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      Time to Recovery and Its Predictors among Children 6–59 Months Admitted with Severe Acute Malnutrition to East Amhara Hospitals, Northeast Ethiopia: A Multicenter Prospective Cohort Study

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          Abstract

          Background

          Malnutrition has been among the most common public health problems in the world, especially in developing countries including Ethiopia. Even though the Ethiopian government launched stabilization centers in different hospitals, there are limited data on how long children will stay in treatment centers to recover from severe acute malnutrition. This study aimed to assess the time to recovery and its predictors among children 6–59 months with severe acute malnutrition admitted to public hospitals in East Amhara, Northeast Ethiopia.

          Methods

          Institution-based, prospective cohort study was conducted in seven public hospitals in East Amhara and a total of 341 children were included in the study. The results were determined by Kaplan–Meier procedure, log-rank test, and Cox-regression to predict the time to recovery and to identify the predictors of recovery time. Variables having P value ≤0.2 during binary analysis were entered into multivarable Cox proportional hazards regression analysis. P value <0.05 was considered statistically significant.

          Results

          The nutritional recovery rate was 6.9 per 100 person-days with a median nutritional recovery time of 11 days (an interquartile range of 6). The independent predictors like using NG tube for feeding (AHR = 0.44, 95% CI: 0.27–0.71), not entering phase 2 on day 10 (AHR = 0.19, 95% CI: 0.12–0.29), and being admitted to referral hospitals (AHR = 0.52 95% CI: 0.37–0.73) were associated with longer periods of nutritional recovery time.

          Conclusion

          Both the recovery rate and the recovery time were within the acceptable minimum standards. But, special attention has to be given to children who failed to enter phase 2 on day 10, for those who needed NG tube for feeding, and for those admitted to referral hospitals during inpatient management.

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          Most cited references26

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          Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

          The Lancet, 382(9890), 452-477
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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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              Obesity and the Mediterranean Diet: A Review of Evidence of the Role and Sustainability of the Mediterranean Diet

              Several different socio-economic factors have caused a large portion of the population to adopt unhealthy eating habits that can undermine healthcare systems, unless current trends are inverted towards more sustainable lifestyle models. Even though a dietary plan inspired by the principles of the Mediterranean Diet is associated with numerous health benefits and has been demonstrated to exert a preventive effect towards numerous pathologies, including obesity, its use is decreasing and it is now being supplanted by different nutritional models that are often generated by cultural and social changes. Directing governments’ political actions towards spreading adherence to the Mediterranean Diet’s principles as much as possible among the population could help to tackle the obesity epidemic, especially in childhood. This document intends to reiterate the importance of acting in certain age groups to stop the spread of obesity and proceeds with a critical review of the regulatory instruments used so far, bearing in mind the importance of the scientific evidence that led to the consideration of the Mediterranean Diet as not just a food model, but also as the most appropriate regime for disease prevention, a sort of complete lifestyle plan for the pursuit of healthcare sustainability.
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                Author and article information

                Contributors
                Journal
                J Nutr Metab
                J Nutr Metab
                jnme
                Journal of Nutrition and Metabolism
                Hindawi
                2090-0724
                2090-0732
                2020
                1 September 2020
                : 2020
                : 5096201
                Affiliations
                1Department of Nursing, Dessie Health Science College, Dessie, Ethiopia
                2Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
                Author notes

                Academic Editor: Jos Mar a Huerta

                Author information
                https://orcid.org/0000-0002-1294-088X
                Article
                10.1155/2020/5096201
                7491447
                d54b9d63-ab94-4b9e-89bd-dc76cbfcfdca
                Copyright © 2020 Telahun Kasa Tefera et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 February 2020
                : 23 July 2020
                : 7 August 2020
                Funding
                Funded by: University of Gondar
                Funded by: Amhara National Regional State Health Bureau
                Categories
                Research Article

                Nutrition & Dietetics
                Nutrition & Dietetics

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