Co-morbidity, treatment outcomes and factors affecting the recovery rate of under -five children with severe acute malnutrition admitted in selected hospitals from Ethiopia: retrospective follow up study

Abstract

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.

Keywords: Co-morbidity; Kwashiorkor; Severe acute malnutrition; Treatment outcomes.