Survival Analysis of Under-Five Children With Severe Acute Malnutrition in Woldia Hospital: Retrospective Cohort Study

Abstract

Abstract
 Background: Globally, 52 million children of age under five years were affected by acute malnutrition from which 17 million were severely wasted. In Ethiopia every month over 25,000 children with severe acute malnutrition are admitted to hospitals, if not identified early and treated properly, these children could die. Therefore this study aimed to assess the determinants of time to death of under-five children with SAM admitted to inpatient therapeutic feeding center in Woldia General Hospital.
 
 Methods: A retrospective cohort study was conducted. The study population were children with severe acute malnutrition aged from 0 to 59 months who have been admitted to woldia general hospital from September 2017 to August 2019.The sample was 150 that fulfils the inclusion criteria were included. Non parametric survival analysis was used to estimate survival time to death and Cox PH model was carried out to determine independent predictors.
 
 Results: The accounted proportion of death of under-five children in the study period was 10%. And the estimated mean survival time of the patient was 4.48 weeks. Both estimates was almost on the recommended Sphere standard which should < 10% and <4 weeks respectively. In the estimated model HR for age groups (24-35 months) is 0.000 with 95% CI [0.000-4.591], wasting is 0.010 with 95% CI [0.000-0.065], referred from is 0.000 with 95% CI [0.000-0.061], cough 133.04 with 95% CI [3.596-4922.83], HIV is 1209.61 with 95% CI [1.137-1286998.42], Iv antibiotic treatment is 0.000 with 95% CI [0.000-0.037] and amoxicillin is 0.001 with 95% CI [0.000-0.736] were significant predictors for time to death of under-five children with SAM.
 
 Conclusions: From the fitted model, age of the children, admission criteria, children referred from,cough, HIV, IV antibiotic treatment and Amoxicillin are the covariates that have significant effect on time to death of under five children by SAM at 5% level of significance. Early identifying cases and giving special attention for children with co morbidities such as HIV and cough is vital for decrease child mortality Ethiopia. 
 Keywords: Severe acute malnutrition, inpatient, semi parametric, non parametric, death

Assessing the survival time of hospitalized patients in Eastern Ethiopia during 2019–2020 using the Bayesian approach: A retrospective cohort study

“…Out of 346 patients, 223 (64.4%) died. 10 Younger age (<24 months) was associated with a 33% shorter expected survival time, and younger children were at a higher risk of mortality due to lower immunity, increased vulnerability to illnesses, and inadequate feeding practices. This was consistent with Jarso et al's research,which indicated that they had a twofold increased risk of passing away earlier.…”

“…The study revealed that out of the 322 SAM children included in the analysis, 118 (36.6%) died, which was higher compared to previous studies conducted in Ethiopia. Out of 346 patients, 223 (64.4%) died 10 . Younger age (<24 months) was associated with a 33% shorter expected survival time, and younger children were at a higher risk of mortality due to lower immunity, increased vulnerability to illnesses, and inadequate feeding practices.…”

“…However, despite the availability of SAM management at hospitals and health centers nationwide, SAM‐related mortality rates remain significant, and there is limited knowledge about the recovery period and associated factors, especially in young children admitted to inpatient therapeutic feeding clinics. 10 …”

“…However, despite the availability of SAM management at hospitals and health centers nationwide, SAM-related mortality rates remain significant, and there is limited knowledge about the recovery period and associated factors, especially in young children admitted to inpatient therapeutic feeding clinics. 10 While previous studies in Ethiopia have focused on predictors of treatment outcomes, determinants of food security, and survival status using logistic regression analysis, descriptive and econometric methods, and survival analysis, 11,12 these studies do not account for critical factors such as shock and nasogastric tube usage, which greatly impact the survival status of children under the age of five.…”

“…To address the high mortality rate among children under the age of five suffering from SAM, the Ethiopian Ministry of Health has implemented inpatient therapeutic feeding programs in medical facilities. However, despite the availability of SAM management at hospitals and health centers nationwide, SAM‐related mortality rates remain significant, and there is limited knowledge about the recovery period and associated factors, especially in young children admitted to inpatient therapeutic feeding clinics 10 …”