埃塞俄比亚南部稳定中心收治的 6-59 月龄重度急性营养不良儿童的治疗结局及其影响康复时间的因素：一项回顾性队列研究。
Treatment outcomes and factors affecting time-to-recovery from severe acute malnutrition in 6-59 months old children admitted to a stabilization center in Southern Ethiopia: A retrospective cohort study.
机构信息
Community Service and Research Directorate, Pharma College Hawassa Campus, P.O.B: 67, Hawassa, Ethiopia.
School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
出版信息
Ital J Pediatr. 2019 Apr 11;45(1):46. doi: 10.1186/s13052-019-0642-x.
BACKGROUND
Despite improving access to Severe Acute Malnutrition (SAM) management, information on the quality of the service, as measured by timely recovery, is scare. This study is designed to assess treatment outcomes and factors affecting time-to-recovery from SAM in children 6-59 months admitted to a stabilizing center in Hawassa University Comprehensive Specialized Hospital (HU-CSH), Southern Ethiopia.
METHODS
Institutional-based retrospective cohort study was conducted on 420 randomly selected children aged 6-59 months. The children were managed at the hospital from July, 2015 to June, 2017. Pre-tested structured questionnaire was used to extract data from medical records. Data were analyzed using Kaplan Meir (KM) curve, Log rank test and Cox-Proportional hazards model. The outputs of the bivariable and multivariable Cox model are presented using Adjusted Hazard Ratio (AHR) with the respective 95% Confidence Intervals (CIs).
RESULTS
After a maximum of 59 days treatment 69.3% of the children recovered and 10.8% died. The mean (±SD) weight gain rates was 12.7 (±8.9) g/kg/days. The overall incidence density rate of recovery was 3.8 per 100 person-days. The overall median (IQR) time of recovery was 17(10, 24) days. F-100 intake (AHR = 0.502, 95%, CI: 0.29-0.86), Tuberculosis infection (AHR = 1.38, 95% CI: 1.00-1.91) and provision of special medication (IV fluid, IV antibiotic and blood transfusion) (AHR = 0.72, 95% CI: 0.52-0.99) at admission were found to be significant predictors of time-to-recovery from SAM.
CONCLUSION
The overall recovery from complicated SAM children admitted at HU-CSH after a maximum of 59 days treatment was low (69.4%) and a very high proportion of children (10.8%) end up in death. Therefore, HU-CSH should give special focus for those children present with medical comorbidities during admission.
背景
尽管严重急性营养不良（SAM）管理的可及性有所提高，但关于服务质量的信息（以及时康复来衡量）却很匮乏。本研究旨在评估在 Hawassa 大学综合专科医院（HU-CSH）稳定中心接受治疗的 6-59 个月大的儿童从 SAM 康复的治疗结果和影响因素。
方法
这是一项在 420 名随机选择的 6-59 个月大的儿童中进行的基于机构的回顾性队列研究。这些儿童于 2015 年 7 月至 2017 年 6 月在医院接受治疗。使用预测试的结构化问卷从病历中提取数据。使用 Kaplan-Meier（KM）曲线、对数秩检验和 Cox 比例风险模型进行数据分析。将 bivariable 和多变量 Cox 模型的输出以调整后的风险比（AHR）和相应的 95%置信区间（CI）呈现。
结果
在最长 59 天的治疗后，69.3%的儿童康复，10.8%的儿童死亡。平均（±SD）体重增加率为 12.7（±8.9）g/kg/天。总体康复的发生率密度为每 100 人-天 3.8 例。总体康复中位数（IQR）时间为 17（10，24）天。F-100 摄入（AHR=0.502，95%CI：0.29-0.86）、结核病感染（AHR=1.38，95%CI：1.00-1.91）和特殊药物的提供（IV 液、IV 抗生素和输血）（AHR=0.72，95%CI：0.52-0.99）在入院时被发现是从 SAM 康复时间的显著预测因素。
结论
在 HU-CSH 接受治疗的复杂 SAM 儿童最长 59 天后的总体康复率较低（69.4%），且有相当高比例的儿童（10.8%）死亡。因此，HU-CSH 应特别关注入院时存在合并症的儿童。
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