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Recovery rate and determinants of severe acute malnutrition children treatment in Ethiopia: a systematic review and meta-analysis.

ABSTRACT: BACKGROUND:Severe acute malnutrition affects more than 20 million children. Africa is pointed out as a region where the problem is highly prevalent. There were individual studies on the recovery rate and its determinants among children with severe acute malnutrition in Ethiopia. But, there is no national pooled estimate. Therefore, this systematic review and meta-analysis aimed to estimate the recovery rate and determinants among children with severe acute malnutrition admitted to the therapeutic feeding unit in Ethiopia. METHODS:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed in this study. Studies were accessed through electronic web-based search from PubMed, Cochrane Library, Google Scholar, and EMBASE. The statistical analysis was conducted using STATA version-11 software. The pooled prevalence was estimated with 95% confidence intervals using a random-effects model. RESULT:A total of 12 studies were included with 2658 participants in the analysis. The overall pooled estimated recovery rate among children with severe acute malnutrition admitted to the inpatient therapeutic feeding unit in Ethiopia was 72.02 % (CI, 64.83, 79.22%). In the subgroup analysis, the highest estimate (80.29%) was observed in studies conducted in Oromia regional state, while 68.63% was observed in studies Southern Nation Nationality of people region 68.63%. Children who had no congestive heart failure were 4.88 times (OR, 4.88; 95% CI, 2.246, 10.586) more likely to recover than their counterparts. CONCLUSION:The recovery rate among severe acute malnourished children on the therapeutic feeding unit in Ethiopia lied within the international minimum sphere. Hence, health care providers shall strengthen the management of severe acute malnutrition and management other co-morbidities like congestive heart failure. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42019119124.

SUBMITTER: Yazew KG

PROVIDER: S-EPMC6911294 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Recovery rate and determinants of severe acute malnutrition children treatment in Ethiopia: a systematic review and meta-analysis.

Yazew Kassahun Gebeyehu KG Kassahun Chanyalew Worku CW Ewnetie Amare Wondim AW Mekonen Habtamu Kerebih HK Abagez Endalamaw Salilew ES

Systematic reviews 20191213 1

<h4>Background</h4>Severe acute malnutrition affects more than 20 million children. Africa is pointed out as a region where the problem is highly prevalent. There were individual studies on the recovery rate and its determinants among children with severe acute malnutrition in Ethiopia. But, there is no national pooled estimate. Therefore, this systematic review and meta-analysis aimed to estimate the recovery rate and determinants among children with severe acute malnutrition admitted to the th ...[more]

PMID: 31836023

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Project description:BACKGROUND:Globally, Severe Acute Malnutrition (SAM) has been reduced by only 11% over the past 20 years and continues to be a significant cause of morbidity and mortality. So far, in Sub-Saharan Africa, several primary studies have been conducted on recovery rate and determinants of recovery from SAM in under-five children. However, comprehensive reviews that would have a shred of strong evidence for designing interventions are lacking. So, this review and meta-analysis was conducted to bridge this gap. METHODS:A systematic review of observational studies published in the years between 1/1/2000 to 12/31/2018 was conducted following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement. Two reviewers have been searched and extracted data from CINAHL (EBSCO), MEDLINE (via Ovid), Emcare, PubMed databases, and Google scholar. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with fair to good quality were included in the final analysis. The review presented the pooled recovery rate from SAM and an odds ratio of risk factors affecting recovery rate after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD42019122085. RESULT:Children with SAM from 54 primary studies (n = 140,148) were included. A pooled rate of recovery was 71.2% (95% CI: 68.5-73.8; I2 = 98.9%). Children who received routine medication (Pooled Odds ratio (POR):1.85;95% CI: 1.49-2.29; I2 = 0.0%), older age (POR: 1.99;95% CI: 1.29-3.08; I2 = 80.6%), and absence of co-morbidity (POR:3.2;95% CI: 2.15-4.76; I2 = 78.7%) had better odds of recovery. This systematic review and meta-analysis suggestes HIV infected children had lower recovery rate from SAM (POR; 0.19; 95% CI: 0.09-0.39; I2 = 42.9%) compared to those non-infected. CONCLUSION:The meta-analysis deciphers that the pooled recovery rate was below the SPHERE standard, and further works would be needed to improve the recovery rate. So, factors that were identified might help to revise the plan set by the countries, and further research might be required to explore health fascilities fidelity to the WHO SAM management protocol.

