Treatment outcome and factors affecting time to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program

Mengesha, Melkamu Merid; Deyessa, Negussie; Tegegne, Balewgizie Sileshi; Dessie, Yadeta

doi:10.3402/gha.v9.30704

Cited by 62 publications

(82 citation statements)

References 14 publications

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“…The present study was consistent with the study done in Debre Markos and Finote Selam hospitals, and Northern India (20,28). However, this study is contrary to studies done in Malawi, Wolisso St. Luke catholic hospital, Gamo-Gofa Zone and Shebedido woreda OTP center (30,(32)(33)(34). This difference may be due to differences in research design, and health care setting.…”

Section: Discussionsupporting

confidence: 89%

Determinants of treatment outcomes of severe acute malnutrition among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

Adimasu¹,

Teshome²,

Fenta³

et al. 2020

Preprint

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Background Devastatingly, the number of children with SAM is still growing globally. Severe acute malnutrition is the third most common contributing factor to the deaths of under-5 children worldwide. According to the World Health Organization, severe acute malnutrition causes 1 million deaths annually via increased susceptibility to death from severe infection. Ethiopia is one of the countries with highest under-5 child mortality rate, with malnutrition underlying to 28% of all children deaths. In Ethiopia, some studies reported an alarming death and default rates which indicate the need for further study to assess contributing factors to the treatment outcomes of severe acute malnutrition. Therefore, the intention of this research is to determine the treatment outcomes of severe acute malnutrition and identify predictors of nutritional recovery. Method: A retrospective cohort study was conducted among 423 under-5 children with severe acute malnutrition. Logistic regression analysis was performed and an adjusted odd ratio with 95%CI was used to determine independent predictors. Result The overall recovery, death and default rates were 81.3%, 11.1% and 7.6% respectively. Age, vaccination status, HIV/AIDS, pneumonia, diarrhea and stunting were found to be significant independent predictors of treatment outcomes. The adjusted odd ratio (AOR) for nutritional recovery increased by 14.6% for every 1-month increase in child age (AOR = 1.146; 95%CI: 1.052–1.249). Regarding vaccination status, those under-5 children who were fully vaccinated for their age were about 4 time more likely to recover than their counterparts (AOR = 4.242; 95%CI: 1.566–11.491) Conclusion In conclusion, the overall nutritional recovery and default rate in this study were in the acceptable range of international standard even though the death rate was higher. Age and full vaccination were proven to increase nutritional recovery. Conversely, the presence of HIV/AIDS, pneumonia, diarrhea and stunting were proven to decrease nutritional recovery.

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Section: Discussionsupporting

confidence: 89%

Determinants of treatment outcomes of severe acute malnutrition among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

Adimasu¹,

Teshome²,

Fenta³

et al. 2020

Preprint

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“…The study in Burkina Faso found an overall treatment duration of 52 days for children admitted with a MUAC <115 mm or WHZ <-3, which is higher than the 42 days registered by the HFs in this study. The same length of stay (42 days) has been reported in other studies in Ethiopia, but they were based on a discharge criterion of 15% weight gain [36,37]. One of them found that considering MUAC, a discharge criterion could mean increased length of stays, since they found that 20.6% of the children who showed a 15% weight gain would still be considered acutely malnourished if a MUAC <115 mm criterion was applied [37].…”

Section: Discussionmentioning

confidence: 78%

Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes

López‐Ejeda

Charle-Cuéllar²,

Alé

et al. 2020

PLoS ONE

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Severe acute malnutrition (SAM) affects over 16.6 million children worldwide. The integrated Community Case Management (iCCM) strategy seeks to improve essential health by means of nonmedical community health workers (CHWs) who treat the deadliest infectious diseases in remote rural areas where there is no nearby health center. The objective of this study was to assess whether SAM treatment delivered by CHWs close to families' locations may improve the early identification of cases compared to outpatient treatment at health facilities (HFs), with a decreased number complicated cases referred to stabilization centers, increased anthropometric measurements at admission (closer to the admission threshold) and similarity in clinical outcomes (cure, death, and default). The study included 930 children aged 6 to 59 months suffering from SAM in the Kita district of the Kayes Region in Mali; 552 children were treated by trained CHWs. Anthropometric measurements, the presence of edema, and other medical signs were recorded at admission, and the length of stay and clinical outcomes were recorded at discharge. The results showed fewer children with edema at admission in the CHW group than in the HF group (0.4% vs. 3.7%; OR = 10.585 [2.222-50.416], p = 0.003). Anthropometric measurements at admission were higher in the CHW group, with fewer children falling into the lowest quartiles of both weight-for-height z-scores (20.2% vs. 31.5%; p = 0.002) and mid-upper arm circumference (18.0% vs. 32.4%; p<0.001), than in the HF group. There was no difference in the length of stay. More children in the CHW group were cured (95.9% vs. 88.7%; RR = 3.311 [1.772-6.185]; p<0.001), and there were fewer defaulters (3.7% vs. 9.8%; RR = 3.345 [1.702-6.577]; p<0.001) than in the HF group. Regression analyses demonstrated that less severe anthropometric measurements at admission resulted in an increased probability of cure at discharge. The study results also showed that CHWs provided more integrated care, as they diagnosed and treated significantly more cases of infectious diseases than HFs (diarrhea: 36.

