Outpatient management of severe acute malnutrition among children under five years old, in Yemen: a retrospective cohort study

Abstract

Background: Severe acute malnutrition is one of the major health problems in Yemen. The aim of this study is to determine the efficacy of national guidelines of C-MAM on management of severe acute malnutrition among under five years old children in Yemen. Methods: Retrospective cohort study, conducted during the period from 5 October 2011 to 5 October 2013. Study procedures involved assessing clinical records of 303 children aged 6-59 months. The outcomes were recovery, death, default and transfer from programme. Results: A total of 303 children (6-59 months old) suffered from SAM were underwent treatment in the C-MAM programme. Recovered 31 (10.2%), died 10 (3.3%), transferred 19 (6.3%), defaulted 243 (80.2%) and median stay of children in programme were 40 days. In children who defaulted from the programme, a Chi-square test for independence indicated significant association to children aged less than 24 months (Chi(2); 4.441, df;1, and p = 0.025). There were no significant associations between defaulted children and gender, residents and distances to OTP service. Logistic regression identified four significant contributing factors to high defaulter rate: new admission in the programme (OR 6.904; 95%CI: 1.089-43.788), MUAC entrance criteria less than 115 (OR 0.247; 95%CI: 0.115-0.533), z-sore less than -3SD (OR 9.236; 95% CI: 4.940-16.475) and length of stay in the programme more than 42 days (OR 6.353; 95% CI: 3.623 – 11.022). Conclusions: Low recovery and high defaulter rates of children with SAM were identified as a major determinant of a performance indicator values in these communities.