Predictors of mortality among under-five children with severe acute malnutrition, Northwest Ethiopia: an institution based retrospective cohort study (original) (raw)
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Nutrition Journal
Background Management of severe acute malnutrition (SAM) has been a program priority in Ethiopia, but it remains the leading cause of mortality in under-five children. Hence, this study aimed to identify the incidence density rate of mortality and determinants among under-five children with severe acute malnutrition in St. Paul’s Hospital Millennium Medical College, 2012 to 2019. Methods A retrospective cohort study was conducted and data were collected using a structured checklist from 673 charts, of which 610 charts were included in the final analysis. The Kaplan-Meier survival curve with Log-rank test was used to estimate the survival time. Bi-variable and multi-variable Cox proportional hazard regression models were fitted to identify determinants of death. Schoenfeld residuals test was used to check a proportional hazard assumption. Goodness of fit of the final model was checked using Nelson Aalen cumulative hazard function against Cox-Snell residual. Results In this study, 61 ...
BMC Nutrition
Background: Severe acute malnutrition remains one of the most common causes of morbidity and mortality in Sub-Saharan Africa. The objective of this study was to investigate morbidity and mortality trends and factors associated with mortality of under-five children admitted and managed for severe acute malnutrition in NEMMH. Methods: Four years retrospective cohort study was conducted on 500 under-five children admitted with the diagnosis of severe acute malnutrition. The study population was all under-five children admitted to the inpatient nutrition unit between 2012 and 2015. Data was entered using Epi-Data version 3.1 and exported to SPSS version 16 for analysis. A Kaplan-Meier curve was also used to estimate survival probability of different types of severe acute malnutrition. Cox proportional hazards regression was used to predict the risk of death among predictor while adjusting for other variables. A P-value less than 0.05 was considered as statistically significant. Result: A total of 500 children were enrolled into the study. Kwashiorkor was the most frequently recorded morbidity accounting for 43.0%. Pneumonia was seen the commonest form of comorbid disease. It was the most common co-morbidity across all morbidity groups. (27.6% in kwashiorkor, 37.5% in marasmus and 37.7% in marasmic-kwashiorkor). The average length of stay in the hospital was 11 days. Children with new admission were 86% less likely to die than repeated admission given that the children were admitted to paediatric ward (HR: 0.14, 95% CI: (0.06, 0.35). Kaplan Meier survival curves also showed children with marasmus and those with repeated admission had reduced survival rates. The overall mortality rate was 7%. The mortality trends vary irregularly in each year but morbidity trend increased with admission from 2014 to 2015. Conclusion: Mortality trends of SAM vary irregularly across the years but morbidity trends increased with admission from 2014 to 2015. An admission type was significantly associated with mortality. Morbidity and co-morbid diseases did not show significant effect on mortality of the children. Health extension workers and stakeholders should give due concern on promotion of proper nutrition in a community.
2020
Background Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. Specifically, childhood mortality attributable to malnutrition is high at Felege-Hiwot Comprehensive Specialized Hospital. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the hospital. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers in the study area.Methods An institutional-based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meir was used to estimate cumulative survival probability and ...
2020
Background: Globally, in 2018, malnutrition contributes to 45% of all child deaths. These early child deaths are due to conditions that could be prevented or treated with access to simple and affordable interventions. Hence, this study intends to provide a quantitative example of factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM). Methods: We studied a retrospective cohort of 304 children aged 6-59 months with complicated SAM admitted to Yekatit 12 teaching hospital from 2013- 2016 . We extracted data from hospital records on nutritional status, socio-demographic factors and medical conditions during admission. The analysis was carried out with SPSS version 20.The Kaplan-Meier estimator was employed to analyze the recovery rate of the children undergoing treatment for SAM and Cox regression was used to adjust for confounding effects of other variables. Result: From overall of 304 under-five children with SAM, 133 (51.4%) were males and 126 (48....
BMC Public Health, 2020
Background In 2018, malnutrition contributed to 45% of all global cause of child death. These early child deaths were due to conditions that could either be prevented or treated with basic interventions. Hence, this study intended to provide a quantitative estimate of factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM). Methods We studied a retrospective cohort of 304 children aged 6–59 months with complicated SAM admitted to Yekatit 12 Hospital Medical College from 2013 to 2016. We extracted data from hospital records on nutritional status, socio-demographic factors and medical conditions during admission. The analysis was carried out using SPSS version 20. The Kaplan-Meier estimator was employed to analyze the recovery rate of the children treated for SAM and multivariable Cox regression was used to determine factors that predict inpatient undesirable treatment outcomes. Result From a total of 304 children 6–59 months with SAM, 133 (51.4%) wer...
