ObjectiveTo present evidence on the burden and outcomes of co-morbidities among severely malnourished (SAM) children admitted to outpatient therapeutic programme (OTP) facilities in the conflict setting of Borno, Nigeria.DesignRetrospective medical chart review.SettingFacility-based study.ParticipantsChildren aged 6–59 months with SAM enrolled in OTP between June and November 2016 whose medical records were analysed. Only pneumonia and diarrhoea were examined due to data limitations. Stata software was used for descriptive, multivariate and survival analyses.ResultsRecords of 396 children with median age of 15 months were identified and analysed from the date of enrolment to exit from OTP. Mean length of stay in OTP was 61d, with co-infected SAM children having shorter stay (P=0·006). Of the total, 148 (37·4 %) had at least one co-morbidity (pneumonia or diarrhoea), of which thirty-nine (26·4 %) had both. Cumulative rate of mortality during follow-up time was 9·5 (95 % CI 6·0, 15·1) per 10 000 child-days; SAM children with co-morbidities were ten times more likely to die than those without (hazard ratio=10·2; 95 % CI 3·4, 31·0). In multivariable analysis, co-morbidity (P=0·01), oedema (P=0·003), dehydration (P=0·02) and weight on admission (P=0·01) were associated with mortality. Both recovery and defaulter rates (57·8 and 36·1 %, respectively) did not meet SPHERE standards.ConclusionsChildren with SAM and co-morbidities are less likely to survive, presenting a significant barrier in improving child survival. The findings call for integrated OTP models that incorporate clinical algorithms and ensure prompt referral for SAM children with co-morbidity.

Background: The Boko Haram insurgency has led to severe humanitarian crisis with high levels of malnutrition and polio outbreak in Borno state, Nigeria. In response, outbreak campaigns were conducted that provided an opportunity to integrate nutrition screening during the combined bivalent oral and inactivated polio vaccination (bOPV/IPV) campaign. Methods: This was a cross-sectional study that measured nutrition status of children using a mid-upper arm circumference (MUAC) measurement tape during bOPV/IPV campaign in 4 of the 24 local government areas (LGAs). Data were collected using tally sheets and mobile ODK Collector and bivariate analysis using logistic regression done. Results: Over 1.66 million and 1.47 million children received bOPV and IPV vaccines respectively in 24 LGAs. The coverage of bOPV and IPV in integrated and non-integrated LGAs were above 90% with no statistical difference (OR:0.85; 95%CI: 0.55-1.29; p=0.42). Only 48.5% (351795/725509) of targeted children were screened for malnutrition, of those 3.7% (13050/351795) had severe acute malnutrition (SAM). Less than 47.5% of children with SAM were successfully referred and enrolled in the treatment facilities. Conclusion: Coverage of bOPV and IPV were similar in both integrated and non-integrated LGAs indicating that integrating nutrition screening in polio campaigns is feasible with minimal negative effects. As children with SAM have lower serological protection against polio, provides a strong rationale for inclusion of nutrition interventions in global polio eradication efforts. There are critical lessons that were identified including joint planning, well-defined optimal partnership including military collaborations, and a need for joint monitoring.