Predictors of Survival among 6-59 Months Old Children with Severe Acute Malnutrition: A Retrospective Cohort

Abstract

BackgroundUndernutrition among children is a significant contributor to the global disease burden and a leading cause of child mortality. Ethiopia, home to more than 16 million children under 5 years old, is one of the countries that have high levels of wasting. The aim of this study was to assess survival status and predictors of mortality among children with severe acute malnutrition admitted to Dubti Zonal Referral hospital from January 1/2017 to September 30/2019.MethodsFacility-based retrospective cohort was conducted among 331 severely acutely malnourished children. Data were collected from SAM management registration, individual patient cards and multi-charts admitted from January 1/2017 to September 30/2019. Cox-regression was used to characterize survival within the cohort and to estimate the effect of specific variables while controlling for potential confounders. The hazard ratio was used as a measure of the outcome. P-value less than 0.05 was considered statistically significant to identify independent predictors in multivariable analysis.ResultThe median age of study participants was 18 months and males were 187(56%). About half of 160 (48.3%) respondents were with co-morbidities during admission: diarrhea (44%) and pneumonia (26%) were the major co-morbidities. From a total of 331 SAM children, 255(77%) were recovered, 34(10%) died, and 40(12%) have defaulted from treatment. The main risk factors for earlier death of severely malnourished children were rural residence (AHR=1.6, 95% CI= 0.745-3.493), being on IV Infusion (AHR=2.5, 95% CI= 1.12-4.18), anemia during admission (AHR= 6.27, 95% CI =2.41-16.36) & pneumonia (AHR=0.27, 95% CI = 0.11-0.68)ConclusionsThe death rate was 10% which is close to the minimum SPHERE standard & national management protocol for SAM. Predictors for earlier hospital deaths were rural residence, IV infusion, Anemia, and Pneumonia.