Survival and nutritional status of children with severe acute malnutrition, six months post-discharge from outpatient treatment in Jigawa state, Nigeria

Abstract

BackgroundThe Outpatient Therapeutic Program (OTP) for treatment brings the management of Severe Acute Malnutrition (SAM) closer to the community. Many lives have been saved through this approach, but little data exists on the outcome of the children after discharge from such programmes. This study was aimed to determine the survival and nutritional status of children at six months after discharge from OTP for SAM.MethodologyThis was a prospective study of children with SAM admitted into 10 OTPs in two local government areas of Jigawa state from June 2016 to July 2016.Home visits at six months after discharge enabled the collection of data on survival and nutritional status.The primary outcome measures were survival and nutritional status (Mid upper arm circumference and weight-for-height z-score).ResultOf 494 children with SAM, 410 were discharged and 379 were followed up. Of these, 354, (93.4%) were found alive while 25 (6.6%) died. Among the survivors 333 (94.1%) had MUAC ≥12.5cm and 64 (18.1%) had WHZ<-3.Mortality rates were higher 10 (8.4%) among the 6-11months old. Most deaths 16 (64%) occurred within the first 3months post-discharge. Those who died were significantly more stunted, p = 0.016 and had a smaller head circumference, p = 0.005 on entry to OTP programme.There was improvement from admission to six months follow up in the number of children with complete immunization (27.4% to 35.6%), and a decrease in the number of unimmunized children (34.8% vs 20.6%) at follow-up.ConclusionThe study demonstrates good post discharge survival rate and improved nutritional status for SAM patients managed in OTPs. There were, however considerable post discharge mortality, especially in the first three months and lower immunization uptake post discharge. A follow-up programme will improve these indices further.

Length of stay to recover from severe acute malnutrition and associated factors among under-five years children admitted to public hospitals in Aksum, Ethiopia

“…This study shows death rate of 6% from the total participants enrolled, which is acceptable by the SPHERE project minimum international standards for managing SAM in NRU/TFU, and better than the recent study findings from University of Gondar [28] and Hawassa University [31] comprehensive specialized hospitals which found mortality rates of 10.8% for each. 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].…”

Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes

“…In the same setting, Kerac et al [27] showed that the death hazard ratio 90 days after discharge decreased with each increased anthropometric measurement unit at admission (HR adjusted for age, edema, and HIV status; 0.80 per cm of MUAC and 0.75 per WHZ unit). Evidence of this relationship between severity at admission and mortality after discharge has also been found for other anthropometric indicators of growth and nutritional status, such as weight-for-age, height-for-age, and head circumference [26][27][28].…”

Clinical and growth outcomes of severely malnourished children following hospital discharge in a South African setting

“…The study intended to enrol 50 participants, allowing for detection of 10% mortality with a 95% confidence interval of 3-22%. A 10% mortality rate at six months following discharge was predicted based on the 0.8-10.3% mortality range identified in previous studies [3][4][5][6][7][8][9]. The actual sample size was, however, limited by fewer than anticipated children with SAM being admitted during the study period.…”

“…Studies conducted in Ethiopia, Malawi, Nigeria, Zimbabwe, Zambia, Bangladesh, and India have described mortality rates ranging between 0.8-10.3% from discharge to up to one year after either hospital or community-based management of SAM [3][4][5][6][7][8][9]. Factors associated with death included younger age (<12 months) and greater malnutrition severity at admission [3][4][5][6][7][8][9]. Mortality was highest among children living with HIV [4][5][6].…”

“…Factors associated with death included younger age (<12 months) and greater malnutrition severity at admission [3][4][5][6][7][8][9]. Mortality was highest among children living with HIV [4][5][6].…”