Department of Paediatrics, Federal Teaching Hospital, Katsina, Katsina State, Nigeria.
Department of Public Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
J Health Popul Nutr. 2023 Feb 17;42(1):10. doi: 10.1186/s41043-023-00352-y.
Severe acute malnutrition (SAM) among children under five years of age remains a huge public health and economic burden in Sub-Saharan Africa. We investigated time to recovery and its predictors among children aged 6 to 59 months admitted into Community-based Management of Acute Malnutrition (CMAM) stabilisation centres for complicated severe acute malnutrition and whether the outcomes met the minimum Sphere standards.
The study was a retrospective cross sectional quantitative review of data recorded in six CMAM stabilization centres registers in four Local Government Areas, Katsina state, Nigeria from September 2010 to November 2016. Records of 6925 children, aged 6-59 months with complicated SAM were reviewed. Descriptive analysis was used to compare performance indicators with Sphere project reference standards. Cox proportional hazard regression analysis was used to estimate the predictors of recovery rate at p < 0.05 and Kaplan-Meier curve to predict the probability of surviving different forms of SAM.
Marasmus was the most common form of severe acute malnutrition (86%). Overall, the outcomes met the minimum sphere standards for inpatient management of SAM. Children with oedematous SAM (13.9%) had the lowest survival rate on Kaplan-Meier graph. The mortality rate was significantly higher during the 'lean season'-May to August (Adjusted Hazard Ratio (AHR) = 0.491, 95% CI = 0.288-0.838). MUAC at Exit (AHR = 0.521, 95% CI = 0.306-0.890), marasmus (AHR = 2.144, 95% CI = 1.079-4.260), transfers from OTP (AHR = 1.105, 95% CI = 0.558-2.190) and average weight gain (AHR = 0.239, 95% CI = 0.169-0.340) were found to be significant predictors of time-to-recovery with p values < 0.05.
The study showed that, despite a high turnover of complicated SAM cases in the stabilization centres, the community approach to inpatient management of acute malnutrition enabled early detection and reduced delays in access to care of complicated SAM cases. In the face of health workforce shortage in rural communities to provide pediatric specialist care for SAM children, we recommend task shifting to community health care workers through in service training could bridge the gap and save more lives of children dying from the complication of SAM in rural communities in Nigeria.
五岁以下儿童严重急性营养不良（SAM）仍然是撒哈拉以南非洲地区巨大的公共卫生和经济负担。我们研究了在社区管理急性营养不良（CMAM）稳定中心接受治疗的 6 至 59 个月大的患有复杂严重急性营养不良的儿童的恢复时间及其预测因素，以及结果是否符合最低Sphere 标准。
本研究是对 2010 年 9 月至 2016 年 11 月尼日利亚卡齐纳州四个地方政府区的六个 CMAM 稳定中心登记册中记录的 6925 名患有复杂 SAM 的 6-59 个月大儿童数据的回顾性横断面定量研究。对表现指标与 Sphere 项目参考标准进行了比较。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。采用 Kaplan-Meier 曲线预测不同形式 SAM 的生存概率。
消瘦是最常见的严重急性营养不良形式（86%）。总体而言，住院治疗 SAM 的结果符合最低 Sphere 标准。在 Kaplan-Meier 图表中，患有水肿性 SAM（13.9%）的儿童存活率最低。在“瘦季”-5 月至 8 月期间，死亡率显著升高（调整后的危险比（AHR）=0.491，95%置信区间（CI）=0.288-0.838）。MUAC 在出院时（AHR=0.521，95%CI=0.306-0.890）、消瘦（AHR=2.144，95%CI=1.079-4.260）、从 OTP 转来（AHR=1.105，95%CI=0.558-2.190）和平均体重增加（AHR=0.239，95%CI=0.169-0.340）与时间恢复呈显著相关，p 值<0.05。
研究表明，尽管稳定中心的复杂 SAM 病例周转率很高，但社区对急性营养不良的住院管理方法使复杂 SAM 病例能够早期发现并减少获得治疗的延迟。在农村社区提供小儿专科 SAM 儿童护理的卫生人力短缺的情况下，我们建议通过在职培训将任务转移到社区卫生工作者，这可以缩小差距，拯救更多在尼日利亚农村社区死于 SAM 并发症的儿童的生命。
