Time-to-recovery from severe acute malnutrition in children 6–59 months of age enrolled in the outpatient treatment program in Shebedino, Southern Ethiopia: a prospective cohort study

Abstract

BackgroundIn Ethiopia uncomplicated severe acute malnutrition (SAM) is managed at health posts level through the outpatient therapeutic program (OTP). Yet, evidence on the treatment success rate of the program is scarce. This study determines the treatment outcomes and predictors of time-to-recovery among children 6–59 months of age with SAM managed at the health posts level in Shebedino district, Southern Ethiopia.MethodsThis was a prospective cohort study that enrolled 216 children with SAM identified through a campaign conducted in May 2015 and treated over eight weeks at 25 health posts of the district. The average time-to-recovery was estimated using Kaplan-Meier survival curve and the independent predictors of the recovery were determined using multivariable Cox-proportional hazard model. The outputs of the analyses are presented via adjusted hazard ratio with 95% confidence intervals (AHR, CI).ResultsAt the end of the eight weeks of treatment 79.6% (95% CI: 74.2–85.0%) of cases recovered from SAM with a weight gain rate of 5.4 g/kg/day. The median time-to-recover was 36 days. The analysis indicated, maternal illiteracy (0.54, 0.38–0.78), severe household food insecurity (0.47, 0.28–0.79), walking for more than 1 h to receive the treatment (0.69, 0.50–0.96), diarrhoea co-morbidity (0.63, 0.42–0.91) and practicing sharing of ready to use therapeutic food (RUTF) (0.53, 0.32–0.88) were associated with slower propensity of recovery from SAM. Children who were enrolled with marasmus diagnosis showed lower recovery than children with kwashiorkor (0.30, 0.18–0.51).ConclusionThe median time-to-recover was 36 days. Discouraging sharing of RUTF, appropriate management of diarrhoea in SAM cases and improving access to OTP sites can help to improve the treatment outcome for SAM.Electronic supplementary materialThe online version of this article (10.1186/s12887-019-1407-9) contains supplementary material, which is available to authorized users.

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

“…At admission, 64.4% of participants showed up with other co-morbidities on top of SAM. Majority of children (64.9%) were hospitalized with marasmus (non-edematous) type of SAM, similar with some recent studies in Ethiopia [1,13,[25][26][27][28][29][30][31] but in contrary to that of Jimma [32], Hadiya, Ethiopia [33] and Uganda [34], which reported edematous type of SAM was highly encountered. This variation might be attributable to the multi-faceted causes of SAM all over the world.…”

“…This is similar with the findings from institution based researches in Bahirdar [13,35] that reported 16 days of recovery time. 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].…”

Treatment outcomes of severe acute malnutrition and Predictors of Recovery in Under-Five children treated within Outpatient Therapeutic Program in Ethiopia: A systematic review and meta-analysis

“…This significant nonrecovery rate could be attributed by high burden of comorbidities, inappropriate feeding process of the RUTFs, non-adherence to follows due to long distance to access RUTFs and drugs in some OTP centers of the country (7,(33)(34)(35). Similarly, food insecurity could contribute to sharing food among family members and this may affect recovery rate of children (33). (60).…”

“…In the current review, eight studies (21,(24)(25)(26)(31)(32)(33)(34) revealed the independent predictors of recovery rate using hazard ratios. The predictors which were reported by the original studies were diarrhea (21,25,31,33), age>24 months (26,32,33) However, diarrhea, no edema and Amoxicillin were found to be independent predictors of recovery rate (Figure 8). The recovery rate of SAM children with diarrhea 16% less likely compared with those children with no diarrhea (HR=0.8, 95% CI: 0.75, 0.94).…”

“…In-addition, the determinants of treatment outcomes, particularly the predictors of recovery rate is not addressed comprehensively. Few studies (21,(24)(25)(26)(31)(32)(33)(34)(35) revealed as edema, diarrhea, deworming, giving antibiotics, vitamin A supplementation, and distance from OTP centers and age as the predictors of recovery of under-five children with SAM in OTPs of Ethiopia.…”