Abdi Mustafe Mahamud, Jama Iid Muktar, Muse Abdilahi Ibrahim, Wedajo Girma Tadesse, Osman Mohamed Omar, Abate Kalkidan Hassen
Department of Medicine, Institute of Health Science, Jigjiga University, Jigjiga, Ethiopia.
Regional Data Management Center, Somali Regional Health Bureau, Jigjiga, Ethiopia.
BMJ Public Health. 2025 Sep 4;3(2):e001737. doi: 10.1136/bmjph-2024-001737. eCollection 2025.
Severe acute malnutrition (SAM) affects about 20 million under-5 children and contributes to one million child deaths annually. Apart from the presence of clinical management protocols capable of reducing case fatality by 1%-5%, case fatality in hospitals in developing countries averages 20%-30% and has remained the same since the 1950s.
This study aimed to assess treatment outcomes and associated factors of severe acute malnutrition among under-5-year-old children admitted to Jigjiga city public hospitals.
A facility-based retrospective cohort study design was employed on patient records between 1 January 2020 and 31 December, 2021. A structured checklist was used for data extraction to collect data from patient record book. Cox proportional hazards model with a hazard ratio of 95% CI was used. The level of statistical significance was declared at a p<0.05.
Overall median length of stay, recovery, death, defaulted and non-responder rate were 7 days, 257 (70.2%), 32 (8.7%), 58 (15.8%) and 19 (5.2%), respectively. Managing facility, tuberculosis (TB), pneumonia and nasogastric (NG) tube insertion were found to be significantly associated with treatment outcomes at a p<0.05.Children who were managed at Jigjiga University Sheik Hassen Yabare Comprehensive Specialised Hospital were 57% less likely to recover from SAM than those managed at Karamardha General Hospital (adjusted hazard ratio (AHR)=0.437, 95% CI: 0.286 to 0.600). Children who did not have TB were almost three times more likely to recover than their counterparts (AHR=2.862, 95% CI: 1.604 to 5.107), and those without pneumonia were also 1.5 times more likely to recover than those with a diagnosis of pneumonia (AHR=1.509, 95% CI: 1.146 to 1.989). Furthermore, children without nasogastric tube insertion were about 1.5 times more likely to recover than their counterparts (AHR=1.472, 95% CI: 1.075 to 2.015).
The recovery and defaulter rates fell outside the acceptable targets set by SPHERE standards; however, the death rate was acceptable. The significant predicting factors of treatment outcome were treating facility, TB, pneumonia and NG tube insertion.
重度急性营养不良（SAM）影响着约2000万5岁以下儿童，每年导致100万儿童死亡。除了存在能够将病死率降低1%-5%的临床管理方案外，发展中国家医院的病死率平均为20%-30%，自20世纪50年代以来一直如此。
本研究旨在评估入住吉吉加市公立医院的5岁以下儿童重度急性营养不良的治疗效果及相关因素。
采用基于机构的回顾性队列研究设计，对2020年1月1日至2021年12月31日期间的患者记录进行研究。使用结构化检查表从患者病历中提取数据。采用危险比为95%置信区间的Cox比例风险模型。统计学显著性水平设定为p<0.05。
总体中位住院时间、康复率、死亡率、失访率和无反应率分别为7天、257例（70.2%）、32例（8.7%）、58例（15.8%）和19例（5.2%）。发现管理机构、结核病（TB）、肺炎和鼻胃管插入与治疗效果显著相关，p<0.05。在吉吉加大学谢赫·哈森·亚巴雷综合专科医院接受治疗的儿童从SAM中康复的可能性比在卡拉马尔达综合医院接受治疗的儿童低57%（调整后危险比（AHR）=0.437，95%置信区间：0.286至0.600）。没有患结核病的儿童康复的可能性几乎是患结核病儿童的三倍（AHR=2.862，95%置信区间：1.604至5.107），没有肺炎的儿童康复的可能性也比诊断为肺炎的儿童高1.5倍（AHR=1.509，95%置信区间：1.146至1.989）。此外，未插入鼻胃管的儿童康复的可能性比插入鼻胃管的儿童高约1.5倍（AHR=1.472，95%置信区间：1.075至2.015）。
康复率和失访率未达到SPHERE标准设定的可接受目标；然而，死亡率是可接受的。治疗效果的显著预测因素是治疗机构、结核病、肺炎和鼻胃管插入。
