Assessment of Time to Recovery and Predictors Among Under-Five Children with Severe Acute Malnutrition Admitted At Stabilizing Centers, In Metekele Zone Northwest Ethiopia: Retrospective Cohort Study

Abstract

Background: Severe acute malnutrition is defined as weight for height below minus three World health organization growth standards or middle upper arm circumference less than 115mm for a child greater than six months and/or presence of bilateral edema. It is the reason for 20% of pediatrics hospital admissions. Despite, a bilateral effort being done at outpatient and inpatient therapeutic programs, time to recovery from severe acute malnutrition remains alarming in Ethiopia. A better understanding of predictors of recovery is important to design appropriate interventions at rehabilitation centers. Objective: To assess time to recovery and its predictors among under-five children with severe acute malnutrition admitted at rehabilitation centers in Metekele Zone, Northwest Ethiopia, 2022. Methods: Facility-based retrospective cohort study was conducted from May 29 to June 21, 2022, among 512 under-five children with severe acute malnutrition admitted at rehabilitation centers in Metekele Zone from 2017-2021. A simple random sampling technique was used to select the samples from the registration log book. Data were collected from medical record numbers and registrations using a structured checklist. The data were entered into Epi-data and exported to STATA for analysis. A Kaplan-Meir curve was used to estimate median survival time. Cox proportional hazard regression model used to identify predictors of time to recovery. Results: In this study, 68.38% of children recovered from severe acute malnutrition with an overall nutritional recovery rate of 6.04 per 100 children-days observation (95% CI: 5.75-7.09). The overall median time of nutritional recovery was 13days (interquartile range10-16). Children with no tuberculosis(AHR)=1.78, 95% CI:1.08-2.92), no human immunodeficiency virus (AHR= 2.98, 95% CI:1.62-5.48), absence of inpatient complication (AHR= 3.71, 95%CI:1.29-10.32), intake of F-100 (AHR= 0.37, 95% CI: 0.16-0.89), plumpy nut (AHR= 4.23, 95%CI: 1.58-11.31), and amoxicillin (AHR= 1.86 95%CI: 1.17-2.94)were significantly predictors of time to recovery. Conclusion and recommendation: Median time of nutritional recovery was in an acceptable range, while the rate of recovery was low compared to the sphere standard. Special attention should be given to those children who had tuberculosis, HIV, inpatient complication, and did not receive (F-100, plump nut, and amoxicillin) during admission. Efforts should be strengthened to facilitate early recovery by considering the identified predictors of time to recovery.