埃塞俄比亚南部沃莱塔地区门诊治疗项目（OTP）中治疗的儿童重度急性营养不良的治疗结果：回顾性横断面研究
Treatment outcomes of severe acute malnutrition in children treated within Outpatient Therapeutic Program (OTP) at Wolaita Zone, Southern Ethiopia: retrospective cross-sectional study.
作者信息
Kabalo Mulugeta Yohannis, Seifu Canaan Negash
机构信息
School of Public Health, Wolaita Sodo University, Southern Ethiopia, P.O.Box 126, Wolaita Sodo, Ethiopia.
School of Public Health, Wolaita Sodo University, Southern Ethiopia, P.O.Box 138, Wolaita Sodo, Ethiopia.
出版信息
J Health Popul Nutr. 2017 Mar 9;36(1):7. doi: 10.1186/s41043-017-0083-3.
BACKGROUND
Children in third world countries suffer from severe acute malnutrition (SAM) in an extent of public health important. SAM management protocol available this time brought the approach from facility-based to community-based by Outpatient Therapeutic Program (OTP). But, little was known about the treatment outcomes of the program in Ethiopia. Thus, this study was aimed to assess treatment outcomes of SAM and identify factors associated among children treated at OTP in Wolaita Zone.
METHODS
A retrospective facility-based cross-sectional study was conducted in OTP records of 794 children, treated at 24 health posts retrieved from January to December 2014. Population proportion to size (PPS) was used to allocate sample for each selected district and OTP sites within district. Individual cards of children were selected by systematic random sampling. Data were entered, thoroughly cleaned, and analyzed in SPSS version 20.
RESULTS
The recovery rate was revealed as 64.9% at 95% CI (61, 68). Death rate, default rate, weight gain, and length of stay were 1.2%, 2.2%, 4.2 g/kg/day, and 6.8 weeks respectively. Children living in <25 min were with 1.53 times higher odds of recovery than children residing in ≥25 min (AOR = 1.53 at 95% CI (1.11, 2.12)). The likelihood of recovery was 2.6 times higher for children with kwashiorkor than for those with marasmus (AOR = 2.62 at 95% CI (1.77, 3.89)). Likewise, children provided with amoxicillin were 1.52 times more likely to recover compared to their counterparts (AOR = 1.52 at 95% CI (1.09, 2.11)).
CONCLUSIONS
The recovery rate and weight gain were lower than sphere standard. Distance from OTP, provision of amoxicillin, and type of malnutrition were factors identified as significantly associated with treatment outcome of SAM. Building capacity of OTP service providers and regular monitoring of service provision based on the management protocol were recommended.
背景
第三世界国家的儿童严重急性营养不良（SAM）问题已达到影响公共卫生的程度。目前可用的SAM管理方案通过门诊治疗项目（OTP）将治疗方式从基于医疗机构转变为基于社区。但是，对于埃塞俄比亚该项目的治疗效果了解甚少。因此，本研究旨在评估SAM的治疗效果，并确定沃莱塔地区OTP治疗的儿童中相关的影响因素。
方法
对2014年1月至12月期间在24个卫生站接受治疗的794名儿童的OTP记录进行了一项基于医疗机构的回顾性横断面研究。采用人口比例规模抽样法（PPS）为每个选定地区及地区内的OTP站点分配样本。通过系统随机抽样选择儿童个体卡片。数据录入、全面清理后，使用SPSS 20版进行分析。
结果
95%置信区间（CI）（61，68）下的恢复率为64.9%。死亡率、失访率、体重增加量和住院时间分别为1.2%、2.2%、4.2克/千克/天和6.8周。居住距离OTP小于25分钟的儿童恢复几率比居住距离≥25分钟的儿童高1.53倍（调整后比值比[AOR]=1.53，95%CI[1.11，2.12]）。夸希奥科病患儿的恢复可能性比消瘦症患儿高2.6倍（AOR=2.62，95%CI[1.77，3.89]）。同样，接受阿莫西林治疗的儿童恢复可能性比未接受治疗的儿童高1.52倍（AOR=1.52，95%CI[1.09，2.11]）。
结论
恢复率和体重增加低于标准水平。距离OTP的远近、阿莫西林的使用以及营养不良类型是被确定与SAM治疗效果显著相关的因素。建议加强OTP服务提供者的能力建设，并根据管理方案定期监测服务提供情况。
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