Predictors of time-to-recovery from severe acute malnutrition treated in an outpatient treatment program in health posts of Arba Minch Zuria Woreda, Gamo zone, Southern Ethiopia: A retrospective cohort study.

backgroundAccess to outpatient therapeutic feeding programs for all children who had uncomplicated severe acute malnutrition (SAM) in need is a global health priority. In Ethiopia SAM is treated in hospitals, health centers and health posts. Health extension workers (HEWs) manage SAM that is uncomplicated at the health posts through the outpatient therapeutic feeding programs (OTP). Identifying predictors that predict time-to-recovery of children on OTP is thus vital to optimizing therapeutic success. However, the factors affecting children's' recovery time at this peripheral health institutions were not well documented. Therefore, this study aimed to identify predictors of time-to-recovery from SAM among children treated at an OTP in health posts of Arba Minch Zuria woreda, Gamo Zone, Southern Ethiopia.

methodsA retrospective cohort study was conducted on 402 children enrolled in an OTP in the health posts of Arba Minch Zuria woreda based on data abstracted from their medical records. The study children were selected using systematic random sampling method using a list of their medical record numbers. Both descriptive and analytic analyses were performed. Median time of recovery was estimated by using the Kaplan-Meier survival curve. Furthermore, bivariate and multivariable Cox proportional hazard regression analyses were used to identify factors significantly associated with outcome variable.

resultThe median time-to-recovery from severe acute malnutrition among children was 49 days (Interquartile range [IQR]: 42-56). Among the participants, 70.40% with 95% CI: (74.2-85.0%) recovered from severe acute malnutrition. The Cox-proportional hazard analysis showed that children's age at admission (Adjusted hazards ratio [AHR] = 3.15; 95% confidence interval [CI]: 1.85, 5.03), diagnosis with edema (AHR = 1.75, 95%CI: (1.27, 2.43), co-morbidity of diarrhea (AHR = 0.22, 95% CI(0.13, 0.39), and anemia (AHR = 0.64, 95% CI:(0.42, 0.98) were found to be predictors of time to recovery from SAM.

conclusionsThe median time-to-recovery at the health posts in this study was in the accepted time period for the maximum Ethiopian standard protocol set for the management of SAM. However, the nutritional recovery rate was lower than the minimum acceptable threshold for the Sphere International Standards. Therefore, early screening of co-morbidity like diarrhea, anemia and edemaand timely intervention would increase the chance of recovery of children.