Department of Nursing, College of Health Sciences, Woldia University, Woldia, Amhara Regional State, Ethiopia.
PLoS One. 2020 Sep 3;15(9):e0238231. doi: 10.1371/journal.pone.0238231. eCollection 2020.
In Ethiopia, uncomplicated severe acute malnutrition is managed through the outpatient therapeutic program at health posts level. This brings the services for the management of Severe Acute Malnutrition closer to the community by making services available at decentralized treatment points within the primary health care settings. So far, evidence of the treatment outcome of the program is limited.
The main aim of this study was to determine the magnitude of treatment outcomes of severe acute malnutrition and associated factors among under-five children at outpatient therapeutic feeding units in Gubalafto Wereda, Ethiopia, 2019.
This was a retrospective cohort study conducted on 600 children who had been managed for Severe Acute Malnutrition (SAM) under Outpatient Therapeutic Program (OTP) in Gubalafto Wereda from April to May/2019. The children were selected using systematic random sampling from 9 health posts. The structured, pre-tested, and adapted questionnaire was used to collect the data. The data was entered by using EPI-data Version 4.2 and exported to SPSS version 24.0 for analysis. Bivariate and Multivariate regression was also carried out to determine the association between dependent and independent variables.
A total of 600 records of children with a diagnosis of severe acute malnutrition were reviewed. Of these cases of malnutrition, the recovery rate was found to be 65%. The death rate, default rate, and medical transfer were 2.0, 16.0, and 17.0 respectively. Immunized children had 6.85 times higher odds of recovery than children who were not immunized (AOR = 6.85 at 95% CI (3.68-12.76)). The likelihood of recovery was 3.78 times higher among children with new admission than those with re-admission (AOR = 3.78at 95% CI ((1.77-8.07))). Likewise, children provided with amoxicillin were 3.38 times recovered than their counterparts (AOR = 3.38 at 95% CI ((1.61-7.08))). SAM treatment in OTP is beneficial because of its local access for most severe cases since children reach early before developing complications as a result fatalities will be reduced.
The recovery rate and medical transfer were lower than the sphere standard. Presence of cough, presence of diarrhea admission category, provision of amoxicillin, and immunization status were factors identified as significantly associated with treatment outcome of severe acute malnutrition. The impact on increasing the recovery rates of children treated using the OTP service indicates the potential benefits of increasing the capacity of such services across a target region on child mortality/recovery. Timely intervention is another benefit of a more local service like OTP. Building capacity of OTP service providers and regular monitoring of service provision based on the management protocol was recommended.
在埃塞俄比亚，复杂的严重急性营养不良通过卫生所一级的门诊治疗方案进行管理。这使得严重急性营养不良的管理服务更接近社区，在初级卫生保健环境中提供分散的治疗点服务。到目前为止，该方案的治疗效果证据有限。
本研究的主要目的是确定 2019 年在埃塞俄比亚 Gubalafto Wereda 的门诊治疗喂养单位中，5 岁以下儿童严重急性营养不良治疗结果的程度及其相关因素。
这是一项回顾性队列研究，共纳入 600 名在 2019 年 4 月至 5 月期间在 Gubalafto Wereda 通过门诊治疗方案（OTP）管理的严重急性营养不良（SAM）儿童。儿童采用系统随机抽样从 9 个卫生所中选取。使用结构化、预测试和适应的问卷收集数据。数据通过 EPI-data 版本 4.2 录入，并导出到 SPSS 版本 24.0 进行分析。还进行了单变量和多变量回归，以确定因变量和自变量之间的关联。
共回顾了 600 例严重急性营养不良儿童的记录。在这些营养不良病例中，恢复率为 65%。死亡率、缺诊率和医疗转归率分别为 2.0%、16.0%和 17.0%。免疫儿童的恢复几率是未免疫儿童的 6.85 倍（AOR=6.85，95%CI（3.68-12.76））。与再次入院的儿童相比，新入院的儿童的恢复可能性高 3.78 倍（AOR=3.78，95%CI（1.77-8.07））。同样，接受阿莫西林治疗的儿童的恢复率比对照组高 3.38 倍（AOR=3.38，95%CI（1.61-7.08））。由于大多数严重病例都能在出现并发症之前早期到达，因此 OTP 中的 SAM 治疗具有局部优势，这将降低死亡率。
恢复率和医疗转归率低于全球标准。咳嗽、腹泻入院类别、阿莫西林的提供和免疫状况是与严重急性营养不良治疗结果显著相关的因素。增加使用 OTP 服务治疗的儿童的恢复率会对降低儿童死亡率/恢复率产生积极影响。类似 OTP 这样的更本地化的服务的另一个好处是及时干预。建议提高 OTP 服务提供者的能力，并根据管理方案定期监测服务提供情况。
