Department of Epidemiology and Biostatics, School of Public Health, College of Health Science, Woldia University, 400, Woldia Town, Ethiopia.
J Health Popul Nutr. 2022 Jul 8;41(1):29. doi: 10.1186/s41043-022-00308-8.
Relapse or repeated episodes is the admission of a child with the diagnosis of severe acute malnutrition (SAM) after being discharged to a status of treated and cured from a stabilizing center. A child may experience more than one episode of SAM depending on the improvement of the underlying comorbidity. Thus, this study aimed to estimate the time to readmission of SAM and associated factors for under-five children in North West Ethiopia.
An institution-based retrospective cohort study was employed in 760 files of under-five children spanning from 2014/15 to 2019/20. The data extraction tool was developed from SAM treatment guidelines and medical history sheets. Epi Data version 3.2 and STATA version 14 were used for data entry and final analysis, respectively. After checking all assumptions, the multivariable Cox Proportional Hazard model was fitted to the isolated independent predictors for time to readmission. A categorical variable with p < 0.05 was considered a risk factor for the relapse of SAM.
The mean (± SD) age of participant children was 27.8 (± 16.5) months with mean (± SD) time to relapse of SAM cases were 30.4(± 21.39) weeks posttreatment discharge. The overall incidence density rate of relapse was determined as 10.8% (95% CI 8.3; 12.6). The average time (± SD) for treatment recovery from the first admission of the SAM case was 28.8(± 18.7) days. Time of readmission was significantly associated with living in rural resident (AHR 5⋅3 = 95% CI, 2⋅95, 13⋅87, p = 0.021), having HIV infection (AHR6⋅8 = 95%CI; 4.1-11.9 p = 0.001), and first admission with edema (AHR = 3.5 = 95% CI; 1.92, 6.2, p = 0.018).
Nearly one in every ten severely acute malnourished under-five children relapsed within a mean time to relapse 30.4(± 21.39) weeks posttreatment discharge. Time to relapse was significantly associated with being a rural resident for children, having edema during the first admission, and being HIV-infected cases. A protocol ought to be drafted for extending Supplementary Nutrition in Acute Malnutrition management program following discharge is highly needed.
复发或反复发作为儿童在严重急性营养不良（SAM）稳定中心接受治疗并治愈出院后再次入院的诊断。根据潜在合并症的改善情况，儿童可能会经历不止一次 SAM 发作。因此，本研究旨在估计西北埃塞俄比亚五岁以下儿童再次入院 SAM 的时间，并确定相关因素。
本研究采用了 2014/15 年至 2019/20 年期间的 760 名五岁以下儿童的基于机构的回顾性队列研究。数据提取工具是根据 SAM 治疗指南和病历表开发的。Epi Data 版本 3.2 和 STATA 版本 14 分别用于数据录入和最终分析。在检查了所有假设后，采用多变量 Cox 比例风险模型对孤立的独立预测因素进行了时间到再次入院的分析。具有 p < 0.05 的分类变量被认为是 SAM 复发的危险因素。
参与者儿童的平均（±SD）年龄为 27.8（±16.5）个月，SAM 病例治疗后复发的平均（±SD）时间为 30.4（±21.39）周。复发的总发生率密度率为 10.8%（95%CI 8.3；12.6）。第一次 SAM 入院治疗恢复的平均时间（±SD）为 28.8（±18.7）天。再次入院时间与居住在农村（AHR 5.3 = 95%CI，2.95，13.87，p = 0.021）、感染 HIV（AHR 6.8 = 95%CI；4.1-11.9，p = 0.001）和第一次入院时伴有水肿（AHR = 3.5 = 95%CI；1.92，6.2，p = 0.018）显著相关。
在治疗后平均 30.4（±21.39）周内，每 10 名严重急性营养不良的五岁以下儿童中就有近 1 名儿童复发。复发时间与儿童居住在农村、首次入院时出现水肿和感染 HIV 显著相关。非常需要制定一项协议，以扩大出院后的急性营养不良补充营养管理方案。
