Treatment cure rate and its predictors among children with severe acute malnutrition in northwest Ethiopia: A retrospective record review

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Abstract

Background

More than 29 million that is an estimated 5%, under-five children suffer from severe acute malnutrition (SAM) globally, with a nine times higher risk of mortality than that of well-nourished children. However, little is known regarding outcomes and predictors of SAM in Ethiopia. Therefore, this study aims to determine treatment cure rate and its predictors among children aged 6–59 months with SAM admitted to a stabilization center.

Methodology

A retrospective record review was employed in SAM children at the University of Gondar Comprehensive Specialized Hospital (UOGCSH) from 2014 to 2016. SAM defined as weight for height below -3 z scores of the median World Health Organization (WHO) growth standards or presence of bilateral edema or mid upper arm circumference < 115mm for a child ≥6months age. All SAM patients with medical complication(s) or failure to pass appetite test are admitted to the malnutrition treatment center for inpatient follow-up. Data were extracted from a randomly selected records after getting ethical clearance. Data were cleaned, coded and entered to Epi-info version-7, and analyzed using STATA/se version-14. Descriptive statistics and analytic analyses schemes including bivariable and multivariable Cox proportional hazards model were conducted.

Result

Among a total of 416 records recruited for this study, 288 (69.2%) SAM children were cured at the end of the follow up, with a median cure time of 11 days. Kwash-dermatosis (AHR (Adjusted Hazard Ratio): 1.48(95% CI: 1.01, 2.16)), anemia (AHR: 1.36(95% CI: 1.07, 1.74)), tuberculosis (AHR: 1.6(95% CI: 1.04, 2.43)) and altered body temperature at admission (AHR: 1.58(95% CI: 1.04, 2.4) were independent predictors of time to cure.

Conclusion

The cure rate in SAM children was low relative to sphere standard guideline. Prognosis of SAM largely depends on the presence of other comorbidities at admission. Available intervention modalities need to address coexisting morbidities to achieve better outcomes in SAM children.

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Most cited references 21

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Management of severe acute malnutrition in children.

Steve Collins, Nicky Dent, Paul Binns … (2006)

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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Association between sudden infant death syndrome and diphtheria-tetanus-pertussis immunisation: an ecological study

Jacqueline Müller-Nordhorn, Chih-Mei Hettler-Chen, Thomas Keil … (2015)

Background Sudden infant death syndrome (SIDS) continues to be one of the main causes of infant mortality in the United States. The objective of this study was to analyse the association between diphtheria-tetanus-pertussis (DTP) immunisation and SIDS over time. Methods The Centers for Disease Control and Prevention provided the number of cases of SIDS and live births per year (1968–2009), allowing the calculation of SIDS mortality rates. Immunisation coverage was based on (1) the United States Immunization Survey (1968–1985), (2) the National Health Interview Survey (1991–1993), and (3) the National Immunization Survey (1994–2009). We used sleep position data from the National Infant Sleep Position Survey. To determine the time points at which significant changes occurred and to estimate the annual percentage change in mortality rates, we performed joinpoint regression analyses. We fitted a Poisson regression model to determine the association between SIDS mortality rates and DTP immunisation coverage (1975–2009). Results SIDS mortality rates increased significantly from 1968 to 1971 (+27% annually), from 1971 to 1974 (+47%), and from 1974 to 1979 (+3%). They decreased from 1979 to 1991 (−1%) and from 1991 to 2001 (−8%). After 2001, mortality rates remained constant. DTP immunisation coverage was inversely associated with SIDS mortality rates. We observed an incidence rate ratio of 0.92 (95% confidence interval: 0.87 to 0.97) per 10% increase in DTP immunisation coverage after adjusting for infant sleep position. Conclusions Increased DTP immunisation coverage is associated with decreased SIDS mortality. Current recommendations on timely DTP immunisation should be emphasised to prevent not only specific infectious diseases but also potentially SIDS.

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Key issues in the success of community-based management of severe malnutrition.

Tanya Khara, Kate Sadler, Patrícia Saboya … (2006)

Acute malnutrition is an underlying factor in almost 50% of the 10 to 11 million children under 5 years of age who die each year of preventable causes. Inpatient treatment for severe acute malnutrition is associated with high opportunity and economic costs for affected families and health service providers. Community-based therapeutic care attempts to address these problems and to maximize population-level impact through improving coverage, access, and cost-effectiveness of treatment. THE COMMUNITY-BASED THERAPEUTIC CARE MODEL: Community-based therapeutic care programs provide effective care to the majority of acutely malnourished people as outpatients, using techniques of community mobilization to engage the affected population and maximize coverage and compliance. People with severe acute malnutrition without medical complications are treated in an outpatient therapeutic program with ready-to-use therapeutic food and routine medication. Those suffering from severe acute malnutrition with medical complications are treated in an inpatient stabilization center according to standard World Health Organization protocols until they are well enough to be transferred to the outpatient therapeutic program. IMPACT OF COMMUNITY-BASED THERAPEUTIC CARE PROGRAMS: Twenty-one (21) community-based therapeutic care programs were implemented in Malawi, Ethiopia, and North and South Sudan between 2000 and 2005. These programs, which treated 23,511 cases of severe acute malnutrition, achieved recovery rates of 79.4% and mortality rates of 4.1%. Coverage rates were approximately 73%. Of the severely malnourished children who presented, 76% were treated solely as outpatients. Initial data indicate that these programs are affordable, with the cost-effectiveness of emergency community-based therapeutic programs varying from US$12 to US$132 per year of life gained.

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Author and article information

Contributors

Fasil Wagnew:

ORCID: http://orcid.org/0000-0003-3087-2312

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: Writing – original draftRole: Writing – review & editing

Getiye Dejenu: Role: ConceptualizationRole: MethodologyRole: Writing – review & editing

Setegn Eshetie: Role: SupervisionRole: Writing – original draftRole: Writing – review & editing

Animut Alebel: Role: Formal analysisRole: Writing – review & editing

Wubet Worku: Role: Writing – review & editing

Amanuel Alemu Abajobir: Role: Writing – original draftRole: Writing – review & editing

Sphiwe Madiba: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 20 February 2019

Publication date Collection: 2019

Volume: 14

Issue: 2

Electronic Location Identifier: e0211628

Affiliations

[1 ] College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia

[2 ] College of Health Sciences, University of Gondar, Gondar, Ethiopia

[3 ] Faculty of Medicine, The University of Queensland, Brisbane, Australia

Sefako Makgatho Health Sciences University, SOUTH AFRICA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: fasilw.n@ 123456gmail.com

Author information

Fasil Wagnew http://orcid.org/0000-0003-3087-2312

Article

Publisher ID: PONE-D-18-19281

DOI: 10.1371/journal.pone.0211628

PMC ID: 6382114

PubMed ID: 30785917

SO-VID: 97aa139c-95ac-4133-9aeb-92b08906245f

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 23 July 2018

Date accepted : 17 January 2019

Page count

Figures: 5, Tables: 5, Pages: 13

Funding

The authors received no specific funding for this work.

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Data Availability All relevant data are within the paper and its Supporting Information files.

Treatment cure rate and its predictors among children with severe acute malnutrition in northwest Ethiopia: A retrospective record review

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Most cited references 21

Management of severe acute malnutrition in children.

Association between sudden infant death syndrome and diphtheria-tetanus-pertussis immunisation: an ecological study

Key issues in the success of community-based management of severe malnutrition.

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