Predictors of undesirable treatment outcomes of severe acute malnutrition among inpatient children in Addis Ababa, Ethiopia: a retrospective cohort study

Abstract Background In 2018, malnutrition contributed to 45% of all global cause of child death. These early child deaths were due to conditions that could either be prevented or treated with basic interventions. Hence, this study intended to provide a quantitative estimate of factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM). Methods We studied a retrospective cohort of 304 children aged 6–59 months with complicated SAM admitted to Yekatit 12 Hospital Medical College from 2013 to 2016. We extracted data from hospital records on nutritional status, socio-demographic factors and medical conditions during admission. The analysis was carried out using SPSS version 20. The Kaplan-Meier estimator was employed to analyze the recovery rate of the children treated for SAM and multivariable Cox regression was used to determine factors that predict inpatient undesirable treatment outcomes. Result From a total of 304 children 6–59 months with SAM, 133 (51.4%) were boys. Marasmus was the most common type (132 (51%)) of severe acute malnutrition. The recovery, death and defaulter rate were 70.4, 12.2 and 8.2% respectively. The main predictors of undesirable treatment outcomes were found to be the presence of HIV antibody (AHR = 3.208; 95% CI: [1.045–9.846]) and sepsis (AHR = 7.677, 95% CI: [2.320–25.404]). Conclusion The study revealed that the overall treatment outcomes were below the SPHERE standard recommendation. The main predictors of undesirable treatment outcomes among inpatient children treated for SAM were HIV and sepsis. Intervention to reduce undesirable treatment outcomes should focus on comorbidities, especially HIV and sepsis.

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Predictors of undesirable treatment outcome of severe acute malnutrition inpatient children in Addis Ababa, Ethiopia: a retrospective cohort study.

10.21203/rs.2.13854/v2 ◽

2020 ◽

Author(s):

Absalat Serawit Negussie ◽

Amare Worku Tadesse

Keyword(s):

Treatment Outcomes ◽

Retrospective Cohort ◽

Cox Regression ◽

Severe Acute Malnutrition ◽

Addis Ababa ◽

Acute Malnutrition ◽

Patient Treatment ◽

Child Deaths ◽

Kaplan Meier ◽

Socio Demographic Factors

Abstract Background: Globally, in 2018, malnutrition contributes to 45% of all child deaths. These early child deaths are due to conditions that could be prevented or treated with access to simple and affordable interventions. Hence, this study intends to provide a quantitative example of factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM). Methods: We studied a retrospective cohort of 304 children aged 6-59 months with complicated SAM admitted to Yekatit 12 teaching hospital from 2013- 2016 . We extracted data from hospital records on nutritional status, socio-demographic factors and medical conditions during admission. The analysis was carried out with SPSS version 20.The Kaplan-Meier estimator was employed to analyze the recovery rate of the children undergoing treatment for SAM and Cox regression was used to adjust for confounding effects of other variables. Result: From overall of 304 under-five children with SAM, 133 (51.4%) were males and 126 (48.6%) were females. Marasmus was the most common type of severe acute malnutrition 132(51%). The recovery, death and defaulter rate were 70.4%, 12.2% and 8.2% respectively. The main predictors of undesirable outcome were found to be presence of HIV antibody (AHR=3.208; 95% CI: [1.045-9.846]) and sepsis (AHR= 7.677, 95% CI: [2.320-25.404])Conclusion: The study revealed that the overall treatment outcomes were below the SPHERE standard recommendation and the main predictors of death in children receiving in-patient treatment for SAM were HIV and sepsis. Intervention to reduce death should focus cases with comorbidities especially HIV and sepsis.

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Predictors of undesirable treatment outcome of severe acute malnutrition inpatient children in Addis Ababa, Ethiopia: a retrospective cohort study

10.21203/rs.2.13854/v3 ◽

2020 ◽

Author(s):

Absalat Serawit Negussie ◽

Amare Worku Tadesse

Keyword(s):

Treatment Outcomes ◽

Retrospective Cohort ◽

Cox Regression ◽

Severe Acute Malnutrition ◽

Addis Ababa ◽

Acute Malnutrition ◽

Patient Treatment ◽

Child Deaths ◽

Kaplan Meier ◽

Socio Demographic Factors

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Predictors of undesirable treatment outcome of severe acute malnutrition inpatient children in Addis Ababa, Ethiopia: a retrospective cohort study

10.21203/rs.2.13854/v4 ◽

2020 ◽

Author(s):

Absalat Serawit Negussie ◽

Amare Worku Tadesse

Keyword(s):

