Abstract
Background:Severe acute malnutrition has been managed at Hospital stabilization centers until the management at health center based stabilization centers was started recently. However, the treatment outcome was not assessed in relation to the existing hospital-based management. Therefore, this study comparatively assessed the treatment outcome and survival status of severe acute malnutrition among Health center-based and hospital-based stabilization centers. The finding will be used by healthcare providers, planners and policymakers at large.Methods:Randomly selected 400 records of under-five children admitted to five stabilization centers (2 hospitals and 3 health center) in Gedeo Zone was included. Data was entered by Epi Info version 7 and analyzed by STATA version 11. Survival difference was checked by life table and Kaplan-Mier with Log-Rank test. Cox proportional hazards model was built by forward stepwise procedure; compared to likely hood ratio test and Harrell’s concordance and fitness checked by the cox-snell residual plot.Result:The study showed that the cumulative probability of Survival is significantly different at Hospital stabilization center and health center stabilization centers (p.value <0.001) with shorter survival at hospitals. During the follow-up period, 28(13.86%) children from hospital and 5(2.5%) children from health center died, while 155(76.73%) children from the hospital and 145(73.23%) children from health center got cured. Eighteen (4.5%)children were defaulted. Death is significantly higher at the hospital, while default rate and cure rate are not significantly different. Altered pulse rate [AHR=2.44, 95% CI =1.47-4, p<0.001], NG tube insertion [AHR=1.8, 95% CI =1.04-3.1, p=0.038], Anemia [AHR=1.53, 95% CI =1.02-2.3, p<0.041] and Hypoglycemia [AHR=2.78, 95% CI =1.8-4.3, p<0.001] were found to be independent predictors of death.Conclusion:The survival of children in hospital is shorter and mortality is higher. An overall treatment outcome was in acceptable ranges. Intervention to further reduce deaths at hospitals has to focus on children with comorbidities and altered general conditions and early detection.
Highlights
Severe acute malnutrition has been managed at Hospital stabilization centers until the management at health center based stabilization centers was started recently
Children are different in terms of MUAC and type of Severe Acute Malnutrition (SAM); HSC has higher 108(53.46%) proportion of MUAC < 11.5 than Health Center based Stabilization Center (HCSC) 86(43.43%) with an overall prevalence of 194(48.5%)
This study revealed that 13.86% of children admitted at HSC died during the period of follow up which is higher than the minimum SPHERE standard of 10% mortality [15] and the finding of Jarso et al [14] and Girum et al [8]
Summary
Severe acute malnutrition has been managed at Hospital stabilization centers until the management at health center based stabilization centers was started recently. Malnutrition contributes to 50 - 60% of deaths in children globally [4, 5, 9, 10] and severe wasting alone attributed 4.4% of the 7.6 million deaths occurring annually among under 5 children [4, 9]. The risk of death is nine times higher among Severely Acute Malnourished (SAM) than well-nourished children; severe wasting alone is estimated to account for around 400,000 child deaths each year [2 - 4]. In Ethiopia, malnutrition contributes to an estimated 270,000 deaths of under-five children each year (6), accounts for 11% of the deaths of under-five children [11] and it constitutes 20% of primary diagnosis in pediatric hospital admissions [12]
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