Treatment outcome of severe acute malnutrition and determinants of survival in Northern Ethiopia: A prospective cohort study

Massa, Desalegn; Woldemichael, Kifle; Tsehayneh, Birtukan; Tesfay, Amanuel

doi:10.5897/ijnam2015.0193

Cited by 31 publications

(19 citation statements)

References 4 publications

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“…The median length of stay was (38.5 ± IQR 14 days) for recovered/cured children and this study was found to be in line with a multicentre, randomized intervention study done in Mali which showed that median recovery time of the entire cohort was 42 days. Another prospective cohort study conducted in southern people, nation and nationalities region of Ethiopia showed that the median recovery time was 49 days [18, 19]. However, the finding of this study found to be lower duration of stay in the outpatient therapeutic program than 92 days length of time to recovery a study done in Afar, Ethiopia [20].…”

Section: Discussionmentioning

confidence: 61%

“…All SAM children between 6 and 59 months and admitted in the selected health facilities were included in the study. Sample size was determined using study conducted from Enderta district, Tigray, Northern Ethiopia, 2012 [18]. So, we calculate the sample size by medcalc©version 18.11.3 survival analysis (logrank test) at http://www.medcal.org [17].…”

Section: Methodsmentioning

confidence: 99%

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Time to recovery and determinants of severe acute malnutrition among 6–59 months children treated at outpatient therapeutic programme in North Gondar zone, Northwest Ethiopia: a prospective follow up study

et al. 2019

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BackgroundDespite the available interventions to tackle nutritional problems, there is scarce information on time to recovery and its determinants among children with SAM in Ethiopia.ObjectiveThis study was aimed at finding the time to recovery and determinants among 6–59 months children with severe acute malnutrition treated at an outpatient therapeutic programme in North Gondar zone, northwest Ethiopia.MethodsFacility based prospective follow up study was conducted from March 24 to May 24, 2017. A total of 408 children with the age of 6–59 months were included in the study. Structured interviewer administered questionnaire was used. Anthropometric measurements were conducted every week. The median time of recovery, Kaplan Meier (KM) curve, and log rank test were computed. Both bi-variable and multivariable Cox regression model was fitted. To establish an association between time to recovery and its determinants 95% confidence interval (CI) and p-value < 0.05 were used. Proportional hazard assumption was checked graphically and using Schoenfeld residual test.ResultsOut of 389 children, 254 (65.3%) recovered. The median time to recovery was 38.5 ± IQR of 14 days. Children with diarrhoea AHR = 0.81 with 95% CI (0.73, 0.99), children taken amoxicillin AHR = 2.304 with 95% CI (1.68–3.161), and had vomiting at admission AHR = 0.430 with 95% CI (0.205, 0.904) were significant predictors of time to recovery.Conclusions and recommendationsThe overall time to recovery has not met the minimum sphere international standard which was lower than 75%. It is advisable to give emphasis to patients with diarrhoea and vomiting.

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Section: Discussionmentioning

confidence: 61%

Section: Methodsmentioning

confidence: 99%

Time to recovery and determinants of severe acute malnutrition among 6–59 months children treated at outpatient therapeutic programme in North Gondar zone, Northwest Ethiopia: a prospective follow up study

et al. 2019

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“…[14] The finding in our study is consistent with that from a non-refugee population study in northern Ethiopia, which found that the majority of carers of children with SAM had a low literacy level. [15] In both SC programmes, the mean (SD) length of stay was longer than the recommended duration of 7 -10 days, [7] namely 10.4 (6) days at Ifo and 9.5 (4) days at Hagadera. Although no comparable studies were found for refugee populations, the finding reported here is consistent with that of a study among paediatric SAM inpatients conducted in northern India, which reported a mean (SD) length of stay of 11.7 (7.6) days.…”

Section: Discussionmentioning

confidence: 99%

“…[7] Studies conducted in OTFPs in north and southwest Ethiopia and Yemen reported a mean length of stay of 45 days, 50 days and 40 days, respectively. [15,18,19] Although early discharge may be associated with relapses of SAM cases, longer stays in a CMAM programme, especially in the case of an OTFP, may be associated with defaulting. [7,20] The shorter stays observed in the OTFPs in this study may be attributed to early discharges following good responses to treatment.…”

Section: Discussionmentioning

confidence: 99%

Carers’ knowledge of treatment of severe acute malnutrition at Dadaab refugee complex, Kenya: A prospective cohort study