Treatment Outcomes ◽

Retrospective Cohort ◽

Cox Regression ◽

Severe Acute Malnutrition ◽

Addis Ababa ◽

Acute Malnutrition ◽

Patient Treatment ◽

Child Deaths ◽

Kaplan Meier ◽

Socio Demographic Factors

Abstract Background: Globally, in 2018, malnutrition contributed to 45% of all child deaths. These early child deaths are due to conditions that could be prevented or treated with basic interventions. Hence, this study intends to provide a quantitative example of factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM). Methods: We studied a retrospective cohort of 304 children aged 6-59 months with complicated SAM admitted to Yekatit 12 teaching hospital from 2013- 2016 . We extracted data from hospital records on nutritional status, socio-demographic factors and medical conditions during admission. The analysis was carried out with SPSS version 20.The Kaplan-Meier estimator was employed to analyze the recovery rate of the children undergoing treatment for SAM and Cox regression was used to adjust for confounding effects of other variables. Result: From overall of 304 under-five children with SAM, 133 (51.4%) were males and 126 (48.6%) were females. Marasmus was the most common type of severe acute malnutrition 132(51%). The recovery, death and defaulter rate were 70.4%, 12.2% and 8.2% respectively. The main predictors of undesirable outcome were found to be presence of HIV antibody (AHR=3.208; 95% CI: [1.045-9.846]) and sepsis (AHR= 7.677, 95% CI: [2.320-25.404])Conclusion: The study revealed that the overall treatment outcomes were below the SPHERE standard recommendation and the main predictors of death in children receiving in-patient treatment for SAM were HIV and sepsis. Intervention to reduce death should focus cases with comorbidities especially HIV and sepsis.

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Survival status and predictors of undesirable treatment outcome of children with severe acute malnutrition admitted to Yekatit 12 hospital medical college from 2013-2016, Addis Ababa, Ethiopia: a retrospective cohort study.

10.21203/rs.2.13854/v1 ◽

2019 ◽

Author(s):

Absalat Serawit Negussie ◽

Amare Worku Tadesse

Keyword(s):

Treatment Outcomes ◽

Retrospective Cohort ◽

Cox Regression ◽

Medical Condition ◽

Severe Acute Malnutrition ◽

Addis Ababa ◽

Institutional Care ◽

Acute Malnutrition ◽

Patient Treatment ◽

Child Deaths

Abstract Background Globally, in 2015, malnutrition contributes to 45% of all child deaths. These early child deaths are due to conditions that could be prevented or treated with access to simple and affordable interventions. Hence, this study intends to provide a quantitative summary of treatment outcomes and to identify factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM) admitted to Yekatit 12 hospital from the year 2013 to 2016.Methods A retrospective cohort of 304 children aged 6-59 months old with complicated SAM admitted to Yekatit 12 teaching hospital from 2013- 2016 were studied. Data on nutritional status, socio-demographic factors and admission medical condition were extracted. Data were analyzed using SPSS version 20. Kaplan-Meier was employed to estimate the recovery rates of the children treated for SAM and Cox regression was used to control for confounding.Result From overall (n = 304) under-five children with SAM, 133 (51.4%) were males and 126 were (48.6%) females. Marasmus was the most common type of severe acute malnutrition 132(51%). The recovery, death and defaulter rate were 70.4%, 12.2% and 8.2% respectively. The main predictors of undesirable outcome were HIV antibody positive children (AHR=3.208; 95% CI: [1.045-9.846]) and sepsis (AHR= 7.677, 95% CI: [2.320-25.404])Conclusion The study revealed that the overall treatment outcomes were below the SPHERE standard recommendation and the main predictors of death in children receiving in-patient treatment for SAM were HIV and sepsis. Intervention to reduce death should focus on institutional care.

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Abacavir versus Zidovudine-Based Regimens for treatment of HIV-Infected Children in resource limited settings: A Retrospective Cohort Study

10.21203/rs.2.20038/v1 ◽

2020 ◽

Author(s):

Teshale Ayele Mega ◽

Firehiwot Belayneh Usamo ◽

Getandale Zeleke Negera

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cox Regression ◽

Opportunistic Infections ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Resource Limited Settings ◽

Propensity Score Matching Analysis ◽

Resource Limited

Abstract BackgroundAbacavir (ABC) and Zidovudine(AZT) based regimens are the preferred first line nucleoside reverse transcriptase (NRTIs) backbones being widely utilized for managing HIV infection in children. However, there is a dearth of data regarding the clinical outcomes and associated risk factors in Ethiopia. We compared the proportion of mortality and the rate of occurrence of Opportunistic Infections (OIs) with ABC versus AZT based regimens in a cohort of HIV-infected children. MethodsA 42 months retrospective cohort study was conducted. A total of 179 records were reviewed by including data from October 2014 to April 2017. Data were collected on socio-demographic, clinical characteristics of patients and drug related variables. Data were analyzed using STATA13.1. Kaplan-Meier and Cox regression were used to compare survival experience and identify independent predictors. Propensity score matching analysis was conducted to elucidate the average treatment effects of each regimen over OIs.ResultOf 179 patients, 98 (54.7%) were females. The mean (+SD) age of the study subjects was 6.53 ± 2.83 years. Through 42 months analysis, a total of 4 patients (1 (1.14%) from ABC group and 3 (3.3%) from AZT group (p=0.339)) were died. The incidence of opportunistic infections attributed to ABC group was 8.77/100,000 person years (py) and that of AZT was 6.9/100,000py. The incidence rate ratio (IRR) for OIs was (IRR=0.87, 95% CI [0.49-1.53] (p=0.304). Baseline CD4 count (AHR= 0.99, 95% CI [0.98-0.99]), Severe acute malnutrition AHR=15.92, 95% CI [5.34-47.50], and exposure to tuberculosis treatment (AHR=2.93, 95% CI [1.39-6.17]) were the independent predictors for the development of OIs. ConclusionABC and AZT based ART regimens seem to have comparable survival benefit among HIV-infected children in Ethiopia. Therefore, both regimens might be used as an alternative in resource limited settings.

