Treatment Outcome of Severe Acute Malnutrition Among Children (6-59 Months) in Outpatient Therapeutic Feeding Program in Gursum District, Somali Region, Ethiopia

Abstract Background: In Ethiopia uncomplicated severe acute malnutrition is managed through the outpatient therapeutic program at health posts level. This brings the services for the management of Severe Acute Malnutrition closer to the community by making services available at decentralized treatment points within the primary health care settings. So far, evidence on the treatment outcome of the program is limited. Thus, the main aim of this study was to determine the magnitude of treatment outcomes of severe acute malnutrition and associated factors among under-five children at outpatient therapeutic feeding units. Methods: This was a retrospective cohort study conducted on 600 children who had been managed for SAM under OTP in Gubalafto Wereda from April to May/2019. The children were selected using systematic random sampling from 9 health posts. The structured, pre-tested and adapted questionnaire was used to collect the data. The data was entered by using EPI-data Version 4.2 and exported to SPSS version 24.0 for analysis. Bivariate and Multivariate regression was also carried out to determine the association between dependent and independent variables. Results: A total of 600 records of children with a diagnosis of severe acute malnutrition were reviewed. Of these cases of malnutrition, the recovery rate was revealed as 65 %. The death rate, default rate, and medical transfer were 2.0, 16.0, and 17.0 respectively. Children who took immunization were had 6.85 times higher odds of recovery than children who were not immunized (AOR=6.85 at 95% CI (3.68-12.76)). The likelihood of recovery was 3.78 times higher among children with new admission than those with re-admission (AOR=3.78at 95% CI ((1.77-8.07))). Likewise, children provided with amoxicillin were 3.38 times more likely to recover compared to their counterparts who were not provided (AOR=3.38 at 95% CI ((1.61-7.08))). Conclusions: The recovery rate and medical transfer were lower than sphere standard. Presence of cough, presence of diarrhea admission category, provision of amoxicillin, and immunization status were factors identified as significantly associated with treatment outcome of Sever Acute Malnutrition. Building capacity of OTP service providers and regular monitoring of service provision based on the management protocol were recommended.

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Comparative Analysis of the Survival Status and Treatment Outcome of Under-five Children Admitted with Severe Acute Malnutrition Among Hospital-based and Health Center Based Stabilization Centers, South Ethiopia

The Open Public Health Journal ◽

10.2174/1874944501811010209 ◽

2018 ◽

Vol 11 (1) ◽

pp. 209-220 ◽

Cited By ~ 5

Author(s):

Tadele Girum ◽

Ebrahim Muktar ◽

Abdulsemed Worku

Keyword(s):

Treatment Outcome ◽

Health Center ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Cumulative Probability ◽

Ratio Test ◽

Stabilization Centers ◽

Under Five ◽

Under Five Children ◽

Survival Status

Background:Severe acute malnutrition has been managed at Hospital stabilization centers until the management at health center based stabilization centers was started recently. However, the treatment outcome was not assessed in relation to the existing hospital-based management. Therefore, this study comparatively assessed the treatment outcome and survival status of severe acute malnutrition among Health center-based and hospital-based stabilization centers. The finding will be used by healthcare providers, planners and policymakers at large.Methods:Randomly selected 400 records of under-five children admitted to five stabilization centers (2 hospitals and 3 health center) in Gedeo Zone was included. Data was entered by Epi Info version 7 and analyzed by STATA version 11. Survival difference was checked by life table and Kaplan-Mier with Log-Rank test. Cox proportional hazards model was built by forward stepwise procedure; compared to likely hood ratio test and Harrell’s concordance and fitness checked by the cox-snell residual plot.Result:The study showed that the cumulative probability of Survival is significantly different at Hospital stabilization center and health center stabilization centers (p.value <0.001) with shorter survival at hospitals. During the follow-up period, 28(13.86%) children from hospital and 5(2.5%) children from health center died, while 155(76.73%) children from the hospital and 145(73.23%) children from health center got cured. Eighteen (4.5%)children were defaulted. Death is significantly higher at the hospital, while default rate and cure rate are not significantly different. Altered pulse rate [AHR=2.44, 95% CI =1.47-4, p<0.001], NG tube insertion [AHR=1.8, 95% CI =1.04-3.1, p=0.038], Anemia [AHR=1.53, 95% CI =1.02-2.3, p<0.041] and Hypoglycemia [AHR=2.78, 95% CI =1.8-4.3, p<0.001] were found to be independent predictors of death.Conclusion:The survival of children in hospital is shorter and mortality is higher. An overall treatment outcome was in acceptable ranges. Intervention to further reduce deaths at hospitals has to focus on children with comorbidities and altered general conditions and early detection.

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Recovery Rate and Determinants in Treatment of Children with Severe Acute Malnutrition using Outpatient Therapeutic Feeding Program in Kamba District, South West Ethiopia

Journal of Nutritional Disorders & Therapy ◽

10.4172/2161-0509.1000155 ◽

2015 ◽

Vol 5 (2) ◽

Cited By ~ 18

Author(s):

Negash Alemu Shanka ◽

Sebelewengel Lemma

Keyword(s):

Recovery Rate ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

South West ◽

Feeding Program ◽

South West Ethiopia

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Comparative Effectiveness of Four Specialized Nutritious Food Products for Treatment of Moderate Acute Malnutrition in Sierra Leone (P10-140-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-140-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Breanne Langlois ◽

Stacy Griswold ◽

Devika Suri ◽

Ye Shen ◽

Kenneth Chui ◽

...

