Mwima Sandrah Joyce, Lubogo David, Bagonza Arthur
Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
Department of Public Health and Nutrition, Faculty of Health Sciences, Victoria University, Kampala, Uganda.
BMC Nutr. 2025 Apr 15;11(1):78. doi: 10.1186/s40795-025-01066-6.
Successful outpatient management of severe acute malnutrition (SAM) significantly lowers the morbidity and mortality of patients. However, 29.5% of children under five years of age default from outpatient management of SAM in the Tooro subregion in southwestern Uganda, and little is known about the associated factors. This study assessed the determinants of default from the outpatient management of SAM among caregivers of children aged 6-59 months. It explored their experiences and perceptions of SAM and its management at Fort Portal Regional Referral Hospital in the Tooro subregion, Uganda.
A mixed methods study was conducted among caregivers of children who received outpatient management between January 2018 and August 2022. Cases were selected purposively, whereas controls were randomly selected. Data was collected using a structured questionnaire and exported to STATA 14 for analysis. Logistic regression was used to identify the determinants of default from the outpatient management of SAM. Fourteen caregivers and five health workers were purposively selected and interviewed, with informed consent. The interviews were audio recorded, transcribed verbatim, and analysed using Atlas. Ti 9 software. Ethical approval was sought from the Makerere School of Public Health Research & Ethics Committee (Protocol ID: 087).
A total of 88 cases and 111 controls were recruited. Several factors, including being Protestant (AOR = 2.60; 95% CI: 1.12-5.90), being Orthodox/Seventh-day Adventist (AOR = 3.65; 95% CI: 1.47-9.10), high transport costs (AOR = 3.30; 95% CI: 1.59-6.80), lacking perceived susceptibility to other illnesses (AOR = 3.90; 95% CI: 1.84-8.30), lacking health education (AOR = 3.97; 95% CI: 1.1-14.30) and lacking self-efficacy (AOR = 0.33; 95% CI: 0.16-0.66), were significantly associated with default from the outpatient management of SAM. Most caregivers reported being afraid of the possible consequences of default and agreed that SAM management was beneficial. However, their confidence in adhering to management was undermined by several factors, including transport costs, distance to the health facility, and discrimination.
Being Protestant, Orthodox/Seventh-day Adventist, high transport costs, lack of perceived susceptibility to other illnesses, lack of health education, and lack of self-efficacy were essential determinants of default from outpatient management of SAM. To reduce the default rate, stakeholders must strengthen peripheral sites and community health workers to bring SAM management services closer to the community. Additionally, a closer examination of the role of religious beliefs in default from the outpatient management of SAM is needed.
成功的重度急性营养不良（SAM）门诊管理可显著降低患者的发病率和死亡率。然而，在乌干达西南部的托罗次区域，29.5%的五岁以下儿童在SAM门诊管理中失访，且对相关因素知之甚少。本研究评估了6至59个月儿童的照料者在SAM门诊管理中失访的决定因素。它探讨了他们在乌干达托罗次区域福特portal地区转诊医院对SAM及其管理的经历和看法。
对2018年1月至2022年8月期间接受门诊管理的儿童的照料者进行了一项混合方法研究。病例是有目的地选择的，而对照是随机选择的。使用结构化问卷收集数据，并导出到STATA 14进行分析。逻辑回归用于确定SAM门诊管理失访的决定因素。有目的地选择了14名照料者和5名卫生工作者并进行访谈，并获得了知情同意。访谈进行了录音，逐字转录，并使用Atlas. Ti 9软件进行分析。向马凯雷雷公共卫生研究与伦理委员会寻求伦理批准（方案编号：087）。
共招募了88例病例和111例对照。几个因素，包括是新教徒（调整后比值比[AOR]=2.60；95%置信区间[CI]：1.12 - 5.90）、是东正教徒/基督复临安息日会教徒（AOR = 3.65；95% CI：1.47 - 9.10）、交通成本高（AOR = 3.30；95% CI：1.59 - 6.80）、缺乏对其他疾病的易感性认知（AOR = 3.90；95% CI：1.84 - 8.30）、缺乏健康教育（AOR = 3.97；95% CI：1.1 - 14.30）和缺乏自我效能感（AOR = 0.33；95% CI：0.16 - 0.66），与SAM门诊管理失访显著相关。大多数照料者报告担心失访可能带来的后果，并同意SAM管理是有益的。然而，包括交通成本、到医疗机构的距离和歧视等几个因素削弱了他们坚持管理的信心。
是新教徒、东正教徒/基督复临安息日会教徒、交通成本高、缺乏对其他疾病的易感性认知、缺乏健康教育和缺乏自我效能感是SAM门诊管理失访的重要决定因素。为了降低失访率，利益相关者必须加强基层医疗机构和社区卫生工作者，使SAM管理服务更贴近社区。此外，需要更仔细地研究宗教信仰在SAM门诊管理失访中的作用。
