, 95% CI, 0.5 (0.350-0.712) were less likely to recover. CONCLUSION AND RECOMMENDATION The recovery rate was within the acceptable ranges of International Sphere Standards. Those children who had cough and diarrhea should be given due attention from health extension workers and program planners. Appropriate provision of routine medication and timely intervention of co-morbidity are needed to increase chance of early recovery.
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Affiliation(s)
| | - Bikila Lencha
- Department of Public Health, Madda Walabu University, Shashemene, Oromia Ethiopia
| | - Kebede Kumsa
- Department of Public Health, Madda Walabu University, Shashemene, Oromia Ethiopia
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Bizuneh FK, Tolossa T, Bekonjo NE, Wakuma B. 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. PLoS One 2022; 17:e0272930. [PMID: 35960715 PMCID: PMC9374216 DOI: 10.1371/journal.pone.0272930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Fassikaw Kebede Bizuneh
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | | | - Bizuneh Wakuma
- Department of Pediatrics and Neonatal Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
- * E-mail:
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