Treatment outcomes and associated factors of severe acute malnutrition among under-5 children in Jigjiga public hospitals, Somali region, Ethiopia: a retrospective cohort study

Abstract

Background: Severe acute malnutrition (SAM) affects about 20 million under-5 children and contributes to one million child deaths annually. Apart from the presence of clinical management protocols capable of reducing case fatality by 1%-5%, case fatality in hospitals in developing countries averages 20%-30% and has remained the same since the 1950s. Objective: This study aimed to assess treatment outcomes and associated factors of severe acute malnutrition among under-5-year-old children admitted to Jigjiga city public hospitals. Methods: A facility-based retrospective cohort study design was employed on patient records between 1 January 2020 and 31 December, 2021. A structured checklist was used for data extraction to collect data from patient record book. Cox proportional hazards model with a hazard ratio of 95% CI was used. The level of statistical significance was declared at a p<0.05. Results: Overall median length of stay, recovery, death, defaulted and non-responder rate were 7 days, 257 (70.2%), 32 (8.7%), 58 (15.8%) and 19 (5.2%), respectively. Managing facility, tuberculosis (TB), pneumonia and nasogastric (NG) tube insertion were found to be significantly associated with treatment outcomes at a p<0.05.Children who were managed at Jigjiga University Sheik Hassen Yabare Comprehensive Specialised Hospital were 57% less likely to recover from SAM than those managed at Karamardha General Hospital (adjusted hazard ratio (AHR)=0.437, 95% CI: 0.286 to 0.600). Children who did not have TB were almost three times more likely to recover than their counterparts (AHR=2.862, 95% CI: 1.604 to 5.107), and those without pneumonia were also 1.5 times more likely to recover than those with a diagnosis of pneumonia (AHR=1.509, 95% CI: 1.146 to 1.989). Furthermore, children without nasogastric tube insertion were about 1.5 times more likely to recover than their counterparts (AHR=1.472, 95% CI: 1.075 to 2.015). Conclusions: The recovery and defaulter rates fell outside the acceptable targets set by SPHERE standards; however, the death rate was acceptable. The significant predicting factors of treatment outcome were treating facility, TB, pneumonia and NG tube insertion.