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 OALibJ  Vol.1 No.4 , July 2014
Treatment Outcomes and Associated Risk Factors of Severely Malnourished under Five Children Admitted to Therapeutic Feeding Centers of Mekelle City, Northern Ethiopia
Melaku Gebremichael1, Afework Mulugeta Bezabih2*, Mache Tsadik2
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Abstract: Background: Despite presence of clinical management protocols for treating severe acute malnutrition, its case fatality rate remains high in health facilities from developing countries. Objectives: To assess treatment outcomes and associated risk factors for death of children aged 6 - 59 months with complicated severe acute malnutrition. Methods: A cohort of 469 children aged 6 - 59 months with complicated severe acute malnutrition admitted to nutritional rehabilitation units of Mekelle City were followed retrospectively. Data on nutritional status, socio-demographic factors, admission medical conditions and management characteristics were collected. Median test, Chi-square test and Cox’s proportional hazard regression were used for statistical analysis. Results: Overall case fatality rate was 12.8%. The median length of stay and median weight gain was 17 days and 12.1 g/kg/day, respectively. Two third of the deaths occurred during the first week of admission. Diarrhea (HR: 2.45, 95% CI: 1.23 - 4.89), IV antibiotic (HR: 5.87, 95% CI: 1.73 - 19.87), blood transfusion (HR: 3.05, 95% CI: 1.51 - 6.17) and IV infusion (HR: 2.52, 95% CI: 1.25 - 5.07) were found to be associated with time to death. Conclusion: Unacceptably high case fatality rate was observed at the therapeutic feeding units of Mekelle City. Diarrhea, IV antibiotic, blood transfusion and IV infusion were the risk factors for death of severely malnourished under five children. Appropriate clinical management of severe acute malnutrition in the first week of inpatient stay with frequent monitoring for signs associated with clinical deterioration of children hospitalized with complicated SAM is most critical to the survival of the children.
Keywords: Severe Acute Malnutrition, Hospitalized Death, Treatment Outcome, Nutritional Rehabilitation Units, Mekelle
Cite this paper: Gebremichael, M. , Bezabih, A. and Tsadik, M. (2014) Treatment Outcomes and Associated Risk Factors of Severely Malnourished under Five Children Admitted to Therapeutic Feeding Centers of Mekelle City, Northern Ethiopia. Open Access Library Journal, 1, 1-9. doi: 10.4236/oalib.1100446.
References

[1]   WHO (2013) Guideline Update: Technical Aspects of the Management of Severe Acute Malnutrition in Infants and Children. World Health Organization, Geneva.

[2]   (2012) Levels and Trends in Child Malnutrition: UNICEF-WHO—The World Bank Joint Child Malnutrition Estimates. Bank U-W-TW, Washington DC.

[3]   Black, R.E., Allen, L.H., Bhutta, Z.A., Caulfield, L.E., de Onis, M., Ezzati, M., Mathers, C. and Rivera, J. (2008) Maternal and Child Undernutrition: Global and Regional Exposures and Health Consequences. Lancet, 371, 243-260.
http://dx.doi.org/10.1016/S0140-6736(07)61690-0

[4]   WHO (2004) Serious Childhood Problems in Countries with Limited Resources: Background Book on Management of the Child with a Serious Infection or Severe Malnutrition. World Health Organization, Geneva.

[5]   WHO (1999) Management of Severe Malnutrition: A Manual for Physicians and Other Health Workers. World Health Organization, Geneva.

[6]   FMoH (2007) Protocol for the Management of Severe Acute Malnutrition. Ethiopia-Federal Ministry of Health, Addis Ababa.

[7]   Ashworth, A., Chopra, M., McCoy, D., Sanders, D., Jackson, D., Karaolis, N., et al. (2004) WHO Guidelines for Management of Severe Malnutrition in Rural South African Hospitals: Effect on Case Fatality and the Influence of Operational Factors. Lancet, 363, 1110-1115.
http://dx.doi.org/10.1016/S0140-6736(04)15894-7

[8]   Teferi, E., Lera, M., Sita, S., Bogale, Z., Datiko, D.G. and Yassin, M.A. (2010) Treatment Outcome of Children with Severe Acute Malnutrition Admitted to Therapeutic Feeding Centers in Southern Region of Ethiopia. Ethiopian Journal of Health Development, 24, 234-238.

