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Overall status of treatment outcome for children with severe acute malnutrition admitted to Ayder Referral Hospital, 2015, n = 195
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Background
Severe acute malnutrition remains the major cause of morbidity and mortality for children under five years of age in developing countries. The prevalence of wasting, underweight and stunting has remained high in Ethiopia and even unacceptably higher in Tigray region. The objective of the study is to assess the survival status and treatme...
Context in source publication
Context 1
... disease compared to 56.4% (n = 110) of the patients whose treatment was censored. In addition to this, 22.1%, 3.6%, 43.6%, 9.2% and 21.5% of the patients were cured, died, defaulting their treat- ment, non-respondent to their treatment and transferred out to a nearby health centres for continuation of their management respectively (Table 3 and Fig. ...
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Citations
... 8-10 Studies in Africa have also reported low cure rates and high default rates for SAM. [11][12][13] Children who were older, had comorbidities, were not receiving folic acid, vitamin A, and deworming medication, had WHZ< 70% and mid-upper arm circumference < 12 cm on admission, were HIV-positive, had edema, or were not immunized for their age were at increased risk of poor treatment outcome. 11,14,15 However, these factors have not been well-studied in settings affected by natural and man-made disasters that result in high levels of malnutrition. ...
... Data were collected using an extraction format developed after reviewing relevant and related literature. 4,11,13 The extraction format included sociodemographic characteristics of the child including age, sex; baseline information including date of admission, type of admission, anthropometric measurements, treatment phase, type and frequency of therapeutic foods, type and number of prescribed medications, and status of treatment outcome from the patient's medical records and laboratory data reports. Data were collected by 10 data collectors trained in the management of SAM, who were recruited from health workers working in the TFU in collaboration with managers. ...
... For analysis, the treatment outcome was dichotomized into recovered (transfer out and cure) and censored. 13 Censoring included death, default, nonrespondent, and medically transferred. We performed bivariable logistic regression analysis for each independent variable with treatment outcome. ...
... However, the default rate in this study was in line with Gondar University Comprehensive Specialized Hospital's 17.79% (11), while higher than Zambia's 17.2% (17), Pawe general hospital's 16.52% (6), and Wag Himra Zone, Amhara National Regional State's 8.2% (22). In contrast, the default rate of this study was lower than that of Bangladesh, which was 29.9% (18), Bahir Dar Felege Hiwot Referral Hospital, which was 21.7% (13), and Ayder referral hospital, which was 43.6% (25). Differences in study sitting, socioeconomic status, quality of care provided for children, health-seeking behavior, and availability and accessibility of therapeutic foods and medications are all possible reasons for the higher default rate in this study. ...
Background
There is improved access to Sever Acute Malnutrition management in Ethiopia; however, studies have revealed an alarming rate of defaulters’ poor recovery and deaths, emphasizing the importance of researching to identify major causes. As a result, the goal of this research is to identify treatment outcome determinants and associated factors in severely malnourished children aged 6–59 months admitted to public hospitals in Eastern Ethiopia’s stabilization centers.
Methods
This study used an institutional-based retrospective cohort study design with 712 children aged 6 to 59 months. Data was gathered using a Sever Acute Malnutrition registration logbook and patient charts. Participants were chosen at random from their respective healthcare facilities based on population proportion. Epi-data was entered and analyzed using STATA version 14. To identify associated factors, the Cox proportional hazard Ratio was calculated, and a p-value of 0.05 at the 95% confidence interval was considered statistically significant.
Results
This study revealed that only 70.65% (95% CI = 67.19, 73.88) of the children were cured while 17.84% defaulted from the management and 5.90% died. Children who did not have tuberculosis (AHR = 1.58, 95%CI:1.04, 2.40), anemia (AHR = 1.31, 95% CI:1.03, 1.68), Kwash dermatosis (AHR = 1.41, 95%CI:1.04, 1.91), or on NG-tube (AHR = 1.71, 95%CI:1.41, 2.08) were more likely to be cured from SAM.
Conclusion
This study discovered that the cure rate is extremely low and the defaulter rate is extremely high. As a result, intervention modalities that address the identified factor are strongly recommended to accelerate the rate of recovery in Eastern Ethiopia.
