Time to relapse of severe acute malnutrition and risk factors among under-five children treated in the health posts of Hadiya Zone, Southern Ethiopia

Abstract

Relapse/repeated episodes are defined as the admission of a child with a diagnosis of severe acute malnutrition (SAM) after being discharged with a status of recovery. However, there is a lack of study that documented the time to relapse of SAM and its risk factors. The present study aimed to identify the time of relapse and its risk factor among under-five children discharged after undergoing treatment for SAM in health facilities of Hadiya Zone, South Ethiopia. An institution-based retrospective cohort study was carried out in the Hadiya Zone of Southern Ethiopia among under-five children. Data were collected from 760 cards of severe acute malnourished children over the past 5 years spanning from 2014/15 to 2019/20. Both first admission and relapse data were abstracted from the records of the SAM children from 1 August to 30 August 2020 and cards of children that were admitted to program by transferee with complete records were included. After checking all the assumptions, multivariable Cox Proportional Hazards model was fitted to isolate independent determinants of time to cure. All tests were two-sided and statistical significance at P-values < 0⋅05. The mean(±sd) time for relapse of SAM among under-five children was 22(±9⋅9) weeks from discharge to relapse time. On multivariable Cox Proportional Hazards model, the hazard of relapse for SAM was significantly higher for children who had oedema (AHR 2⋅02, 95 % CI 1⋅17, 3⋅50), age of 6–11 months (AHR 5⋅2, 95 % CI 1⋅95, 13⋅87) had discharge MUAC not cured (AHR12, 95% CI 7⋅90, 19⋅52). The finding showed that children discharged from SAM are likely to have relapse in 3 weeks time.

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

“…SAM is a worldwide problem and one of the top dead diseases for children less than five years of age, and children with SAM have nine times more mortality rates than their peers do have [ 3 ]. It is responsible directly or indirectly for 60% of the 10.9 million deaths annually among under-five children, and two-thirds of these deaths occur during the first year of life [ 4 – 6 ]. Globally, in 2018, one in 12 of the estimated 52 million children under five had SAM [ 7 , 8 ], and 2.9 million of these children were admitted for inpatient treatment [ 2 , 4 , 9 ].…”

“…It is responsible directly or indirectly for 60% of the 10.9 million deaths annually among under-five children, and two-thirds of these deaths occur during the first year of life [ 4 – 6 ]. Globally, in 2018, one in 12 of the estimated 52 million children under five had SAM [ 7 , 8 ], and 2.9 million of these children were admitted for inpatient treatment [ 2 , 4 , 9 ].…”

“…The peak age for SAM is 6–18 months, which is the time of fast growth and brain development [ 4 , 10 ] and has several immediate, underlying, and fundamental factors [ 11 ]. Every month, over 25,000 children with SAM are admitted to Ethiopia, and survivors are more likely to perform poorly in school and, once they are, adults, and girls are more likely to suffer from complications [ 4 ].…”

“…The peak age for SAM is 6–18 months, which is the time of fast growth and brain development [ 4 , 10 ] and has several immediate, underlying, and fundamental factors [ 11 ]. Every month, over 25,000 children with SAM are admitted to Ethiopia, and survivors are more likely to perform poorly in school and, once they are, adults, and girls are more likely to suffer from complications [ 4 ]. Early identification of SAM is important for initiating treatment and minimizing the risk of complications, which can be done in both community and healthcare settings using appropriate indicators [ 10 ].…”

“…This has been reported as 9% in Bangladesh and 34.6% in Ethiopia. Even though the WHO recommends that children with SAM who are discharged from treatment, the programmer should be periodically monitored to avoid relapse with strong recommendations [ 1 , 4 ]. However, in Ethiopia, there is a lack of studies that address either time to relapse or post-discharge status [ 4 , 5 ].…”