Community based outpatient therapeutic programme for severe acute malnutrition in rural southern Ethiopia; Recovery, fatality and nutritional status after discharge
(English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203Article in journal, News item (Refereed) Submitted
Background: A scaled up and integrated outpatient therapeutic program (OTP) brings the treatment of severely malnourished children closer to the community. However, studies documenting program outcome and nutritional status beyond discharge from OTP are scarce. This study evaluated recovery from severe acute malnutrition (SAM), fatality and nutritional status up to 14 weeks after admission to the programme.
Methods: In this cohort study, 1048 children admitted to 94 OTPs in southern Ethiopia were followed for 14 weeks. Independent anthropometric measurements and information on treatment outcome were collected at four home visits.
Results: On admission 78.8% (826/1048) of the children had severe acute malnutrition. The mean length of admission to the programme was 7.1 weeks [95% CI 6.9 -7.3]. Only 37.8% (216/571) of children with SAM on admission fulfilled the programme recovery criteria (gained 15% in weight or oedema resolved, if present on admission) at discharge. However, of the children who achieved programme recovery criteria at discharge, 57.6% (121/210) were still acutely malnourished. Of all children admitted to the programme for whom nutritional assessment was done 14 weeks later, 34.6% (321/928) were severely and 34.4% (348/928) were moderately malnourished, thus 69.0% were acutely malnourished. A total of 27/982 (2.7%) of the children had died by 14 weeks, of whom all but one had SAM on admission. Children with severe oedema on admission had the highest fatality rate (12.0%, 9/75).
Conclusion: Despite children participating for the recommended duration of the programme, many were discharged without reaching programme criteria for recovery and acute malnutrition remained prevalent beyond discharge. Further research is needed to understand the factors constraining community management of acute malnutrition.
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-291455OAI: oai:DiVA.org:uu-291455DiVA: diva2:925628