... Several studies in Ethiopia and different African countries documented predictors of time to recovery [13][14][15][16][17][18]. However, studies focused on therapeutic foods on time to recovery are limited, and the findings are inconsistent [15,16,19]. In a pilot study from India [20] and a randomized controlled trial from Senegal [21], children treated with RUTF had better average weight gain and shorter recovery time. ...
Background
The therapeutic feeding unit (TFU) provides comprehensive inpatient clinical care for children suffering from severe acute malnutrition (SAM) in three stages: stabilization, transition, and rehabilitation. During the transitional and rehabilitation phases, children receive either F-100 or ready-to-use therapeutic food (RUTF). Although both promote weight gain, RUTF is more energy dense than F-100. There is limited and contrasting evidence regarding their effect on recovery time. Therefore, this study aimed to assess the effect of RUTF on time to recovery among SAM children aged 6–59 months admitted to the TFU in Ethiopia.
Methods
Health Facility-based prospective cohort study was conducted among 476 children treated in three hospitals and four health centers in the Sidama region from September 2021 to January 2022. A structured questionnaire adopted from the Ethiopian national protocol for the management of SAM was used for data collection. Data were entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. The Kaplan-Meir curve and log-rank test were used to compare time to recovery between children who received RUTF and F-100. Multivariable Cox proportional hazard analysis was conducted to assess the association between time to recovery and the type of therapeutic food, controlling for the confounding variables.
Results
The median recovery time was significantly shorter in children receiving RUTF (7 days; 95% CI: 6.62–7.38) compared to F-100 (10 days; 95% CI: 8.94–11.06). Children below 24 months (AHR = 0.54, 95% CI: 0.42–0.69), dehydrated (AHR = 1.34, 95% CI: 1.07–1.75), edematous malnutrition (AHR = 1.29, 95% CI: 1.03–1.61), and anemic (AHR = 2.57, 95% CI: 1.90–3.48) during admission were associated with time to recovery.
Conclusions
Children who received RUTF recovered faster than children who received F-100. Administering RUTF to children below 24 months, who present with anemia and dehydration can improve their recovery rate and shorten their stay in the health facility.
... With this regard, existing pieces of evidence are showing as Ethiopia has failed to fully meet this standard. For instance, the proportion of children recovered from SAM ranges from 43.6% to 87% [13,14]. Several factors such as age of the child, Tuberculosis infection, retroviral infection, type of malnutrition, and inpatient complications could influence both recovery rate and time from SAM [14][15][16][17][18]. Recovery from SAM remains challenging [3], insufficient [7], and even little is known about recovery time from SAM and its predictors among children aged 6-59 months in Ethiopia in general, and in the study area in particular. ...
Background
Severe Acute Malnutrition (SAM) has become a major public health challenge in developing countries including Ethiopia, especially among the underprivileged population. Ethiopia is among the developing countries with the highest burden of acute malnutrition among under-five children. Though, plenty of studies were done on the magnitude of acute malnutrition among under-five children in Ethiopia, there is a limited evidence on time to recovery from SAM and its predictors among children aged 6–59 months in Ethiopia, particularly in the study area.
Objectives
The study was aimed to assess the time to recovery from SAM and its predictors among children aged 6–59 months at Asosa general hospital (AGH), Benishangul Gumuz, Ethiopia.
Methods
A Five years retrospective follow-up study design was employed among 454 children admitted with SAM in AGH from January 2015 to December 2019. The data were extracted from the patient medical records using checklist. The data were coded and entered into Epi-Data 3.1; then exported to STATA/SE-14 for analysis. Proportional Cox regression was performed to identify predictors of recovery time. A proportional hazard assumption was checked. Variables with AHR at 95% CI and P-value less than 0.05 in the multivariable Cox proportional regression was considered as significant predictors of recovery time.
Findings
Among the 454 included records of children with SAM, 65.4% (95%CI: 50.1, 69.2) of them were recovered at the end of the follow-up with a median recovery time of 15 IQR(11–18)days. The incidence rate of recovery was 5.28 per 100 child days’ observations. Being HIV Negative (AHR = 2.19: 95% CI 1.28, 3.73), Marasmic (AHR = 1.69: 95% CI 1.18, 2.42), and marasmic-kwashiorkor child (AHR = 1.60: 95% CI (1.09, 2.37) independently predicted recovery time.
