alnutrition among Children Aged 6-59 Months Treated in Outpatient Therapeutic Feeding in Girar Jarso District, North Shoa Zone, Oromia Region;- Three Years Retrospective Cohort Study

Abstract

Background: World Health Organization recommends outpatient therapeutic feeding program as a standard treatment protocol for the management of uncomplicated severe acute malnutrition. This program has been decentralized to health post in Ethiopia. However, time to recovery from severe acute malnutrition under this program varies. Objective: This study identified determinants of time to recovery from severe acute malnutrition Methods: Three years institution based retrospective cohort study was conducted in Girar Jarso district from January 2015 to December, 2017. Six of 17 health posts, selected by lottery method and 363 charts of children were selected by simple random sampling. Data extracted retrospectively by checklist and data collectors were nurses. The study variable includes; socio-demographic characteristics, anthropometries, co-morbid conditions and routine medications. Difference in rate of survival for grouped factors was assessed by Kaplan-Meier curves with log-rank test. Cox-proportional hazard regression was used to identify predictor factors. Proportionality of hazard over time was assessed graphically by log minus log survival. Effect was reported by adjusted hazard ratio with its 95%CI at pvalue <0.05. Results: Total 342 charts of children included in this study. Proportion of recovery, defaulter, and not-responded to treatment were 85.1%, 6.4%, 8.5% respectively with no death. The median time to recovery was 42 days. Children, who received vitamin A (AHR= 2.9, 95% CI, 1.6- 5.2), referred by community volunteers for treatment (AHR =1.3, 95%CI, 1.01-1.7), vaccinated (AHR= 2.0, 95%CI, 1.3- 3.1), family travel ≤ 30 minute to treatment site (AHR =1.5, 95%CI 1.13 -1.9), without diarrhea (HR=1.36, 95%CI 1.01-1.86), and without pneumonia (HR=1.8, 95%CI, 1.2-2.6), recovered by higher rate at any unit time during follow-up period than their counter group. Conclusions: Receiving Vitamin A, being vaccinated, referred by community volunteer for treatment and not having diarrhea and pneumonia were significant predictors of time to recovery from severe acute malnutrition. Community referral and routine immunization should be strengthened. The service providers should adhere to guide line to prevent comorbid condition.