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“…In the current review, eight studies (21,(24)(25)(26)(31)(32)(33)(34) revealed the independent predictors of recovery rate using hazard ratios. The predictors which were reported by the original studies were diarrhea (21,25,31,33), age>24 months (26,32,33) However, diarrhea, no edema and Amoxicillin were found to be independent predictors of recovery rate (Figure 8). The recovery rate of SAM children with diarrhea 16% less likely compared with those children with no diarrhea (HR=0.8, 95% CI: 0.75, 0.94).…”

Section: Predictors Of Recovery Rate Of Sam Children In Ethiopiamentioning

confidence: 99%

“…In-addition, the determinants of treatment outcomes, particularly the predictors of recovery rate is not addressed comprehensively. Few studies (21,(24)(25)(26)(31)(32)(33)(34)(35) revealed as edema, diarrhea, deworming, giving antibiotics, vitamin A supplementation, and distance from OTP centers and age as the predictors of recovery of under-five children with SAM in OTPs of Ethiopia.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes of severe acute malnutrition and Predictors of Recovery in Under-Five children treated within Outpatient Therapeutic Program in Ethiopia: A systematic review and meta-analysis

Bitew

Alemu

Worku

2020

Preprint

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Introduction Severe acute malnutrition affects around 17 million under-five children in the world, of which the highest burden is accounted by Sub-Saharan Africa where Ethiopia is found. Besides few individualized, inconsistent and inconclusive studies, there is no nationally representative study conducted on treatment outcomes of SAM in outpatient therapeutic feeding programs in Ethiopia. This study aimed at estimating the pooled treatment outcomes and predictors of recovery rate among under- five children with SAM in Ethiopia. Methods Both electronic databases (PubMed, Medline (EBSCOhost), EMBASE (Elsevier), CINAHL (EBSCOhost), web of science, Scopus, Science Direct and Food Science and Technology Abstracts (FSTA)) and grey literature sources (Google scholar, Mednar, World Cat and google) were used to retrieve articles. The random effect model was used to estimate the pooled treatment outcomes. Hazard ratios were used to determine the predictors of recovery rate. Cochran’s Q, I 2 , and univariate Meta regression were done for heterogeneity as well as Begg’s & Egger’s tests for publication bias. Results Nineteen articles with a total number of 23395 under-five children with SAM were used for this meta-analysis. The pooled recovery, death, defaulter and non-recovery rates were 70% (95% CI: 64.45, 75.72), 1.69% (95% CI: 1.06, 2.31), 9.7% (95%CI: 7, 12.4), 15.14% (95% CI: 10.11, 20.16), respectively. Diarrhea (HR=0.8, 95% CI: 0.75, 0.94), no edema (HR=0.41, 95% CI: 0.33, 0.50) and amoxicillin (HR=1.81, 95% CI: 1.18, 2.44) were independent predictors of recovery rate of children with SAM in Ethiopia. Publication year was found to be the potential source of heterogeneity among the included studies. Conclusion The treatment outcomes of children with SAM from outpatient therapeutic feeding programs of Ethiopia are lower than the sphere guidelines, WHO and national recommendations. Diarrhea and no edema antagonized the recovery rate of children while amoxicillin enhanced the recovery rate of children from SAM. Community health workers need to be trained. Especial attention should be given while treating children with diarrhea and severe wasting. Community mobilization is also recommended to increase community awareness about the therapeutic foods.

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Treatment outcome and factors affecting time to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program

Cited by 62 publications

References 14 publications

Determinants of treatment outcomes of severe acute malnutrition among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

Determinants of treatment outcomes of severe acute malnutrition among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes

Treatment outcomes of severe acute malnutrition and Predictors of Recovery in Under-Five children treated within Outpatient Therapeutic Program in Ethiopia: A systematic review and meta-analysis

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