Conclusions
Though the time to recovery from severe acute malnutrition was in the acceptable range, the proportion of recovery was found to be low in the study area compared to sphere standard. The prognosis of children with severe acute malnutrition was determined by the HIV status of the child and the type of malnutrition experienced. Further strengthening of malnutrition therapeutic centers and routine checkup of the nutritional status of HIV positive children should be emphasized to reduce child mortality and morbidity from under-nutrition.
... 5,[17][18][19][20][21][22] In comparison to the standard, research conducted in India and Tigray had a greater recovery rate. 23,24 The average length of hospital stay in this research was 18.5 days, which falls within the SPHERE project's acceptable range of fewer than 28 days. 14 Similarly, several studies done in various countries, such as India, Uganda's Tamale hospital, Zambia, and Tigray indicate shorter hospital stays, 20,21,23,24 while studies conducted in Gonder and Ayder hospitals show the same length of hospital stay. ...
... 23,24 The average length of hospital stay in this research was 18.5 days, which falls within the SPHERE project's acceptable range of fewer than 28 days. 14 Similarly, several studies done in various countries, such as India, Uganda's Tamale hospital, Zambia, and Tigray indicate shorter hospital stays, 20,21,23,24 while studies conducted in Gonder and Ayder hospitals show the same length of hospital stay. 19,25 Children who stayed in the hospital for more than a week had a better chance of recovering. ...
Background:
Severe acute malnutrition is the most prevalent reason for admission to a pediatric unit, and it is a leading cause of mortality in many countries, including Ethiopia, at 25% to 30%, where it affects both developed and developing countries. The objective of this study was to assess treatment outcomes and associated factors among children aged 6-59 months with severe acute malnutrition.
Methods:
A cross-sectional study was conducted using secondary data from medical records of patients enrolled in the therapeutic feeding center from January 2016 to March 2019. There were 385 samples collected at 3 public referral hospitals in Addis Ababa, which were selected by simple random sampling. A structured questionnaire was used to collect data from the available individual folders and registers. The data analysis was performed using binary and multivariable logistic regression models. The odds ratio with 95% CI was used to identify predictor variables. Variables that have a p-value <0.05 were considered significant.
Results:
Children who had tuberculosis were 79% less likely to recover than those who had no tuberculosis. In this study, deaths accounted for 9.1%, recovered were 72.2%, and defaulters accounted for 11.6% with a mean length of stay of 18.6 (CI: 16.9, 20.2) days and an average weight gain of 7.2 g/kg/day (CI: 5.7, 8.2).
Conclusion:
Treating comorbidities on time can help children to recover early and reduce readmission. Integration of severe acute malnutrition screening into all service delivery points can help early identification and treatment. In the meantime, treating them with ready-to-use therapeutic feeding has a significant change in recovery.
... These mostly occur in low-and middle-income countries. Globally MAM and SAM affects approximately 52 million children of under five (11). Children with SAM are 10 times more likely to die than well-nourished children with indirect result of childhood illness (diarrhea, pneumonia).Nepal has very high rate of child malnutrition: nearly half (49%) children are stunted and 45% are under weight (13). ...
Introduction: Child malnutrition is still as major public health problem in many parts of the world especially in developing countries like Nepal. There are numerous causes of child malnutrition among which demographic, socio-economic as well as many other factors are responsible for this condition. So this study was done to identify factors associated with malnutrition among under five children of
Jaimini Municipality, Baglung. Study Groups: The study population was the children of 6-59months along with their mothers was study population. Method: A community based cross-sectional study was conducted in Jaimini Municipality of Baglung district among the children of 6-59months with their mothers. The anthropometric measurement was done to assess their nutritional status with the
approval of participants through informed consent. The analysis of data after data collection was proceeded thoroughly applying various statistical tests as required using statistical software (SPSS Version 20), Essential Nutritional Assessment (ENA) and Ms-Excel 2007. Result: Out of 150 children of Jaimini municipality the prevalence of malnutrition among under five children was calculated based on z-scores and it was found that 30% of the children were underweight, 29.3% were stunted and 17.3 % were wasted. The recent diarrheal cases, exclusive breastfeeding and colostrums milk were found highly significant (p<0.01) factors for underweight and wasting among these
children. Conclusion: The result of this report has highlighted the necessity of long term interventions in nutritional strategies and awareness raising programs to achieve better nutritional status among under-five children.
