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Meta-Analysis
. 2020 Mar 18;15(3):e0229698.
doi: 10.1371/journal.pone.0229698. eCollection 2020.

The recovery rate from severe acute malnutrition among under-five years of children remains low in sub-Saharan Africa. A systematic review and meta-analysis of observational studies

Hanna Demelash Desyibelew  1 , Mulat Tirfie Bayih  1 , Adhanom Gebreegziabher Baraki  2 , Abel Fekadu Dadi  2   3
Affiliations
Meta-Analysis

The recovery rate from severe acute malnutrition among under-five years of children remains low in sub-Saharan Africa. A systematic review and meta-analysis of observational studies

Hanna Demelash Desyibelew et al. PLoS One. .

Abstract

Background: Globally, Severe Acute Malnutrition (SAM) has been reduced by only 11% over the past 20 years and continues to be a significant cause of morbidity and mortality. So far, in Sub-Saharan Africa, several primary studies have been conducted on recovery rate and determinants of recovery from SAM in under-five children. However, comprehensive reviews that would have a shred of strong evidence for designing interventions are lacking. So, this review and meta-analysis was conducted to bridge this gap.

Methods: A systematic review of observational studies published in the years between 1/1/2000 to 12/31/2018 was conducted following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement. Two reviewers have been searched and extracted data from CINAHL (EBSCO), MEDLINE (via Ovid), Emcare, PubMed databases, and Google scholar. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with fair to good quality were included in the final analysis. The review presented the pooled recovery rate from SAM and an odds ratio of risk factors affecting recovery rate after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD42019122085.

Result: Children with SAM from 54 primary studies (n = 140,148) were included. A pooled rate of recovery was 71.2% (95% CI: 68.5-73.8; I2 = 98.9%). Children who received routine medication (Pooled Odds ratio (POR):1.85;95% CI: 1.49-2.29; I2 = 0.0%), older age (POR: 1.99;95% CI: 1.29-3.08; I2 = 80.6%), and absence of co-morbidity (POR:3.2;95% CI: 2.15-4.76; I2 = 78.7%) had better odds of recovery. This systematic review and meta-analysis suggestes HIV infected children had lower recovery rate from SAM (POR; 0.19; 95% CI: 0.09-0.39; I2 = 42.9%) compared to those non-infected.

Conclusion: The meta-analysis deciphers that the pooled recovery rate was below the SPHERE standard, and further works would be needed to improve the recovery rate. So, factors that were identified might help to revise the plan set by the countries, and further research might be required to explore health fascilities fidelity to the WHO SAM management protocol.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Funnel plot presented the visual inspection of publication bias for systematic review and meta-analysis of studies conducted on SAM children, 2019, N = 54, Sub-Saharan Africa.
Fig 2
Fig 2. One-leave-out sensitivity analysis for studies conducted on sever acute malnutrition children, 2019, N = 54, Sub-Saharan Africa.
Fig 3
Fig 3. PRISMA statement presentation for meta-analysis of recovery rate among SAM under-five children in Sub-Saharan African countries.
Fig 4
Fig 4. A meta-analysis of factors associated with recovery rate from SAM in Sub-Saharan Africa.
Fig 5
Fig 5. A meta-analysis of factors associated with recovery rate from SAM in under five children in Sub-Saharan Africa.
See this image and copyright information in PMC

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