A Comparative Study between SAM with Edema and SAM without Edema and Associated Factors Influencing Treatment, Outcome & Recovery

Abstract

Severe acute malnutrition (SAM) is an established contributor of under-five mortality and morbidity. Achieving desired treatment outcome has proven to be challenging. There is limited data concluding the success of treatments in the study area. Objective: This study was aimed to compare the recovery from severe acute malnutrition with identified medical complications where presence or absence of edema denotes a major predictor among children aged 0-59 months of age. Methods: This was a retrospective observational study on facility based management which was conducted in SAM block of Chattogram Medical College hospital, Chattogram, Bangladesh. Here a total of 485 patients were admitted during the period of 2013-2017 and among them, 266 patients were successfully discharged from the hospital. Based on WHO & National guidelines for management of severely malnourished children in Bangladesh, treatment protocol, admission and discharge criteria were followed. A structured and prescribed data format was prepared and data were collected from the hospital records. Daily observation, monitoring and follow-up notes of the patients were also recorded. After data collection, they were cleaned, edited and stored into excel, EPI-INFO and analyzed by SPSS. Results: More than half of the admitted patients were cured and routinely discharged. 8.04% patients died during this period. 39.7% (193) children recovered according to the set discharge criteria as per guidelines. Mean age of the observed patients was 22.35±15.8607 months. More than half of the admitted patients showed moderate to good weight gain during hospital stay. Mean weight gain was higher in non-edematous patients. 50% of non – edematous patients started to gain weight in 3-5 days while 76% of edematous patients required 6-10 days to start weight gain. 4.3% patients did not gain weight during hospital stay. Both descriptive and analytic analyses were executed. P value<0.05 was considered as statistically significant Conclusions: The mean duration of hospital stay (in days) of the patients with oedema (15.64±SD 7.133 days) was higher than that of the patients without oedema (9.47±SD 5.881 days). But greater portion of patients with edema were cured. Independent-Sample T Test revealed the difference statistically significant, where t=(438,485)=-9.878, p=0.002.