... But this finding is far less than the report from Sidama zone Shebedino district of southern Ethiopia [29] which found the median LOS of 36 days. It is also lower than several studies conducted in the Ethiopia [1,8,11,24,32] and that of Yemen [36]. However, the median LOS is higher than some study reports from some parts of Ethiopia [25,26,33], Ghana [20] and India [37]. ...
... The overall rate of recovery from SAM was found to be 56%, that is consistent with findings from Debrebrhan University that revealed 55.9% rate of recovery [37]. It is significantly higher than that of Ayder hospital (11) other similar studies from Bahirdar [13,35], Ghana [20] and Yemen [36]. Nevertheless, it is by greater margin below the minimum international standards [15], in comparison with other study findings in Ethiopia [1,8,24,25,[27][28][29][30][31][32] and similar reports from India, Malawi and Uganda [34,[37][38][39] as well. ...
... It is similar with the findings of two studies done in Ethiopia [25,26] and one conducted in Nigeria [40]. But the mortality rate is greater than that of some studies done in Ethiopia [11,13,35], India [37,38], Ghana [20] and Yemen [36]. This could be due to lack of close follow up of patients with strict adherence to the national or international SAM management protocols and socioeconomic differences in the different areas. ...
Background:
Severe acute malnutrition is defined by <70% weight for length/height, by visible severe wasting, by the presence of pitting edema, and in children 6 to 59 months of age, mid upper arm circumference <110 mm. Severe acute malnutrition remains to be a worldwide problem, claiming lives of millions of children, especially in sub-Saharan Africa and south Asia. Though the Ethiopian national guideline states the total length of stay in therapeutic feeding units should not be more than four weeks, there is huge difference, varying from 8 to 47 days of stay. Therefore, the objective of this study was to assess length of stay to recover from severe acute malnutrition and associated factors among under five children hospitalized to the public hospitals in Aksum Town.
Methods:
Sample size was calculated using STATA version 12.0. A retrospective cohort study was conducted using pretested questionnaire in the public hospitals in Aksum on children aged 0-59 months. Cleaned data was entered to Epi info version 7.1.4 and then exported into SPSS version 21 for analysis. Bivariable and multivariable analyses were performed using Kaplan Meier and Cox regression models. During bivariable analysis, variables with p-value < 0.05 were selected for multivariable analysis to identify independent factors associated with length of stay.
Results:
A total of 564 participants enrolled to the study. The rate of recovery was 56% with median length of stay of 15 days (95% CI: 14.1, 15.9). The independent predictors of length of stay to recovery were presence of diarrhea at admission (AHR = 0.573, 95% CI: 0.415-0.793), being HIV positive (AHR = 0.391, 95% CI: 0.194-0.788), palmar pallor (AHR = 0.575, 95% CI: 0.416-0.794), presence of other co-morbidities at admission (AHR = 0.415, 95% CI: 0.302-0.570) and not being treated with plumpy nut (AHR = 0.368, 95% CI: 0.262-0.518).
Conclusions:
Length of stay is in the acceptable range of the international and national set of standards. Nevertheless, the recovery rate was lower compared to the Sphere standard. Presence of diarrhea, palmar pallor, HIV other co-morbidities and not treated with plumpy nut were found independent protective factors for recovery from sever acute malnutrition.
... Developmental, economic, social, and medical impacts of global burdens of malnutrition are serious and lasting for individuals and their family, community, and countries. [2][3][4][5] The majority of children with SAM should be managed in hospital as the alteration in their physiology and metabolic function predisposes them to complications. Therefore, successful management of SAM patient, based on appropriate WHO management guidelines is mandatory. ...
