在埃塞俄比亚部分医院接受治疗的五岁以下严重急性营养不良儿童的合并症、治疗结果和影响康复率的因素：回顾性随访研究。
Co-morbidity, treatment outcomes and factors affecting the recovery rate of under -five children with severe acute malnutrition admitted in selected hospitals from Ethiopia: retrospective follow up study.
机构信息
Department of Public Health, College of Health Sciences, Debre Berhan University, P.O. Box 445, Debre Berhan, Ethiopia.
出版信息
Nutr J. 2018 Dec 18;17(1):116. doi: 10.1186/s12937-018-0423-1.
BACKGROUND
In spite of the availability of guidelines for the management of severe acute malnutrition (SAM) in Ethiopia, high comorbidity and poor treatment outcomes are still observed in therapeutic feeding centers among under -five children with SAM. The aim of this study was to assess comorbidity, treatment outcomes and factors affecting the recovery rate of children aged 1-59 months with SAM admitted into Therapeutic Feeding Centers (TFCs).
METHODS
A total of 413 records of children with SAM admitted in three selected hospitals from July 2013 to July 2015 G.C were retrospectively reviewed. Descriptive analysis was used to compare performance indicator values with SPHERE project reference standards (the minimum standard to be attained during nutritional therapy). Cox-proportional hazard regression analysis was performed to estimate the predictors of recovery rate at p-value < 0.05.
RESULT
The mean age of children was 16 months (95% CI, 15.0, 17.0). Out of 413 children with SAM, 231 (55.9%) recovered, 24 (5.8%) died and 16.3% were defaulted from TFCs. The mean weight gain (in gram per weight of kilogram per day) for recovered children was 15.61 g/kg/day (95% CI, 14.15, 17.07). The overall median recovery time for these children was 12 days (95% CI, 11.22, 12.78). Moreover, most (77.5%) of children admitted with SAM were marasmic followed by Kwash (16%). Pneumonia (54.8%), diarrhea (41.8%) and rickets (21.4%) were co-morbidities which affected SAM children. A child being admitted at Mehal Meda Hospital (Adjusted Hazard Ratio (AHR) = 2.01; 95% CI: 1.34, 2.91), edematous form of malnutrition (AHR = 0.59; 95% CI: 0.39, 0.90) and being a child infected with pneumonia (AHR = 0.71; 95% CI: 0.51, 0.98) were predictors of nutritional recovery rate.
CONCLUSION
Under five pneumonia, diarrhea and rickets were co-morbidities that should be prevented. Recovery rate was poor when compared to SPHERE project reference value (which is > 75%). Predictors, namely presence of pneumonia and edematous form of malnutrition reduced nutritional recovery rate. Whereas, being admitted at Mehal Meda Hospital improved recovery rate. Therefore, hospitals should work in collaboration with health extension workers to prevent co-morbidities and strengthen screening and referral of malnutrition cases at community level. Moreover, Zonal Health Department and District Health Offices should facilitate experience sharing among health facilities.
背景
尽管埃塞俄比亚有严重急性营养不良（SAM）管理指南，但在接受 SAM 治疗的 5 岁以下儿童的治疗喂养中心中，仍观察到高合并症和不良治疗结局。本研究旨在评估 1-59 月龄 SAM 儿童在治疗喂养中心（TFC）的合并症、治疗结局以及影响其恢复率的因素。
方法
对 2013 年 7 月至 2015 年 7 月期间从三家选定医院入院的 413 名 SAM 儿童的病历进行回顾性分析。使用描述性分析比较表现指标值与 SPHERE 项目参考标准（营养治疗期间应达到的最低标准）。采用 Cox 比例风险回归分析估计恢复率的预测因素，p 值<0.05。
结果
儿童的平均年龄为 16 个月（95%置信区间，15.0，17.0）。413 名 SAM 儿童中，231 名（55.9%）康复，24 名（5.8%）死亡，16.3%从 TFC 退出。康复儿童的平均体重增加量（每公斤体重每天克数）为 15.61g/kg/day（95%置信区间，14.15，17.07）。这些儿童的总体中位恢复时间为 12 天（95%置信区间，11.22，12.78）。此外，大多数（77.5%）入院的 SAM 儿童为消瘦型，其次是消瘦型（16%）。肺炎（54.8%）、腹泻（41.8%）和佝偻病（21.4%）是影响 SAM 儿童的合并症。在 Mehal Meda 医院入院的儿童（调整后的危险比（AHR）=2.01；95%置信区间：1.34，2.91）、水肿性营养不良形式（AHR=0.59；95%置信区间：0.39，0.90）和肺炎感染儿童（AHR=0.71；95%置信区间：0.51，0.98）是营养恢复率的预测因素。
结论
五岁以下儿童肺炎、腹泻和佝偻病是应预防的合并症。与 SPHERE 项目参考值（>75%）相比，恢复率较差。预测因素，即肺炎和水肿性营养不良的存在，降低了营养恢复率。而在 Mehal Meda 医院入院则提高了恢复率。因此，医院应与卫生推广工作者合作，预防合并症，并在社区一级加强对营养不良病例的筛查和转诊。此外，地区卫生部门和地区卫生办公室应促进卫生机构之间的经验交流。
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