Time to readmission and associated factors after post treatment discharge of severe acute malnourished under-five children in Pawe General Hospital

Abstract

Background Relapse or repeated episodes is the admission of a child with the diagnosis of severe acute malnutrition (SAM) after being discharged to a status of treated and cured from a stabilizing center. A child may experience more than one episode of SAM depending on the improvement of the underlying comorbidity. Thus, this study aimed to estimate the time to readmission of SAM and associated factors for under-five children in North West Ethiopia. Methods An institution-based retrospective cohort study was employed in 760 files of under-five children spanning from 2014/15 to 2019/20. The data extraction tool was developed from SAM treatment guidelines and medical history sheets. Epi Data version 3.2 and STATA version 14 were used for data entry and final analysis, respectively. After checking all assumptions, the multivariable Cox Proportional Hazard model was fitted to the isolated independent predictors for time to readmission. A categorical variable with p < 0.05 was considered a risk factor for the relapse of SAM. Result The mean (± SD) age of participant children was 27.8 (± 16.5) months with mean (± SD) time to relapse of SAM cases were 30.4(± 21.39) weeks posttreatment discharge. The overall incidence density rate of relapse was determined as 10.8% (95% CI 8.3; 12.6). The average time (± SD) for treatment recovery from the first admission of the SAM case was 28.8(± 18.7) days. Time of readmission was significantly associated with living in rural resident (AHR 5⋅3 = 95% CI, 2⋅95, 13⋅87, p = 0.021), having HIV infection (AHR6⋅8 = 95%CI; 4.1–11.9 p = 0.001), and first admission with edema (AHR = 3.5 = 95% CI; 1.92, 6.2, p = 0.018). Conclusion Nearly one in every ten severely acute malnourished under-five children relapsed within a mean time to relapse 30.4(± 21.39) weeks posttreatment discharge. Time to relapse was significantly associated with being a rural resident for children, having edema during the first admission, and being HIV-infected cases. A protocol ought to be drafted for extending Supplementary Nutrition in Acute Malnutrition management program following discharge is highly needed.

Disease profile, HIV prevalence and vaccination status of HIV-infected children admitted at a hospital complex, Northern Cape Province, South Africa

“…Furthermore, other studies have shown that most children admitted to the hospital were less than 1 year old [11,12]. In line with our results, studies conducted by Cohen, et al [9] and Kebede [26] also found a higher proportion of female children than males, constituting 43% and 56%, respectively, with a higher proportion of children residing in rural areas [26].…”

“…They resided in rural areas and were predominantly female. Similar to our findings, previous studies on hospital admissions among children have consistently shown that the majority of admitted children are below 24 months of age [9,26,27]. Furthermore, other studies have shown that most children admitted to the hospital were less than 1 year old [11,12].…”

Rate, risk factors and estimated time to develop attrition after under-five children started moderate acute malnutrition treatment in Gubalafto, North East Ethiopia

“…Globally, in 2018, one in twelve of the estimated 52 million children under five had acute malnutrition, and 2⋅9 million of these children were admitted for ready-to-use therapeutic feeding (RUTF) ( 7 ) . This might be due to loss to follow-up or attrition of caregivers from the centre after starting the treatment ( 8 ) . Whereas attrition is the interruption or defaulting before reaching the target weight for at least two consecutive weeks and it is a composite term of defaulted and self-discharged cases ( 3 , 9 , 10 ) .…”

“…Moreover, a remarkable variation is observed in attrition rates ranging as high as 1⋅67 % ( 17 ) to 25⋅2 % ( 18 ) . This might be associated with the increased intention of self-discharging at thetime of caregiver from the treatment centre before reaching the reference weight of the child with or without treatment progression ( 8 , 19 ) .…”

Incidence and predictors of attrition rate after children started inpatient treatments for complicated severe acute malnutrition in North West Ethiopia

“…According to international Sphere standards, there are three main exit criteria for inpatient treatment of complicated SAM including cured, attrition, and death [ 6 , 10 ]. However, previous study finding indicated that about 20% to 36% self-discharged after treatment initiated was responsible for incidence of 1.2% to 10.4% re-admission of cases [ 3 , 4 , 9 , 11 ].…”