et al. 2020

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This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Globally, about 55 million children under the age of 5 years (10%) are undernourished. Of these, 19 million suffer from severe acute malnutrition (SAM). [1] SAM contributes to about one million deaths every year in children under the age of 5 years. [1,2] Most SAM cases are from sub-Saharan Africa and South Asia. [3] The prevalence of SAM is generally higher in emergency contexts and contributes to about half of the deaths in children under the age of 5 years in refugee camps. [4] Initially, therapeutic feeding centres treated SAM cases through inpatient care. They admitted all children with SAM, with or without medical complications. This approach was associated with high mortality and default rates. [4] To address setbacks associated with this approach, the community-based management of acute malnutrition (CMAM) model was globally adopted in 2007 and implemented the same year in Kenya. [5,6] CMAM entails treatment of SAM cases at community level using ready-to-use therapeutic foods. In this model, SAM cases without medical complications are treated as outpatients in an outpatient therapeutic feeding programme (OTFP) and those with medical complications are treated as inpatients at stabilisation centres (SCs). [7] Programmes that integrate the CMAM model in an existing health system are referred to as integrated management of acute malnutrition. [5] In Kenya, such integrated programmes are implemented in both rural areas and refugee camp settings using the same national treatment guidelines. However, despite successes being reported through the implementation of the CMAM model, poor treatment outcomes, such as high default rates and long recovery periods, are still being reported. [2,4,8] Studies from paediatric clinical settings suggest that carers' lack of understanding on the nature of treatment may contribute to poor adherence to treatment modalities. [9,10] No studies have assessed carers' understanding of the nature of treating acute malnutrition in a refugee population. The aim of this study was therefore to describe carers' knowledge of treating SAM at the Dadaab refugee complex. Methods Study setting The study was conducted between 21 May and 31 July 2015 at the Dadaab refugee complex in Garissa County, Kenya. The complex consists of four refugee camps, namely Hagadera, Dagahaley, Ifo I and Ifo II. The majority (97.5%) of the refugees are of Somalian nationality. [11] Two camps (Ifo I and Hagadera) were randomly selected from the four sites. At the time of the study, Hagadera had a population of ~106 751 adults and 21 351 children under the age of 5 years, while the Ifo camp had a population of 84 269 adults and 16 854 children under the age of 5 years. [12,13] CMAM services were provided by the International Rescue Committee and Islamic Relief Kenya. Each camp had a CMAM Background. Severe acute malnutrition causes half of the deaths in children under the age of 5 years in refugee camps. Objective. To describe carers' ...

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“…Previous research studies conducted in the country identified determinants of children's survival. Sex of child, medical comorbidities, treatment and follow-up status, and clinical diagnosis of SAM were associated to survival of children [12–16]. The Ethiopian Ministry of Health established inpatient therapeutic feeding centers in the health facilities to reduce SAM-related mortalities of under-five children.…”

Section: Introductionmentioning

confidence: 99%

Survival Status and Its Determinants among Under-Five Children with Severe Acute Malnutrition Admitted to Inpatient Therapeutic Feeding Centers in South Wollo Zone, Amhara Region, Ethiopia

Hassen

Astatkie

Mekonnen

et al. 2019

Journal of Nutrition and Metabolism

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Background. Under nutrition is one of the leading causes of morbidity and mortality in under-five children in developing countries including Ethiopia. In Ethiopia, many children with severe acute malnutrition (SAM) are treated at inpatient therapeutic feeding centers. However, the survival status and its determinants are not well understood. Therefore, the aim of this study was to estimate the survival status and its determinants among under-five children with severe acute malnutrition admitted to inpatient therapeutic feeding centers (ITFCs). Methods. A record review was conducted on 414 under-five children who were admitted with severe acute malnutrition to ITFCs in South Wollo Zone, northeast Ethiopia, between September 11, 2014, and January 9, 2016. Data were entered into Epi-Info version 7.2 and analyzed using SPSS version 20. Life table analysis was used to estimate cumulative proportion of survival. The relationship between time to recovery and covariates was determined using Cox-proportional hazards regression model. p<0.05 was used to declare presence of significant association between recovery time and covariates. Results. Of the total children recorded, 75.4% of children were recovered and discharged, 10.3% were defaulters, 3.4% died, 7.4% were nonresponders, and 3.4% were unknown. The mean (±standard deviation) time to recovery was 12 (±5.26) days, whereas the median time to recovery was 11 (interquartile range of 8–15) days. Children’s breastfeeding status at admission (AHR: 1.42, 95% CI: 1.10, 1.83) and children without comorbidities at admission (AHR: 1.44, 95% CI: 1.03, 2.00) had statistically significant effect on time to recovery from SAM. Conclusion. All treatment responses in this study were within the recommended and acceptable range of global standards. Policy makers, health facilities, and care providers may need to focus on the importance of breastfeeding especially for those under two years of age and give emphasis for cases with comorbidities.

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Treatment outcome of severe acute malnutrition and determinants of survival in Northern Ethiopia: A prospective cohort study

Cited by 31 publications

References 4 publications

Time to recovery and determinants of severe acute malnutrition among 6–59 months children treated at outpatient therapeutic programme in North Gondar zone, Northwest Ethiopia: a prospective follow up study

Time to recovery and determinants of severe acute malnutrition among 6–59 months children treated at outpatient therapeutic programme in North Gondar zone, Northwest Ethiopia: a prospective follow up study

Carers’ knowledge of treatment of severe acute malnutrition at Dadaab refugee complex, Kenya: A prospective cohort study

Survival Status and Its Determinants among Under-Five Children with Severe Acute Malnutrition Admitted to Inpatient Therapeutic Feeding Centers in South Wollo Zone, Amhara Region, Ethiopia

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