儿童在出院后再次出现严重急性营养不良的情况，这是在埃塞俄比亚西部门诊治疗项目中发现的。
Relapse of severe acute malnutrition among children discharged from outpatient therapeutic program in western Ethiopia.
机构信息
Gambella Region Health Office, Gambella, Ethiopia.
Department of Public Health Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
BMC Pediatr. 2023 Sep 2;23(1):441. doi: 10.1186/s12887-023-04269-7.
BACKGROUND
Children with severe acute malnutrition (SAM) without complication are treated in the outpatient therapeutic program (OTP) and the program has been reported to be effective. However, relapse post-discharge from the program is poorly defined, and scarcely evaluated across programs and research. The objective of this study is to assess the prevalence of SAM among children post-discharge from the OTP and to identify factors associated with SAM relapse in Gambella Region, Western Ethiopia.
METHODS
We conducted a facility-based cross-sectional study among 208 children aged 6-59 months who have been discharged from the OTP as cured. Baseline data were collected from caregivers using structured questionnaire. Child anthropometry and oedema was measured. The association between SAM relapse and the risk factors were assessed using bivariate and multivariable logistic regression models.
RESULTS
The prevalence of SAM relapse was 10.1% (95% CI: 5.8-14.0%). The odds of SAM relapse was significantly higher in children with mothers who had no exposure to education and promotion about infant and young child feeding (IYCF) practices (OR = 5.7; 95% CI: 1.3-12.6), children who were not fully immunized for their age (OR = 8.0; 95% CI: 3.8-23.4), and children with mid-upper arm circumference (MUAC) at discharge of < 12.5 cm (OR = 4.4; 95% CI: 2.1-12.8) than their counterparts.
CONCLUSIONS
To reduce SAM relapse, the OTP programs should avoid premature discharge and consider provision of supplementary food for children with low MUAC at discharge. Further, the OTP discharge criteria should consider both the anthropometric indicators - weight-for-height/length z-score (WHZ) and MUAC - and the absence of bilateral pitting oedema irrespective of the anthropometric indicator that is used during admission. Promotion of nutrition education and improving child immunization services and coverage would help reduce SAM relapse.
背景
无并发症的严重急性营养不良 (SAM) 儿童在门诊治疗方案 (OTP) 中接受治疗，该方案已被证明是有效的。然而，该方案出院后的复发情况定义不明确，且在各方案和研究中评估甚少。本研究的目的是评估在 Gambella 地区，从 OTP 出院的儿童中 SAM 的流行情况，并确定与 SAM 复发相关的因素。
方法
我们在 208 名年龄在 6-59 个月之间、已从 OTP 治愈出院的儿童中开展了一项基于机构的横断面研究。使用结构化问卷从照顾者处收集基线数据。测量儿童的人体测量学和水肿情况。使用二变量和多变量逻辑回归模型评估 SAM 复发与危险因素之间的关联。
结果
SAM 复发率为 10.1%（95%CI：5.8-14.0%）。母亲未接受婴儿和幼儿喂养（IYCF）实践教育和推广的儿童（OR=5.7；95%CI：1.3-12.6）、未按年龄完全免疫的儿童（OR=8.0；95%CI：3.8-23.4）、出院时上臂中部周长（MUAC）<12.5cm 的儿童（OR=4.4；95%CI：2.1-12.8）的 SAM 复发风险显著更高。
结论
为了降低 SAM 复发率，OTP 项目应避免过早出院，并考虑为出院时 MUAC 较低的儿童提供补充食物。此外，OTP 出院标准应同时考虑人体测量指标——身高/长度体重指数（WHZ）和 MUAC——以及无论在入院期间使用哪种人体测量指标，都应消除双侧凹陷性水肿。推广营养教育和改善儿童免疫接种服务和覆盖率将有助于降低 SAM 复发率。
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