Adem Fuad, Edessa Dumessa, Bayissa Bodena, Mohammed Hassen Mesud, Mohammed Mohammed A
Department of Clinical Pharmacy, School of Pharmacy, Haramaya University, Oromia, Ethiopia.
Jimma University, School of Pharmacy, Jimma, Ethiopia.
Pediatric Health Med Ther. 2020 Jul 21;11:235-243. doi: 10.2147/PHMT.S253396. eCollection 2020.
Malnutrition continues to be a public health challenge in sub-Saharan African countries. In Ethiopia, there is a paucity of data regarding factors affecting treatment outcomes in children with severe acute malnutrition (SAM).
A prospective cohort study was conducted among children aged 6 to 59 months with SAM, receiving care at Jimma University Medical center, Ethiopia. Bivariate and multivariate analyses were computed to determine factors associated with treatment outcomes. Kaplan-Meier survival analysis, life-table analysis, and Log rank test were used to determine death rates, estimate the proportion of surviving, and compare time to recovery (nutritional cure).
A total of 133 children were included in this study and 79.7% had medical comorbidities. Overall, nutritional recovery, death, and default rates were 25.6%, 3.8%, and 7.6%, respectively. There was no significant difference in the nutritional recovery rate (26.1% versus 25.4%; p=0.4) and the median time to recovery between children who had diarrhea at admission (26 days; 95% CI: 24.0-28.7) and those who had not (26.0 days; 95% CI: 21.90-30.10). Likewise, the average daily weight gain was not significantly different between the two groups (6.34 g/kg/day versus 7.76g/kg/day, p=0.4). Having diagnosed with tuberculosis (Adjusted Hazard Ratio (AHR)=0.19, CI 0.06-0.62) and anemia (AHR =0.32, CI 0.14-0.74) and treatment failures (AHR=0.17, CI, 0.16-0.03) were predicting factors for time to recovery.
The recovery rate and average daily weight gain were found to be sub-optimal in the study population. However, the median time to recovery was within the national recommendation. There was no significant difference in the recovery rate and time to recovery between the two groups. Treatment failures and the presence of tuberculosis and anemia were indicators for prolonged stabilization phase and time to achieve nutritional cure. Optimal average daily weight gain and clinical management of comorbidities may enhance early recovery in hospitalised children with SAM.
营养不良仍是撒哈拉以南非洲国家面临的一项公共卫生挑战。在埃塞俄比亚，关于影响重度急性营养不良（SAM）儿童治疗结果的因素的数据匮乏。
在埃塞俄比亚吉马大学医学中心接受治疗的6至59个月大的SAM儿童中进行了一项前瞻性队列研究。进行了双变量和多变量分析以确定与治疗结果相关的因素。采用Kaplan-Meier生存分析、生命表分析和对数秩检验来确定死亡率、估计存活比例并比较恢复时间（营养治愈）。
本研究共纳入133名儿童，79.7%患有合并症。总体而言，营养恢复率、死亡率和失访率分别为25.6%、3.8%和7.6%。入院时患有腹泻的儿童与未患腹泻的儿童之间，营养恢复率（26.1%对25.4%；p = 0.4）和恢复的中位时间（26天；95%置信区间：24.0 - 28.7）没有显著差异。同样，两组之间的平均每日体重增加也没有显著差异（6.34克/千克/天对7.76克/千克/天，p = 0.4）。被诊断患有结核病（调整后风险比（AHR）= 0.19，置信区间0.06 - 0.62）、贫血（AHR = 0.32，置信区间0.14 - 0.74）和治疗失败（AHR = 0.17，置信区间0.16 - 0.03）是恢复时间的预测因素。
研究人群中的恢复率和平均每日体重增加未达到最佳水平。然而，恢复的中位时间在国家推荐范围内。两组之间的恢复率和恢复时间没有显著差异。治疗失败以及结核病和贫血的存在是延长稳定期和实现营养治愈时间的指标。最佳的平均每日体重增加和合并症的临床管理可能会促进住院的SAM儿童早日康复。