[9]   Lenters, L.M., Wazny, K., Webb, P., Ahmed, T. and Bhutta, Z.A. (2013) Treatment of Severe and Moderate Acute Malnutrition in Low- and Middle-Income Settings: A Systematic Review, Meta-Analysis and Delphi Process. BMC Public Health, 13, S23.
http://dx.doi.org/10.1186/1471-2458-13-S3-S23

[10]   Schofield, C. and Ashworth, A. (1996) Why Have Mortality Rates for Severe Malnutrition Remained So High? Bulletin of the World Health Organization, 72, 223-229.

[11]   Irena, A., Mwambazi, M. and Mulenga, V. (2011) Diarrhea Is a Major Killer of Children with Severe Acute Malnutrition Admitted to Inpatient Set-Up in Lusaka, Zambia. Nutrition Journal, 10, 110.

[12]   Bachou, H., Tumwine, J.K., Mwadine, R.K. and Tylleskar, T. (2006) Risk Factors in Hospital Deaths in Severely Malnourished Children in Kampala, Uganda. BMC Pediatrics, 6, 7.
http://dx.doi.org/10.1186/1471-2431-6-7

[13]   Fergusson, P. and Tomkins, A. (2009) HIV Prevalence and Mortality among Children Undergoing Treatment for Severe Acute Malnutrition in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Transactions of the Royal Society of Tropical Medicine and Hygiene, 103, 541-548.
http://dx.doi.org/10.1016/j.trstmh.2008.10.029

[14]   Chinkhumba, J., Tomkins, A., Banda, T., Mkangama, C. and Fergusson, P. (2008) The Impact of HIV on Mortality during Inpatient Rehabilitation of Severely Malnourished Children in Malawi. Royal Society of Tropical Medicine and Hygiene, 102, 639-644.

[15]   CSA (2011) Ethiopia Demographic and Health Survey 2011. Central Statistical Agency (CSA), Addis Ababa.

[16]   (2004) Humanitarian Charter and Minimum Standards in Disaster Response. The Sphere Project, Geneva.

[17]   Savadogo, L., Zoetaba, I., Donnen, P., Hennart, P., Sondo, B. and Dramaix, M. (2007) Management of Severe Acute Malnutrition. Urban Nutritional Rehabilitation Center, Burkina Faso.

[18]   Zelalem, T., Tsinuel, G. and Ayalew, T. (2010) Treatment Outcome of Severe Acute Malnutrition in Children with and without HIV Infection: A Historical Cohort Study in South-West Ethiopia. Ethiopian Journal of Pediatrics and Child Health, 6, 14-26.

[19]   Thurstans, S., Kerac, M., Maleta, K., Banda, T. and Nessbit, A. (2008) HIV Prevalence in Severely Malnourished Children Admitted to Nutritional Rehabilitation Centers in Malawi: Geographical and Seasonal Variations a Cross-Sectional Study. BMC Pediatrics, 8, 22.
http://dx.doi.org/10.1186/1471-2431-8-22

[20]   Amsalu, S. and Asnakew, G. (2006) The Outcome of Severe Malnutrition in Northwest Ethiopia: Retrospective Analysis of Admissions. Ethiopian Medical Journal, 44, 151-157.

[21]   Nzioki, C., Irimu, G., Musoke, R. and English, M. (2009) Audit of Care for Children Aged 6 - 59 Months Admitted with Severe Acute Malnutrition at Kenyatta National Hospital, Kenya. International Health, 1, 91-96.

[22]   Talbert, A., Thuo, N., Karisa, J., Chesaro, C., Ohuma, E., Ignas, J., Berkley, J.A., Toromo, C., Atkinson, S. and Maitland, K. (2012) Diarrhea Complicating Severe Acute Malnutrition in Kenyan Children: A Prospective Descriptive Study of Risk Factors and Outcome. PLoS ONE, 7, Article ID: e38321.
http://dx.doi.org/10.1371/journal.pone.0038321

[23]   Brewster, D.R., Manary, M.J., Menzies, I.S., O’Loughlin, E.V. and Henry, R.L. (1997) Intestinal Permeability in Kwashiorkor. Archives of Disease in Childhood, 76, 236-241.
http://dx.doi.org/10.1136/adc.76.3.236

[24]   WHO (1999) Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. World Health Organization, Geneva.

[25]   Berkley, J.A., Lowe, B.S., Mwangi, I., Williams, T., Bauni, E., et al. (2005) Bacteremia among Children Admitted to a Rural Hospital in Kenya. The New England Journal of Medicine, 352, 39-47.
http://dx.doi.org/10.1056/NEJMoa040275

[26]   Brewster, D.R. (2006) Critical Appraisal of the Management of Severe Malnutrition: 3. Complications. Journal of Paediatrics and Child Health, 42, 583-593.
http://dx.doi.org/10.1111/j.1440-1754.2006.00933.x

 
 
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