Abstract
BackgroundIn developing countries including Ethiopia, children under five years old are likely to suffer from repeated bouts of severe acute malnutrition as home level drivers are not mostly improved although the child is discharged after clinical and anthropometric cure. There is lack of study that documented time to relapse of severe acute malnutrition and its determinants.ObjectiveTo identify time of relapse and its determinants among children discharged after undergoing treatment for SAM in health facilities of Hadiya Zone, South, Ethiopia MethodsAn institution based retrospective cohort study was carried out in Hadiya Zone, of Southern Ethiopia among under-five children admitted to health posts for treatment of SAM in the past five years spanning from 2014/2015 to 2019/2020 and discharged after cure. Both first admission data and relapse data were abstracted from the records of the SAM children from Aguste 1 – 30 /2020 Using a data collection format. Data were coded and edited manually, then doubly entered into Epi-Data statistical software version 3.1 and then exported to SPSS for windows version 26. After checking all the assumptions, multivariable Cox Proportional Hazards model was fitted to isolate independent determinants of time to cure. All tests were two sided and P values <0.05 were used to declare statistical significance. ResultsThe mean(±SD) time for relapse of severe acute malnutrition among under five children was 22(±9.9) weeks from discharge to relapse time.On multivariable Cox Proportional Hazards model, after adjusting for background variables the hazard of relapse for severe acute malnutrition was significantly higher for children who had edema during admission with (AHR =2.02 ,95%, CI: 1.17-3.50), were in the age group of 6-11 months (AHR = 5.2, 95%, CI:1.95-13.87), had discharge MUAC for the first admission not cured (AHR = 12,95%, CI: 7.90-19.52)ConclusionThe finding showed that children discharged from Severe acute malnutrition are likely to have relapse in three weeks’ time given the prevailing situation of the home environment. Having edema during admission, younger age and not being cured by MUAC at discharge were independent determinants of relapse. The results imply that the need for reviewing follow-up system after discharge and working on the caring practices through behavior change communication to improve the home environment. There also a need for revising the discharge criteria for edematous children rather than basing only on weight change.
Manifolds boosting severe acute malnutrition burden among children in and around Wolaita Zone, Southern Ethiopia: mini-review