Frequency of relapse for severe acute malnutrition and associated factors among under five children admitted to health facilities in Hadiya Zone, South Ethiopia

Abstract

Background Severe acute malnutrition is a common cause of morbidity and mortality among under five children in Ethiopia. A child may experience more than one episode of SAM depending on the improvement of the underlying factors. However, there is no study that determined the frequency of relapse of SAM cases after discharge in Ethiopia. Objective To identify the frequency of relapse and associated factors among children discharged after undergoing treatment for SAM in Hadiya Zone, South, Ethiopia. Methods An institution based retrospective cohort study was done among children admitted to health posts for treatment of SAM from 2014/2015-2019/2020 under-five children’s after discharge in health post for severe acute malnutrition in the last five years in Hadiya zone, SNNPR, Ethiopia. Both first admission data and relapse data were abstracted from the records of the SAM children from Aguste 1–30 /2020 Using a data collection format. Data were coded and edited manually, then doubly entered into Epi-Data statistical software version 3.1 and then exported to SPSS for windows version 26. After checking all the assumptions finally Negative binomial regression for poison has been used. All tests were two sided and P values <0.05 were used to declare statistical significance. Results In the last five year there were the proportion of relapsed cases were 9.6%, 95% CI: (7.7%, 11.7%) On multivariable negative binomial regression model, after adjusting for background variables relapse of severe acute undernutrition was significantly associated with having edema during admission with (IRR = 2.21, 95% CI:1.303–3.732), being in the age group of 6–11 months (IRR = 4.74,95% CI:1.79–12.53), discharge MUAC for the first admission (P = 0.001, IRR = 0.37, 95% CI:0.270–0.50) increase the risk of incidence rate ratio(IRR) relapse case of severe acute under nutrition. Conclusion Frequency of SAM relapse was positively associated with age, having edema during admission, while it was negatively associated with discharge MUAC. The results imply the need for reviewing the discharge criteria taking into account the recovery of MUAC as a marker for lean tissue accretion, especially in edematous children and those in the younger age.

Burden and risk factors for relapse following successful treatment of uncomplicated severe acute malnutrition in young children: Secondary analysis from a randomised trial in Niger

“…Older children were at lower risk of relapse in line with recent evidence from Ethiopia (Lambebo et al, 2021). Older children may be protected from relapse due to fewer nutritional and health problems often associated with improper introduction of complementary foods in younger children (Lambebo et al, 2021). In terms of case characteristics, our results showed that season of discharge predicted SAM relapse and postdischarge hospitalisation.…”

Time to readmission and associated factors after post treatment discharge of severe acute malnourished under-five children in Pawe General Hospital

“…This may be due to differences in study design and population as a study conducted in Nigeria was a prospective cohort conducted for only 6 months, while the present study captured data over 5 years of the retrospective cohort, which may result in differences. In the present study, the overall relapse rate of SAM was found to be10.8% (95% CI 8.3; 12.6) which is consistent with the finding in the Hadya zone, Ethiopia [ 4 , 5 ]. This may show the commonality of the problem in our country, where the home environment is not usually altered although the child is treated for SAM in the health facility, which could lead to relapse of SAM.…”

“…Possibly early discharge form an inpatient treatment programs by using weight as discharge criteria from the treatment centers; they may have early weight gain as a remnant of nutritional edema-related weight. As nutritional edema affects the function of the glycocalyx is dependent upon sulfated proteoglycans and other glycosaminoglycans fundamentally related to a defect in sulphur metabolism, which can explain all clinical features of the condition, including the re-formation of edema [ 2 , 5 , 15 ]. The probability of getting readmission was increased for cases being a member of rural residents and the finding in our report show that being children resident in a rural setting were 5.3(AHR 5⋅3 = 95% CI 2⋅95, 13⋅87, p = 0.021) times the increased the hazard of SAM relapse as compared with their peers do live in an urban setting.…”

“…Even though the WHO recommends that children with SAM who are discharged from treatment, the programmer should be periodically monitored to avoid relapse with strong recommendations [ 1 , 4 ]. However, in Ethiopia, there is a lack of studies that address either time to relapse or post-discharge status [ 4 , 5 ]. As we have seen above, after treatment of SAM and discharge under five children may face multiple health challenges, so this study is paramount and important for the government to focus on the postdischarge status of SAM children.…”

Incidence and predictors of severe acute malnutrition mortality in children aged 6–59 months admitted at Pawe general hospital, Northwest Ethiopia

“…The association of anemia and death has also been reported by others in Gondar [2], Nekemte referral hospital [27], and in South Africa had (2.5-fold risk) [28]. A child may experience more than one episode of SAM, depending on the improvement of the underlying factors during inpatient treatment [29], but if re-admitted with a relapse, then the risk of death is doubled. Other factors that may be important in our setting include serving a poor pastoralist community, delayed presentation, lack of maternal participation in feeding programs, over prescription of intravenous therapies, early discontinuation of treatment due to insufficient financial means [2], and poor adherence of WHO SAM treatment guidelines [11,30].…”