Recovery time from severe acute malnutrition and associated factors among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study.

Mekonen Adimasu,Fikrtemariam Abebe,Getaneh Baye,Kerebih Abere,Girum Sebsibie

doi:10.4178/epih.e2020003

Mekonen Adimasu, Fikrtemariam Abebe + Show 3 more

Open Access

https://doi.org/10.4178/epih.e2020003

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Abstract

OBJECTIVESRecovery time from severe acute malnutrition (SAM) is often a neglected topic despite its clinical impact. Although a few studies have examined nutritional recovery time, the length of hospitalization in those studies varied greatly. Therefore, the aim of this study was to determine the recovery time from SAM and to identify predictors of length of hospitalization among under-5 children.METHODSA retrospective cohort study was conducted among 423 under-5 children with SAM who had been admitted to Yekatit 12 Hospital. Kaplan-Meier analysis was used to estimate time to nutritional recovery, and Cox proportional hazard regression analysis was performed to determine independent predictors.RESULTSThe nutritional recovery rate was 81.3%, and the median recovery time was 15.00 days (95% confidence interval [CI], 13.61 to 16.39). Age, daily weight gain per kilogram of body weight, vaccination status, and the existence of at least 1 comorbidity (e.g., pneumonia, stunting, shock, and deworming) were found to be significant independent predictors of nutritional recovery time. The adjusted hazard ratio (aHR) for nutritional recovery decreased by 1.9% for every 1-month increase in child age (aHR, 0.98; 95% CI, 0.97 to 0.99).CONCLUSIONSThe overall nutritional recovery time in this study was within the Sphere standards. However, approximately 13.0% of children stayed in the hospital for more than 28.00 days, which is an unacceptably large proportion. Daily weight gain of ≥8 g/kg, full vaccination, and deworming with albendazole or mebendazole reduced nutritional recovery time. Conversely, older age, pneumonia, stunting, and shock increased nutritional recovery time.

Highlights

The study included records of 423 under-5 children with the diagnosis of severe acute malnutrition (SAM) admitted over 3 consecutive years (2016, 2017, and 2018) to the therapeutic feeding unit (TFU) of Yekatit 12 Hospital in Addis Ababa, Ethiopia
313 (74.0%) of the under-5 children admitted to the TFU had marasmus, and 69 (16.3%) had kwashiorkor
Of the 423 children included in the study, 81.3% recovered, and the median nutritional recovery time of the entire cohort was 15.00 days

Summary

Introduction

It encompasses overnutrition, which manifests as overweight or obesity; undernutrition, which includes acute and chronic malnutrition; and micronutrient deficiencies. Undernutrition is associated with > 50% of deaths caused by infectious disease. There were around 60 million and 20 million children with moderate acute malnutrition and severe acute malnutrition (SAM), respectively, in 2013 [1,2]. SAM is defined as a weight-for-height (WFH) measurement below 70% or a WFH z-score below 3 standard deviations from It can be defined as the presence of bilateral pitting edema of nutritional origin or a mid-upper arm circumference (MUAC) of less than 11 cm in children aged 1-5 years [3]

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