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      Survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study

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          Abstract

          Despite the existence of standard protocol, many stabilization centers (SCs) continue to experience high mortality of children receiving treatment for severe acute malnutrition. Assessing treatment outcomes and identifying predictors may help to overcome this problem. Therefore, a 30-month retrospective cohort study was conducted among 545 randomly selected medical records of children <5 years of age admitted to SCs in Gedeo Zone. Data was entered by Epi Info version 7 and analyzed by STATA version 11. Cox proportional hazards model was built by forward stepwise procedure and compared by the likelihood ratio test and Harrell’s concordance, and fitness was checked by Cox–Snell residual plot. During follow-up, 51 (9.3%) children had died, and 414 (76%) and 26 (4.8%) children had recovered and defaulted (missed follow-up for 2 consecutive days), respectively. The survival rates at the end of the first, second and third weeks were 95.3%, 90% and 85%, respectively, and the overall mean survival time was 79.6 days. Age <24 months (adjusted hazard ratio [AHR] =2.841, 95% confidence interval [CI] =1.101–7.329), altered pulse rate (AHR =3.926, 95% CI =1.579–9.763), altered temperature (AHR =7.173, 95% CI =3.05–16.867), shock (AHR =3.805, 95% CI =1.829–7.919), anemia (AHR =2.618, 95% CI =1.148–5.97), nasogastric tube feeding (AHR =3.181, 95% CI =1.18–8.575), hypoglycemia (AHR =2.74, 95% CI =1.279–5.87) and treatment at hospital stabilization center (AHR =4.772, 95% CI =1.638–13.9) were independent predictors of mortality. The treatment outcomes and incidence of death were in the acceptable ranges of national and international standards. Intervention to further reduce deaths has to focus on young children with comorbidities and altered general conditions.

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          Most cited references 27

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

          The Lancet, 382(9890), 427-451
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            Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles.

            Previous analyses derived the relative risk (RR) of dying as a result of low weight-for-age and calculated the proportion of child deaths worldwide attributable to underweight. The objectives were to examine whether the risk of dying because of underweight varies by cause of death and to estimate the fraction of deaths by cause attributable to underweight. Data were obtained from investigators of 10 cohort studies with both weight-for-age category ( -1 SD) and cause of death information. All 10 studies contributed information on weight-for-age and risk of diarrhea, pneumonia, and all-cause mortality; however, only 6 studies contributed information on deaths because of measles, and only 3 studies contributed information on deaths because of malaria or fever. With use of weighted random effects models, we related the log mortality rate by cause and anthropometric status in each study to derive cause-specific RRs of dying because of undernutrition. Prevalences of each weight-for-age category were obtained from analyses of 310 national nutrition surveys. With use of the RR and prevalence information, we then calculated the fraction of deaths by cause attributable to undernutrition. The RR of mortality because of low weight-for-age was elevated for each cause of death and for all-cause mortality. Overall, 52.5% of all deaths in young children were attributable to undernutrition, varying from 44.8% for deaths because of measles to 60.7% for deaths because of diarrhea. A significant proportion of deaths in young children worldwide is attributable to low weight-for-age, and efforts to reduce malnutrition should be a policy priority.
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              Management of severe acute malnutrition in children.

              Severe acute malnutrition (SAM) is defined as a weight-for-height measurement of 70% or less below the median, or three SD or more below the mean National Centre for Health Statistics reference values, the presence of bilateral pitting oedema of nutritional origin, or a mid-upper-arm circumference of less than 110 mm in children age 1-5 years. 13 million children under age 5 years have SAM, and the disorder is associated with 1 million to 2 million preventable child deaths each year. Despite this global importance, child-survival programmes have ignored SAM, and WHO does not recognise the term "acute malnutrition". Inpatient treatment is resource intensive and requires many skilled and motivated staff. Where SAM is common, the number of cases exceeds available inpatient capacity, which limits the effect of treatment; case-fatality rates are 20-30% and coverage is commonly under 10%. Programmes of community-based therapeutic care substantially reduce case-fatality rates and increase coverage rates. These programmes use new, ready-to-use, therapeutic foods and are designed to increase access to services, reduce opportunity costs, encourage early presentation and compliance, and thereby increase coverage and recovery rates. In community-based therapeutic care, all patients with SAM without complications are treated as outpatients. This approach promises to be a successful and cost-effective treatment strategy.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2017
                23 January 2017
                : 13
                : 101-110
                Affiliations
                [1 ]Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite
                [2 ]Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch
                [3 ]Department of Planning, Adare Hospital, Southern Region Health Bureau, Hawassa, Ethiopia
                Author notes
                Correspondence: Tadele Girum, Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite city, PO Box 07, Ethiopia, Tel +251 9 1365 2268, Email girumtadele@ 123456yahoo.com
                Article
                tcrm-13-101
                10.2147/TCRM.S119826
                5271381
                © 2017 Girum et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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