Predictors for a Cure Rate of Severe Acute Malnutrition 6-59 Month Children in Stabilizing Center at Pawe General Hospital, Northwest Ethiopia: Retrospective Cohort Study (original) (raw)
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Journal of Nutritional Science, 2021
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.
2020
Severe acute malnutrition (SAM) is still among the major health problems especially in low and middle-income countries.<em>According to the report of the new standards for the management of acute malnutrition in Ethiopia, every month over 25,000 children with severe acute malnutrition are admitted to hospitals, </em>if not identified early and treated properly, these children could die (WHO, 2019). Therefore, the aim of this study is to assess time to cure and its determinants among under-five children with SAM admitted to inpatient therapeutic feeding unit.<em>The hospital record based retrospective cohort study the data for this study is from September 2017 to August 2019. The statistical method survival analysis is appropriate to assess the stated objectives of this study. Non parametric, semi parametric and AFT models are used. </em>The estimated median survival time of the patient was 14 days (2 weeks) with inter- quartile range 1.2 to 3.3 weeks, which i...
Nutrition Journal
Background: In spite of the availability of guidelines for the management of severe acute malnutrition (SAM) in Ethiopia, high comorbidity and poor treatment outcomes are still observed in therapeutic feeding centers among under-five children with SAM. The aim of this study was to assess comorbidity, treatment outcomes and factors affecting the recovery rate of children aged 1-59 months with SAM admitted into Therapeutic Feeding Centers (TFCs). Methods: A total of 413 records of children with SAM admitted in three selected hospitals from July 2013 to July 2015 G.C were retrospectively reviewed. Descriptive analysis was used to compare performance indicator values with SPHERE project reference standards (the minimum standard to be attained during nutritional therapy). Cox-proportional hazard regression analysis was performed to estimate the predictors of recovery rate at p-value < 0.05. Result: The mean age of children was 16 months (95% CI, 15.0, 17.0). Out of 413 children with SAM, 231 (55.9%) recovered, 24 (5.8%) died and 16.3% were defaulted from TFCs. The mean weight gain (in gram per weight of kilogram per day) for recovered children was 15.61 g/kg/day (95% CI, 14.15, 17.07). The overall median recovery time for these children was 12 days (95% CI, 11.22, 12.78). Moreover, most (77.5%) of children admitted with SAM were marasmic followed by Kwash (16%). Pneumonia (54.8%), diarrhea (41.8%) and rickets (21.4%) were co-morbidities which affected SAM children. A child being admitted at Mehal Meda Hospital (Adjusted Hazard Ratio (AHR) = 2.01; 95% CI: 1.34, 2.91), edematous form of malnutrition (AHR = 0.59; 95% CI: 0.39, 0.90) and being a child infected with pneumonia (AHR = 0.71; 95% CI: 0.51, 0.98) were predictors of nutritional recovery rate. Conclusion: Under five pneumonia, diarrhea and rickets were co-morbidities that should be prevented. Recovery rate was poor when compared to SPHERE project reference value (which is > 75%). Predictors, namely presence of pneumonia and edematous form of malnutrition reduced nutritional recovery rate. Whereas, being admitted at Mehal Meda Hospital improved recovery rate. Therefore, hospitals should work in collaboration with health extension workers to prevent co-morbidities and strengthen screening and referral of malnutrition cases at community level. Moreover, Zonal Health Department and District Health Offices should facilitate experience sharing among health facilities.
PLOS ONE
Background More than 29 million that is an estimated 5%, under-five children suffer from severe acute malnutrition (SAM) globally, with a nine times higher risk of mortality than that of well-nourished children. However, little is known regarding outcomes and predictors of SAM in Ethiopia. Therefore, this study aims to determine treatment cure rate and its predictors among children aged 6-59 months with SAM admitted to a stabilization center. Methodology A retrospective record review was employed in SAM children at the University of Gondar Comprehensive Specialized Hospital (UOGCSH) from 2014 to 2016. SAM defined as weight for height below-3 z scores of the median World Health Organization (WHO) growth standards or presence of bilateral edema or mid upper arm circumference < 115mm for a child �6months age. All SAM patients with medical complication(s) or failure to pass appetite test are admitted to the malnutrition treatment center for inpatient follow-up. Data were extracted from a randomly selected records after getting ethical clearance. Data were cleaned, coded and entered to Epi-info version-7, and analyzed using STATA/se version-14. Descriptive statistics and analytic analyses schemes including bivariable and multivariable Cox proportional hazards model were conducted. Result Among a total of 416 records recruited for this study, 288 (69.2%) SAM children were cured at the end of the follow up, with a median cure time of 11 days. Kwash-dermatosis (AHR (
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.
