Outcomes of Severely Malnourished Children Aged 6 - 59 Months on Outpatient Management Program in Kitui County Hospital, Kenya

Abstract

Background: Severe acute malnutrition is a widely prevalent problem in developing countries and a major cause of morbidity and mortality. Traditionally, children with severe acute malnutrition were rehabilitated within inpatient services. Advent of ready to use therapeutic food made it possible to treat majority of these children in their homes. However, there is limited data about the outcomes of the program. Objectives: To determine the outcomes (recovery, default, mean weight gain and non-response rates) of severely malnourished children aged 6-59 months enrolled in outpatient therapeutic program at Kitui County Hospital. Methodology: A prospective longitudinal study design was carried out for one month. Hundred and four (104) children with SAM were recruited in the study. Anthropometric measurements, physical examination and appetite test of the children were conducted on a weekly basis for 28 days. Descriptive analysis was conducted using means, frequency and proportions. Paired t test was computed for mean weight gain and mid-upper arm circumference between admission and subsequent visits. Results: The findings of the study revealed that the recovery rate was 73.3%, weight gain rate of 5.1 g/kg/day, defaulter rate was 2.9% and non-response rate was 13.9% (WHZ = −3SD). Mean weight increased from 6.8 kg on the 1 st visit to 7.5 kg in the 4 th visit (P = 0.000) and the meanmid-upper arm circumferenceincreased from 11.1 cm at admission to 11.9 cm at 4 th visit (P = 0.000). Conclusion: The recovery and weight gain rates were below the global acceptable SPHERE of minimum standards * Corresponding author. D. Mbaya et al. 327 (recovery rate > 75% and weight gain rate > 8 g/kg/day). The defaulter rate was within the acceptable international standards (<15%).

Predictors of time-to-recovery from severe acute malnutrition treated in an outpatient treatment program in health posts of Arba Minch Zuria Woreda, Gamo zone, Southern Ethiopia: A retrospective cohort study

“…Also, this finding was comparable with a study conducted among children treated at OTP in Wolaita zone (4.2 g/kg/day) [21]. This finding was slightly lower than the study conducted in Kenya (5.1 g/kg/day), Kamba district (5.76 g/kg/day) and Shebedino district (5.4 g/kg/day) [4,20,22]. The possible reasons for the low weight gain might be associated with late detection of children with SAM that would increase the risk of co-morbidities which in turn would have resulted in the weight gain falling short of the standard.…”

“…The disparities in recovery time might be attributable to differences in treatment and caring practices among facilities since most of the previous studies were conducted on data from hospitals, health centers and health posts [22,25] and this study assessed the recovery at health post level. Besides this, the difference might be due to differences in adherence to guidelines to optimal management of children under OTP across regions [4], differences in seasons and setting-specific differences in predictors of time-torecovery in the different contexts of the studies. The finding might particularly indicate that HEWs at health posts in the periphery of the health care system are able to provide management of SAM at OTPs to the national recommended standards set for median recovery time though efforts are needed to shorten the time-to-recovery to the global standards.…”

“…Malnutrition is a condition that results from deficiencies, excess or imbalance in a person's energy intake and/or nutrients [1]. Acute malnutrition is the most severe form of malnutrition potentially affecting all categories of the population especially children under five years of age [2][3][4]. Severe acute malnutrition is one of the forms of acute malnutrition which is defined as below 3 standard deviations (SD) of the WHO growth standards or weight for height(W/H) <70% of the median National Center for Health Statistics standard and the presence of bilateral pitting edema or Mid-Upper Arm Circumference(MUAC) <11cm [5].…”

Factors Influencing Outcomes of Children Hospitalized with Acute Severe Malnutrition

“…4 These results provide notice that the recovery rate of children with acute severe malnutrition is still low, therefore an intervention program is needed to improve welfare and health of the child in the future. 14 The differences in recovery outcomes may be influenced by socioeconomic status, quality of treatment, clean and healthy life behavior, access to supplementary food and health services, and finally the difference in malnutrition management guidelines in each area. The study in Africa conducted by Grebemichael et al 10 shows similar results.…”

“…The study reported that socio-demographic factors such as age and residence are not associated with recovery rates, however immunization status is proportionally correlated with severe acute malnutrition in children. 14 Furthermore, pneumonia occurred in 35% of SAM patients, pneumonia is the most frequent comorbid disease suffered by the subjects. The incidence of pneumonia is still high in Indonesia, data from a study conducted by Rudan et al in Tan 15 also showed that in Surabaya and Denpasar are 283 cases/100,000 children and 347 cases/100,000 children.…”