Research Article: Treatment cure rate and its predictors among children with severe acute malnutrition in northwest Ethiopia: A retrospective record review

Date Published: February 20, 2019

Publisher: Public Library of Science

Author(s): Fasil Wagnew, Getiye Dejenu, Setegn Eshetie, Animut Alebel, Wubet Worku, Amanuel Alemu Abajobir, Sphiwe Madiba.

http://doi.org/10.1371/journal.pone.0211628

Abstract

More than 29 million that is an estimated 5%, under-five children suffer from severe acute malnutrition (SAM) globally, with a nine times higher risk of mortality than that of well-nourished children. However, little is known regarding outcomes and predictors of SAM in Ethiopia. Therefore, this study aims to determine treatment cure rate and its predictors among children aged 6–59 months with SAM admitted to a stabilization center.

A retrospective record review was employed in SAM children at the University of Gondar Comprehensive Specialized Hospital (UOGCSH) from 2014 to 2016. SAM defined as weight for height below -3 z scores of the median World Health Organization (WHO) growth standards or presence of bilateral edema or mid upper arm circumference < 115mm for a child ≥6months age. All SAM patients with medical complication(s) or failure to pass appetite test are admitted to the malnutrition treatment center for inpatient follow-up. Data were extracted from a randomly selected records after getting ethical clearance. Data were cleaned, coded and entered to Epi-info version-7, and analyzed using STATA/se version-14. Descriptive statistics and analytic analyses schemes including bivariable and multivariable Cox proportional hazards model were conducted. Among a total of 416 records recruited for this study, 288 (69.2%) SAM children were cured at the end of the follow up, with a median cure time of 11 days. Kwash-dermatosis (AHR (Adjusted Hazard Ratio): 1.48(95% CI: 1.01, 2.16)), anemia (AHR: 1.36(95% CI: 1.07, 1.74)), tuberculosis (AHR: 1.6(95% CI: 1.04, 2.43)) and altered body temperature at admission (AHR: 1.58(95% CI: 1.04, 2.4) were independent predictors of time to cure. The cure rate in SAM children was low relative to sphere standard guideline. Prognosis of SAM largely depends on the presence of other comorbidities at admission. Available intervention modalities need to address coexisting morbidities to achieve better outcomes in SAM children.

Partial Text

Childhood under-nutrition refers to a combination of nutritional disorders that include underweight (mixed), wasting (acute), stunting (chronic) and micronutrient deficiency (2). Wasting (weight for height) is an acute malnutrition due to a recent failure to receive adequate nutrition and may be affected by recent episodes of diarrhea and other acute illnesses (3). Based on severity, acute malnutrition is classified as moderate acute malnutrition (MAM) and Severe Acute Malnutrition (SAM) (5).

Regarding treatment outcomes of SAM, 288 (69.2%) children were cured while 45(10.8%) died (Fig 1). Among admitted children, the most frequent co-morbidities were dehydration (33.2%), pneumonia (20.6%) and tuberculosis (15.9%) (Fig 2).

The current study determined treatment cure rate and its predictors among 6–59 months old children with SAM admitted to hospital’s stabilization center. The study found a cure rate of 69.2% which was unacceptably low when compared to the sphere standards that recommend the cure rate should exceed 75% [26] in malnourished children on relevant treatment protocol. This low cured rate may be attributable to a late presentation [27], higher defaulter rate and patient overload [15]. As well, this low cure rate may be attributable to non-adhering with the standard protocol for management of SAM [15, 28]. Thus, to achieve a better cure rate, the management of SAM standard protocol needs to be implemented properly. This means that strengthening outpatient treatment programme should tackle barriers to access, encourage early identification of SAM, reduce inpatient caseloads and decrease the risks of cross-infection [29, 30]. Lastly, in this study achieving low cure rate may be because of mismanagement of children such as partial prescription of routine medication and due to comorbidity at admission like a presence of pneumonia and tuberculosis. However, the average length of hospital stay (i.e., 18 days) is less than the sphere international standard set length of hospital stay (i.e., <28 days). The median cure time was consistent with other studies done in Karat and Fasha, and Debre Markos and Finote Selam stabilization centers [10, 13], although the findings showed a wide range of variations in the cure rate as compared to other studies in other parts of the country [10, 11, 13, 15–17, 31, 32]. This could be due to differences in socioeconomic status, quality of health care provision, availability of therapeutic feeding and special medications[33]. The cure rate in SAM children was low relative to sphere standard guideline. Prognosis for SAM treatment largely depends on the presence of other comorbidities at admission. Available intervention modalities need to address coexisting morbidities to achieve a better cure rate in SAM children.   Source: http://doi.org/10.1371/journal.pone.0211628

 

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