Background: Severe acute malnutrition (SAM) is the leading cause of child mortality in developing nations. In Ethiopia, despite the presence of clinical management protocols, under-five mortality is still high. Moreover, many of the predictors for mortality during inpatient care were not well addressed. Therefore, the aim of the current study was to determine the time to death and its predictors among children under five with severe acute malnutrition. Patients and Methods: A 48-month retrospective cohort study was carried out among 346 children under five from 6 to 59 months of SAM. Data were collected from patient charts by using simple random sampling and entered in EpiData 3.1 and analyzed with STATA 14. A Kaplan-Meier curve and long rank test were used to estimate the survival time and compare survival curves between variables. A Cox proportional hazard model was fitted to identify predictors. Variable with P-value <0.05 with 95% confidence interval was considered as significant for this study. Results: A total of 346 children were followed with an incidence rate of 5.5 deaths per 1000 person-day observation (95%CI: 3.5-8.5). During the follow-up, 212 (61%) were males, 20 (5.8%) had died. This study also showed that males were nearly twice as likely to die than females. Sepsis (AHR: 1.62; 95%CI: 1.10-2.37), hospital admission (AHR: 2.29; 95%CI: 1.43-3.65), presence of edema, (AHR: 1.81; 95%CI: 1.2-2.19), TB (AHR: 1.62; 95%CI: 1.10-2.37) and breast feeding (AHR: 0.41; 95%CI: 0.29-2.37) were predictors of mortality. Conclusion: The overall mean survival time and death was in line with the minimum SPHERE standard. The main predictors of death were having edema, sepsis, hospital admission and breast feeding status at admission. Therefore, it should be better to treat patients with TB, sepsis, edema according to SAM national protocol and promote breast feeding practice.
... Developmental, economic, social, and medical impacts of global burdens of malnutrition are serious and lasting for individuals and their family, community, and countries. [2][3][4][5] The majority of children with SAM should be managed in hospital as the alteration in their physiology and metabolic function predisposes them to complications. Therefore, successful management of SAM patient, based on appropriate WHO management guidelines is mandatory. ...
... is study revealed that the nutritional recovery rate is 74.49%, which was consistent with studies in Kenya [22] and South Wollo [23] and with the national minimum standards of the cure rate of 75% [24]. But, this recovery rate was better than findings from studies conducted in Ghana [25], Mekele [26], Gondar [27], Nekemte [28], and Bahir Dar [29] of [20], Jimma [30], Wolaita [31], and Tigray [32]. is difference might be due to differences in settings, caseload, and severity of cases [33] and the availability of skilled and trained staff [34], socioeconomic status, and availability as well as the accessibility of therapeutic foods and medications [20]. e median nutritional recovery time which is 11 days in this study was similar to that in studies conducted in Debremarkos and Finoteselam [20], South Wollo [23], Gondar [27], Tigray region, and Northern Ethiopia [32] and the national minimum standards of the average length of stay [13]. ...
Background:
Malnutrition has been among the most common public health problems in the world, especially in developing countries including Ethiopia. Even though the Ethiopian government launched stabilization centers in different hospitals, there are limited data on how long children will stay in treatment centers to recover from severe acute malnutrition. This study aimed to assess the time to recovery and its predictors among children 6-59 months with severe acute malnutrition admitted to public hospitals in East Amhara, Northeast Ethiopia.
Methods:
Institution-based, prospective cohort study was conducted in seven public hospitals in East Amhara and a total of 341 children were included in the study. The results were determined by Kaplan-Meier procedure, log-rank test, and Cox-regression to predict the time to recovery and to identify the predictors of recovery time. Variables having P value ≤0.2 during binary analysis were entered into multivarable Cox proportional hazards regression analysis. P value <0.05 was considered statistically significant.
Results:
The nutritional recovery rate was 6.9 per 100 person-days with a median nutritional recovery time of 11 days (an interquartile range of 6). The independent predictors like using NG tube for feeding (AHR = 0.44, 95% CI: 0.27-0.71), not entering phase 2 on day 10 (AHR = 0.19, 95% CI: 0.12-0.29), and being admitted to referral hospitals (AHR = 0.52 95% CI: 0.37-0.73) were associated with longer periods of nutritional recovery time.
Conclusion:
Both the recovery rate and the recovery time were within the acceptable minimum standards. But, special attention has to be given to children who failed to enter phase 2 on day 10, for those who needed NG tube for feeding, and for those admitted to referral hospitals during inpatient management.
