Effect of Diarrhea at Admission on Time to Recovery in Treatment of Severe Acute Malnourished Children in Inpatient Therapeutic Feeding Program in Tigray Region, Ethiopia

Abstract

The mortality rate in inpatient settings remained unacceptably higher, 20–30% for marasmus and 50–60% for Kwashiorkor. This is due to inappropriate case management and co-morbidities mainly diarrhea. Despite, there was no study conducted to show the effect of diarrhea at admission on the length of time to recovery in the treatment of severe acute malnutrition among children aged 6–59 months and then there is little understanding about this issue.  The aim of this study is to determine the effect of diarrhea at admission on the length of time to recovery and its determinants among children aged 6–59 months admitted to therapeutic feeding program in the treatment of severe acute malnutrition. A retrospective cohort study was conducted on children treated for severe acute malnutrition based on the WHO protocol in Tigray region. Simple random sampling was used to select four hospitals and systematic random sampling for selecting study unit records after proportional allocation technique to each hospital was carried out. Data was entered using Epi info 3.5.1 software, and transferred to SPSS 20.0 for windows for cleaning and analysis. The results were estimated using Kaplan-Meier survival curves, log-rank test, and Cox-regression. The average length of time to recovery was around 11–12 days in both children, without and with diarrhea at admission. The proportion of recovered children among children admitted with diarrhea (42%) was less than those admitted without diarrhea (48%), but it had no statistically significant difference (HR= 0.84, 95%, CI= 0.65,1.07, P= 0.14). Co-morbidities statistically associated with the length of time to recover among children admitted with diarrhea were pneumonia (HR= 0.69, 95%, CI= 0.48, 0.99, P= 0.046), dehydration (HR= 0.50, 95%, CI= 0.34, 0.73, P< 0.001) and anemia (HR=0.61, 95%, CI= 0.37, 0.98, P= 0.04), but not among children admitted without diarrhea. Routine medicines; antibiotics, vitamin A and folic acid were rarely given. The effect of diarrhea on the treatment length of time among severe acute malnutrition management on the inpatient feeding program did not show statistically significant difference in this study. However, there was a slight difference in length of time to recovery i.e. the length of time to recovery was higher among children admitted with diarrhea (12 days) than those admitted without diarrhea (11 days). The results from the current study can be utilized to pinpoint the effect of diarrhea at admission on the length of time to recovery in the treatment of severe acute malnutrition among patients at governmental hospitals in Tigray region, thereby to provide knowhow for health workers and policy makers to improve their knowledge and performance on inpatient therapeutic feeding program through effective implementation of the WHO inpatient SAM management protocol and for efficient resource allocation and health workers to avoid poor treatment in an inpatient admission.

Keywords: Diarrhea, admission on time, severe acute malnourished children, mortality, co-morbidities

Cite this Article

Mehari Kahsay, Gidey Gebremeskel, Belachew Etana, Usha Kulkarni. Effect of Diarrhea at Admission on Time to Recovery in Treatment of Severe Acute Malnourished Children in Inpatient Therapeutic Feeding Program in Tigray Region, Ethiopia. Research and Reviews: Journal of Medical Science and Technology. 2016; 5(2): 25–40p