A meta-analysis of inpatient treatment outcomes of severe acute malnutrition and predictors of mortality among under-five children in Ethiopia

Fasil Wagnew,Dessalegn Haile,Getenet Dessie,Wubet Worku Takele,Amanuel Alemu Abajobir,Ayenew Negesse,Aster Tadesse,Henok Mulugeta,Sheikh Mohammed Shariful Islam

doi:10.1186/s12889-019-7466-x

Abstract

BackgroundSevere forms of malnutrition have drastic effects on childhood morbidity and mortality in sub-Saharan countries, including Ethiopia. Although few studies have previously estimated treatment outcomes of severe acute malnutrition (SAM) in Ethiopia, the findings were widely varied and inconsistent. This study thus aimed to pool estimates of treatment outcomes and identify predictors of mortality among children with SAM in Ethiopia.MethodsA systematic review was carried out to select 21 eligible articles from identified 1013 studies (dating from 2000 to 2018) that estimated treatment outcomes and predictors of mortality among SAM children. Databases including PubMed, CINHAL, Web of Sciences; Cochrane, Psych INFO and Google Scholar were comprehensively reviewed using medical subject headings (MESH) and a priori set criteria PRISMA guideline was used to systematically review and meta-analyze eligible studies. Details of sample size, magnitude of effect sizes, including Hazard Ratio (HRs) and standard errors were extracted. Random-effects model was used to calculate pooled estimates in Stata/se version-14. Cochran’s Q, I2, and meta-bias statistics were assessed for heterogeneity and Egger’s test for publication bias.ResultTwenty-one studies were included in the final analysis, which comprised 8057 under-five children with SAM in Ethiopia. The pooled estimates of treatment outcomes, in terms of death, recovery, defaulter and transfer out and non-response rates were 10.3% (95% CI: 8.3, 12.3), 70.5% (95% CI: 65.7, 72.2), 13.8% (95% CI: 10.8, 16.9) and 5.1% (95% CI: 3.3, 6.9), respectively. Diarrhea (HR: 1.5, 95% CI: 1.1, 2.2), dehydration (HR: 3.1, 95% CI: 2.3, 4.2) and anemia (HR: 2.2, 95% CI: 1.5, 3.3) were statistically significant predictors of mortality among these children. No publication bias was detected.ConclusionTreatment outcomes in under-five children with SAM are lower than the World Health Organization (WHO) standard, where mortality is being predicted by comorbidities at admission. Children with SAM need to be treated for diarrhea, dehydration and anemia at the primary point of care to reduce mortality.

Highlights

Severe forms of malnutrition have drastic effects on childhood morbidity and mortality in sub-Saharan countries, including Ethiopia
Treatment outcomes in under-five children with severe acute malnutrition (SAM) are lower than the World Health Organization (WHO) standard, where mortality is being predicted by comorbidities at admission
Children with SAM need to be treated for diarrhea, dehydration and anemia at the primary point of care to reduce mortality

Summary

Introduction

Severe forms of malnutrition have drastic effects on childhood morbidity and mortality in sub-Saharan countries, including Ethiopia. Acute malnutrition is a major challenge for achieving sustainable development goals (e.g., Goals 2 and 3–Zero Hunger and Good Health and Wellbeing) as it is associated with major causes of under-five mortality. It leads to adverse maternal and child health consequences including retarded school performance and aggravating maternal related problems [5, 6] especially in poorer settings. 2% of children (nearly 13 million) suffer from SAM in developing countries [7] of which over 90% live in South- East Asia and sub-Saharan Africa [8]. Mortality of children from SAM in inpatient set-ups in sub-Saharan Africa still remains significantly high, with ten-folds higher the risk of death than well-nourished children [9]

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