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

Abstract

Introduction Severe acute malnutrition affects around 17 million under-five children in the world, of which the highest burden is accounted by Sub-Saharan Africa where Ethiopia is found. Besides few individualized, inconsistent and inconclusive studies, there is no nationally representative study conducted on treatment outcomes of SAM in outpatient therapeutic feeding programs in Ethiopia. This study aimed at estimating the pooled treatment outcomes and predictors of recovery rate among under- five children with SAM in Ethiopia. Methods Both electronic databases (PubMed, Medline (EBSCOhost), EMBASE (Elsevier), CINAHL (EBSCOhost), web of science, Scopus, Science Direct and Food Science and Technology Abstracts (FSTA)) and grey literature sources (Google scholar, Mednar, World Cat and google) were used to retrieve articles. The random effect model was used to estimate the pooled treatment outcomes. Hazard ratios were used to determine the predictors of recovery rate. Cochran’s Q, I 2 , and univariate Meta regression were done for heterogeneity as well as Begg’s & Egger’s tests for publication bias. Results Nineteen articles with a total number of 23395 under-five children with SAM were used for this meta-analysis. The pooled recovery, death, defaulter and non-recovery rates were 70% (95% CI: 64.45, 75.72), 1.69% (95% CI: 1.06, 2.31), 9.7% (95%CI: 7, 12.4), 15.14% (95% CI: 10.11, 20.16), respectively. Diarrhea (HR=0.8, 95% CI: 0.75, 0.94), no edema (HR=0.41, 95% CI: 0.33, 0.50) and amoxicillin (HR=1.81, 95% CI: 1.18, 2.44) were independent predictors of recovery rate of children with SAM in Ethiopia. Publication year was found to be the potential source of heterogeneity among the included studies. Conclusion The treatment outcomes of children with SAM from outpatient therapeutic feeding programs of Ethiopia are lower than the sphere guidelines, WHO and national recommendations. Diarrhea and no edema antagonized the recovery rate of children while amoxicillin enhanced the recovery rate of children from SAM. Community health workers need to be trained. Especial attention should be given while treating children with diarrhea and severe wasting. Community mobilization is also recommended to increase community awareness about the therapeutic foods.

Effectiveness of a nonweight‐based daily dosage of ready‐to‐use therapeutic food in children suffering from uncomplicated severe acute malnutrition: A nonrandomized, noninferiority analysis of programme data in Afghanistan

“…In our case, we can confirm that this condition was met. Indeed, the recovery rate of the STD group met the minimum SPHERE standards and is among the higher rates reported in the literature for similar programmes that range from below 50% to above 90% (Bailey et al, 2020;Bitew et al, 2020;Desyibelew et al, 2020;Hitchings et al, 2022;Kangas et al, 2019;Mangal & Sivaraman, 2020;UNICEF, 2021). The weight gain velocity of the STD group also met the minimum SPHERE standard of ≥5 g/kg/day which indicates that the programme was of good quality as usually observed figures in IMAM programmatic and even research contexts are below this minimum and rate as low as 2.4 g/kg/day have been reported (Chase et al, 2020;Hendrixson et al, 2020;Trehan et al, 2013).…”

Outcome after Discharge from Hospital of Children with Complicated Severe Acute Malnutrition and Predictors Factors of Non-Response during Outpatient Treatment, in Senegal

“…The rate of lost to follow-up ranged from 0.0% to 45% [14]. It was 6% in Nigeria [15], 34.2% in Burkina Faso [16], and 10% in Ethiopia Open Journal of Pediatrics [17]. Although WHO recommends inpatient follow-up for SAM with complications and continued management in the community after resolution of complications and for uncomplicated SAM [18], hospitalized children continued to be followed up in the hospital after discharge by medical staff.…”