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Recovery rate and its predictors among children with severe acute malnutrition in Addis Ababa, Ethiopia: A retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0235259 ◽

2020 ◽

Vol 15 (7) ◽

pp. e0235259

Author(s):

Zebenay Workneh Bitew ◽

Animut Alebel ◽

Teshager Worku ◽

Ayinalem Alemu

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Recovery Rate ◽

Retrospective Cohort ◽

Severe Acute Malnutrition ◽

Addis Ababa ◽

Acute Malnutrition

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Determinants of treatment outcomes of severe acute malnutrition among under-5 children in Yekatit 12 Hospital, Addis Ababa, Ethiopia: a retrospective cohort study

10.21203/rs.3.rs-30080/v1 ◽

2020 ◽

Author(s):

Mekonen Adimasu Kebede ◽

Girum Sebsbie Teshome ◽

Fkirtemariam Abebe Fenta ◽

Melaku Bimerew Getahun

Keyword(s):

Cohort Study ◽

Treatment Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Severe Acute Malnutrition ◽

Vaccination Status ◽

Acute Malnutrition ◽

Nutritional Recovery ◽

Default Rates ◽

Hiv Aids

Abstract Background Devastatingly, the number of children with SAM is still growing globally. Severe acute malnutrition is the third most common contributing factor to the deaths of under-5 children worldwide. According to the World Health Organization, severe acute malnutrition causes 1 million deaths annually via increased susceptibility to death from severe infection. Ethiopia is one of the countries with highest under-5 child mortality rate, with malnutrition underlying to 28% of all children deaths. In Ethiopia, some studies reported an alarming death and default rates which indicate the need for further study to assess contributing factors to the treatment outcomes of severe acute malnutrition. Therefore, the intention of this research is to determine the treatment outcomes of severe acute malnutrition and identify predictors of nutritional recovery. Method: A retrospective cohort study was conducted among 423 under-5 children with severe acute malnutrition. Logistic regression analysis was performed and an adjusted odd ratio with 95%CI was used to determine independent predictors. Result The overall recovery, death and default rates were 81.3%, 11.1% and 7.6% respectively. Age, vaccination status, HIV/AIDS, pneumonia, diarrhea and stunting were found to be significant independent predictors of treatment outcomes. The adjusted odd ratio (AOR) for nutritional recovery increased by 14.6% for every 1-month increase in child age (AOR = 1.146; 95%CI: 1.052–1.249). Regarding vaccination status, those under-5 children who were fully vaccinated for their age were about 4 time more likely to recover than their counterparts (AOR = 4.242; 95%CI: 1.566–11.491) Conclusion In conclusion, the overall nutritional recovery and default rate in this study were in the acceptable range of international standard even though the death rate was higher. Age and full vaccination were proven to increase nutritional recovery. Conversely, the presence of HIV/AIDS, pneumonia, diarrhea and stunting were proven to decrease nutritional recovery.

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Treatment outcomes and factors affecting time-to-recovery from severe acute malnutrition in 6–59 months old children admitted to a stabilization center in Southern Ethiopia: A retrospective cohort study

Italian Journal of Pediatrics ◽

10.1186/s13052-019-0642-x ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 5

Author(s):

Anteneh Fikrie ◽

Akalewold Alemayehu ◽

Samson Gebremedhin

Keyword(s):

Cohort Study ◽

Treatment Outcomes ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Southern Ethiopia ◽

Factors Affecting

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Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study

BMC Pediatrics ◽

10.1186/s12887-021-02651-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amare Kassaw ◽

Desalegne Amare ◽

Minyichil Birhanu ◽

Aragaw Tesfaw ◽

Shegaw Zeleke ◽

...

Keyword(s):

Public Health ◽

Oxygen Saturation ◽

Retrospective Cohort ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Altered Consciousness ◽

Time To Death ◽

Under Five ◽

Predictors Of Mortality ◽

Malnourished Children

Abstract Background Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers. Methods A facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance. Results Out of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition. Conclusion The overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.

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