Predictors of Death from Complicated Severe Acute Malnutrition in East Ethiopia: Survival Analysis
International Journal of General Medicine, 2021
Background Severe acute malnutrition (SAM) is still the leading cause of global child morbidity and mortality, with a greater burden in sub-Saharan Africa. A facility-based treatment of SAM demands critical care for improved outcomes and survival of children. However, there is a need to understand predictors for time to death among SAM children for effective interventions. Objective To assess the predictors of death from complicated severe acute malnutrition among admitted children treated in East Ethiopia. Methods A 31-month retrospective cohort study was conducted among a total of 665 under-five children admitted with complicated SAM in Dilchora hospital, eastern Ethiopia. The data was extracted from the patient register and medical charts using the kobo tool. The life table, survival, and hazard curves were plotted. Kaplan–Meier with Log rank tests was used to estimate and compare the mean survival time. The bivariable and multivariable Cox proportional hazards models were used t...
2020
Sever acute malnutrition (SAM) remains a major public health problem contributing to morbidity and mortality among children aged 0-59 months. However, little is known about the survival status and determinants of mortality among children admitted to stabilization centers (SC) in Ethiopia particularly in study setting. The objective: to assess the survival status and determinants of mortality among severely malnourished children aged 0-59 months admitted to SC in Jinka general hospital from September 1, 2014 to August 30, 2018. Hospital based retrospective cohort study design was used among 588 severely malnourished children aged 0-59 months admitted to SC of Jinka general hospital from March 20-30, 2019. Simple random sampling method was used to select medical records of the study participants. Proportional hazard assumption over time was checked by Schoenfeld’s global test. The Kaplan-Meier survival curve with log-rank test was used to compare survival across groups. Bivariable an...
BMC Public Health
Background: Severe forms of malnutrition have drastic effects on childhood morbidity and mortality in sub-Saharan countries, including Ethiopia. Although few studies have previously estimated treatment outcomes of severe acute malnutrition (SAM) in Ethiopia, the findings were widely varied and inconsistent. This study thus aimed to pool estimates of treatment outcomes and identify predictors of mortality among children with SAM in Ethiopia. Methods: A systematic review was carried out to select 21 eligible articles from identified 1013 studies (dating from 2000 to 2018) that estimated treatment outcomes and predictors of mortality among SAM children. Databases including PubMed, CINHAL, Web of Sciences; Cochrane, Psych INFO and Google Scholar were comprehensively reviewed using medical subject headings (MESH) and a priori set criteria PRISMA guideline was used to systematically review and meta-analyze eligible studies. Details of sample size, magnitude of effect sizes, including Hazard Ratio (HRs) and standard errors were extracted. Random-effects model was used to calculate pooled estimates in Stata/se version-14. Cochran's Q, I 2 , and meta-bias statistics were assessed for heterogeneity and Egger's test for publication bias. Result: Twenty-one studies were included in the final analysis, which comprised 8057 under-five children with SAM in Ethiopia. The pooled estimates of treatment outcomes, in terms of death, recovery, defaulter and transfer out and nonresponse rates were 10.3% (95% CI: 8.
Ethiopian Journal of Pediatrics and Child Health
Background: Malnutrition continues to be a long-term year-round phenomenon, threatening under 5 children unacceptably the most. It is responsible for 25,000 children’s hospitalization per month and nearly 50% of all under-5 mortalities in Ethiopia. The national burden of SAM highlights the importance of addressing predictors of recovery rates. Methodology: An institution-based retrospective cohort study was implemented from a period of august 2020- august 2021. Data were collected using a structured questionnaire and entered and analyzed using SPSS 25. The output of both bivariate and multivariate logistic regression analysis was presented using an odd ratio and 95% CI. A p-value of less than 0.05 was taken as statistically significant. Results: Among the total study cases of 241 children, 192(79.7%) records were recovered, 15 (6.2%) died, and 20(8.3%) were defaulted. The majority of the children, 155(64.3%) had nonedematous malnutrition. The independent predictors of mortalit...