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

Abstract

BackgroundIn 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).MethodsA 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.ResultThe 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.ConclusionUnder 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 treatment outcomes of severe acute malnutrition among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

“…The present study is consistent with a study nding in Bahir Dar (19). Nevertheless, studies done in North Shoa as well as Enderta Woreda, Tigray, did not show any association between vaccination status and nutritional recovery time (26,33). The reason for variation could be deference in health care setup and sample size.…”

“…The present study is in line with a retrospective cohort study done in Zambia and Debre Berhan referral hospital, Enat general hospital and Mehal Meda primary hospital (25,26,39). However, pneumonia was not a signi cant predictor of nutritional recovery time in a retrospective cohort study done in Southern Ethiopia, Wolaita Zone and Bahir Dar city (11,23,40).…”

“…However, the death rate was somewhat higher than acceptable death gure (< 10%) even though it was not alarming (> 15%) (21). Compared to other studies in different countries, the recovery rate in this study was higher than studies done in Indonesia, Zambia, Bahir Dar city, Ayder hospital, Gedeo Zone-health, Wolaita Zone, Debre Markos and Finote Selam hospitals Dilchora Dawa and North Shoa Zone (10,11,20,(22)(23)(24)(25)(26)(27) Differences in sample size, socio-demography and health care setup might be possible reasons for difference of recovery rate in Indonesia, Zambia and Ayder referral hospital. However, the low recovery rate observed in Felege-Hiot referral hospital Gedeo Zone, Wolaita Zone, Debre Markos and Finote Selam hospital, Dilchora hospital and North Shoa Zone might be due to the health care setup(these studies include HC, primary hospitals and general hospitals with no TFU).…”

“…The explanation for this association might be, management of acute malnutrition is similar regardless of whether there is stunting, although obviously the most stunted children will have the highest risk of failing to respond to therapy and die in hospital. Around 25% of under-5 children in the present study were stunted, however none of studies done in Bahir Dar city, Debre Markos and Finote Selam, Debre Berhan referral, Enat general and Mehal Meda primary hospitals (11,20,26) included stunting as co-factor.…”

“…The present study also reported a death rate higher than reported from the study done in India, Gambia, Bahir Dar City, North Shoa, Debre Markos and Finote Selam hospitals, and Wolaita zone (8,11,20,26,27,31). The possible reason for lower death rate in India and Gambia might be only case speci c mortality will be recorded and there might be differences in socio-economic status, treatment and caring practice.…”