Keyword(s):

International Development ◽

Graduation Rates ◽

Sierra Leone ◽

Severe Acute Malnutrition ◽

Cluster Randomized Trial ◽

Humanitarian Assistance ◽

Acute Malnutrition ◽

Mixed Effect ◽

Feeding Program ◽

Moderate Acute Malnutrition

Abstract Objectives This study compared the effectiveness of 4 specialized nutritious foods (SNFs) used for the treatment of moderate acute malnutrition (MAM) in children <5 years of age in Pujehun District, Sierra Leone. Methods This was a cluster-randomized trial operating through a supplementary feeding program (SFP) providing SNFs for treatment of MAM. Three study foods were fortified blended foods – Super Cereal Plus w/amylase (SC + A), Corn-soy Blend Plus w/oil (CSB + w/oil), and Corn-soy-whey Blend w/oil (CSWB w/oil) – and one was a lipid-based Ready to Use Supplementary Food (RUSF). From 4/2017 to 11/2018, children with MAM, defined as mid-upper arm circumference (MUAC) ≥11.5 cm and <12.5 cm without bipedal edema, were enrolled at participating health clinics and received rations bi-weekly until they reached an outcome or for up to 12 weeks. A stratified randomization technique was used to select 28 sites and randomize them into 7 per arm based on pre-determined criteria. During the study, an 8th site was added to the CSWB w/oil arm due to low enrollment. The primary outcome was graduation from SFP defined as MUAC ≥12.5 cm within the 12-week treatment period. Mixed-effect regression assessed whether there were differences in graduation rates among children treated with one of the 4 SNFs. Results A total of 2683 children were enrolled out of a planned sample size of ∼5000. Overall: 63% graduated from MAM, 19% developed severe acute malnutrition (SAM), 7% defaulted (missed 3 visits in a row), 1% died, and 10% reached no outcome within 12 weeks. Twenty-five % were transferred into the study from SAM treatment. By study arm, graduation rates were: 62% in CSWB w/oil, 65% in SC + A, 64% in CSB + w/oil, 62% in RUSF. In an unadjusted model, statistically significant differences in graduation rates between the arms were not detected. Data analysis is ongoing to determine if this finding is maintained in adjusted models. Conclusions The 4 foods performed comparably in treating MAM in unadjusted analysis. Decision-making by donors, governments, and programmers on which food to program should also be based on cost-effectiveness analysis. Funding Sources Supported by the Office of Food for Peace, Bureau for Democracy, Conflict, and Humanitarian Assistance, U.S. Agency for International Development.

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The effects of psychosocial stimulation on the development, growth, and treatment outcome of children with severe acute malnutrition age 6–59 months in southern Ethiopia: a parallel group cluster randomized control trial (EPSoSAMC study)

BMC Public Health ◽

10.1186/s12889-019-7916-5 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Tesfalem T. Tessema ◽

Andamlak G. Alamdo ◽

Tewodrose G. Yirtaw ◽

Fana A. Deble ◽

Eyoel B. Mekonen ◽

...

Keyword(s):

Treatment Outcome ◽

Inpatient Care ◽

Severe Acute Malnutrition ◽

Scientific Evidence ◽

Acute Malnutrition ◽

Southern Ethiopia ◽

Parallel Group ◽

Psychosocial Stimulation ◽

Cluster Randomized

Abstract Background Severe Acute Malnutrition (SAM) remains a major cause of child mortality. To improve the management and survival of children the World Health Organization (WHO) endorsed the protocol for the management of SAM. The protocol suggested the integration of psychosocial stimulation as part of the medico-nutritional care process to prevent the long-term adverse developmental impact of the SAM. However, there is little scientific evidence behind the recommended stimulation intervention. Method A parallel-group cluster-randomized controlled trial will be conducted among 144 children with SAM age 6–59 months in Southern Ethiopia. The study will have two groups where: children with SAM admitted in the intervention health facilities will receive psychosocial stimulation in addition to the routine inpatient care and for 6 months after discharge. Children with SAM admitted in the SC of the control health facilities will receive the routine inpatient care without psychosocial stimulation and home-based follow up for 6 months after discharge. All mothers/ caregivers will also receive uniform health education on child health-related issues. The primary outcome of the study will be child development while the secondary outcomes will include child growth and treatment outcome. All outcomes will be assessed four times: at enrollment, upon discharge from the SC, at 3 and 6 months of follow up. The data will be analyzed using STATA Version 15 Statistical Software. The anthropometric Z-scores and percentile of the median will be calculated child using WHO Anthro Version 3.2.2 Statistical Software. To assess the overall effect of the intervention by controlling other potential contributing factors, a generalized linear mixed model will be used. Discussion The present study will have an important contribution in generating supplementary evidence regarding the effect of psychosocial stimulation interventions on the development and growth outcomes of children with SAM. The study will further address the impact of the intervention on treatment outcome indicators that are still under-researched areas requiring new scientific evidence. Trial registration Pan African Clinical Trials Registry -PACTR201901730324304. Registered 25 November 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5739

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