Predictors of Death from Complicated Severe Acute Malnutrition in East Ethiopia: Survival Analysis
International Journal of General Medicine
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 to identify predictors of time to death. Crude and adjusted hazard ratios with 95% confidence intervals and p-values were reported. Results: A total of 665 full medical charts were reviewed with a total of 60 (9%; 95% CI: 6.8-11.2%) deaths were observed, where most of the deaths occurred during the first two weeks of admission, while 74 (11%) and 449 (68%) were cured and recovered (stabilized and transferred to outpatient), respectively. Admitted children having good appetite (AHR=0.15; 95% CI: 0.64-0.33), pneumonia (AHR=2.46, 95% CI: 1.436, 4.22), diarrhea (AHR=2.16, 95% CI: 1.16, 4.06), tuberculosis (AHR=2.86, 95% CI: 1.08, 7.63) and having a nasogastric tube inserted (AHR=2.33, 95% CI: 1.15, 4.72) were significant predictors of time to death among SAM children. Conclusion: There is unacceptably high under-five mortality due to SAM, which is predicted by co-morbidities (pneumonia, diarrhea, and tuberculosis), with medical complications and nasogastric tubes.
Journal of Nutrition & Food Sciences, 2014
Background: Severe acute malnutrition is a major challenge to achieve the millennium development goals. It is also the least preventable causes of child deaths. Limited information is found on the factors that influences improvement of treatment outcome in the admitted children. So the study tries to identify associated factors that compromise outcome. Objectives: Assessment of treatment outcome and associated factors among under-five children with severe acute malnutrition admitted to therapeutic feeding unit at Woldia general Hospital. Method: A Hospital record based retrospective cohort study supplemented with qualitative inquiry was conducted. The study period was from January 01 to 06, 2014. Records of 324 children with severe acute undernutrition were taken as the study sample. In-depth interview was conducted with six Health professionals in the ward. Multivariate analyses were done by using logistic regression to identify predictors. Result: Among 324 admitted children, 85% with 95% CI (81%-88.7%), 6% with CI (3.8%-9.2%), 5% and 4% of the cases were cured, died, defaulters and transferred out respectively. children with edema (AOR: 0.2(0.10-0.79), HIV positive children AOR: 0.12(0.032-0.42), Children who gained Plumpy'nut AOR: 3.70(CI: 1.22-11.23) were significant predictors for cure rate of severe acute malnutrition. Conclusion: Even though recovery and death rates were found above and below the minimum acceptable cutoff points of the sphere standards respectively, better achievement should be expected to reduce mortality rate and increase cure rate. The burden of co morbidities plus lack of training and supportive supervision in the Hospital compromise the rate of recovery. There should be a strong linkage between the Health sector and other stakeholders to minimize the level of child under-nutrition via nutrition education.
Italian Journal of Pediatrics, 2019
Background: Despite improving access to Severe Acute Malnutrition (SAM) management, information on the quality of the service, as measured by timely recovery, is scare. This study is designed to assess treatment outcomes and factors affecting time-to-recovery from SAM in children 6-59 months admitted to a stabilizing center in Hawassa University Comprehensive Specialized Hospital (HU-CSH), Southern Ethiopia. Methods: Institutional-based retrospective cohort study was conducted on 420 randomly selected children aged 6-59 months. The children were managed at the hospital from July, 2015 to June, 2017. Pre-tested structured questionnaire was used to extract data from medical records. Data were analyzed using Kaplan Meir (KM) curve, Log rank test and Cox-Proportional hazards model. The outputs of the bivariable and multivariable Cox model are presented using Adjusted Hazard Ratio (AHR) with the respective 95% Confidence Intervals (CIs). Results: After a maximum of 59 days treatment 69.3% of the children recovered and 10.8% died. The mean (±SD) weight gain rates was 12.7 (±8.9) g/kg/days. The overall incidence density rate of recovery was 3.8 per 100 persondays. The overall median (IQR) time of recovery was 17(10, 24) days. F-100 intake (AHR = 0.502, 95%, CI: 0.29-0.86), Tuberculosis infection (AHR = 1.38, 95% CI: 1.00-1.91) and provision of special medication (IV fluid, IV antibiotic and blood transfusion) (AHR = 0.72, 95% CI: 0.52-0.99) at admission were found to be significant predictors of time-torecovery from SAM. Conclusion: The overall recovery from complicated SAM children admitted at HU-CSH after a maximum of 59 days treatment was low (69.4%) and a very high proportion of children (10.8%) end up in death. Therefore, HU-CSH should give special focus for those children present with medical comorbidities during admission.
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...
Journal of Nutritional Medicine and Diet Care, 2021
Childhood malnutrition is still a major global health problem, contributing to morbidity, mortality and risk for disability [1]. It refers to a combination of nutritional disorders that include underweight (mixed), wasting (acute), stunting (chronic) and micronutrient deficiency [2,3]. Wasting (weight for height) is an acute malnutrition due to a recent failure to receive adequate nutrition and may be affected by recent episodes of diarrhea and other acute illnesses [2] and chronic malnutrition might due to immune-compromisizations from complex, adaptive physiologic and metabolic processes secondary to insufficient nutrients [2]. Around 45%-60% of deaths for children less than 5 years of age were linked to under nutrition, while this is mostly occur in low-and middleincome countries makes most difficulty [1,4]. The current burden of malnutrition globally is unacceptably and every country in the world is affected