Project description:BACKGROUND:More than 29 million that is an estimated 5%, under-five children suffer from severe acute malnutrition (SAM) globally, with a nine times higher risk of mortality than that of well-nourished children. However, little is known regarding outcomes and predictors of SAM in Ethiopia. Therefore, this study aims to determine treatment cure rate and its predictors among children aged 6-59 months with SAM admitted to a stabilization center. METHODOLOGY:A retrospective record review was employed in SAM children at the University of Gondar Comprehensive Specialized Hospital (UOGCSH) from 2014 to 2016. SAM defined as weight for height below -3 z scores of the median World Health Organization (WHO) growth standards or presence of bilateral edema or mid upper arm circumference < 115mm for a child ?6months age. All SAM patients with medical complication(s) or failure to pass appetite test are admitted to the malnutrition treatment center for inpatient follow-up. Data were extracted from a randomly selected records after getting ethical clearance. Data were cleaned, coded and entered to Epi-info version-7, and analyzed using STATA/se version-14. Descriptive statistics and analytic analyses schemes including bivariable and multivariable Cox proportional hazards model were conducted. RESULT:Among a total of 416 records recruited for this study, 288 (69.2%) SAM children were cured at the end of the follow up, with a median cure time of 11 days. Kwash-dermatosis (AHR (Adjusted Hazard Ratio): 1.48(95% CI: 1.01, 2.16)), anemia (AHR: 1.36(95% CI: 1.07, 1.74)), tuberculosis (AHR: 1.6(95% CI: 1.04, 2.43)) and altered body temperature at admission (AHR: 1.58(95% CI: 1.04, 2.4) were independent predictors of time to cure. CONCLUSION:The cure rate in SAM children was low relative to sphere standard guideline. Prognosis of SAM largely depends on the presence of other comorbidities at admission. Available intervention modalities need to address coexisting morbidities to achieve better outcomes in SAM children.

Project description:BackgroundCurrent (1999) World Health Organization guidelines recommend giving routine antibiotics (AB) for all children with severe acute malnutrition (SAM), even if they have uncomplicated disease with no clinically obvious infections. We examined the evidence behind this recommendation.Methods and findingsOVID-MEDLINE, EMBASE, COCHRANE, GLOBAL-HEALTH, CINAHL, POPLINE, AFRICA-WIDE-NiPAD, and LILACS were searched for AB efficacy, bacterial resistance, and infection rates in SAM. Following PRISMA guidelines, a systematic review and meta-analysis were performed. Three randomised controlled trials (RCT), five Cochrane reviews, and 37 observational studies were identified. One cohort-study showed no increase in nutritional-cure and mortality in uncomplicated SAM where no AB were used. (p>0.05). However, an unpublished RCT in this setting did show mortality benefits. Another RCT did not show superiority of ceftriaxone over amoxicilllin for these same outcomes, but adressed SAM children with and without complications (p?=?0.27). Another RCT showed no difference between amoxicillin and cotrimoxazole efficacies for pneumonia in underweight, but not SAM. Our meta-analysis of 12 pooled susceptibility-studies for all types of bacterial isolates, including 2767 stricly SAM children, favoured amoxicillin over cotrimoxazole for susceptibility medians: 42% (IQR 27-55%) vs 22% (IQR 17-23%) and population-weighted-means 52.9% (range 23-57%) vs 35.4% (range 6.7-42%). Susceptibilities to second-line AB were better, above 80%. Prevalence of serious infections in SAM, pooled from 24 studies, ranged from 17% to 35.2%. No study infered any association of infection prevalence with AB regimens in SAM.ConclusionsThe evidence underlying current antibiotic recommendations for uncomplicated SAM is weak. Susceptibility-studies favour amoxicillin over cotrimoxazole. However, given that these antibiotics have side-effects, costs, and risks as well as benefits, their routine use needs urgent testing. With reliable monitoring, we believe that there is sufficient equipoise for placebo controlled RCTs, the only robust way to demonstrate true efficacy.

Project description:BackgroundChildren hospitalized with severe acute malnutrition (SAM) have poor long-term outcomes following discharge, with high rates of mortality, morbidity, and impaired neurodevelopment. There is currently minimal guidance on how to support children with SAM following discharge from inpatient treatment.ObjectivesThis systematic review and meta-analysis aimed to examine whether postdischarge interventions can improve outcomes in children recovering from complicated SAM.MethodsSystematic searches of 4 databases were undertaken to identify studies of interventions delivered completely or partially after hospital discharge in children aged 6-59 mo, following inpatient treatment of SAM. The main outcome of interest was mortality. Random-effects meta-analysis was undertaken where ≥2 studies were sufficiently similar in intervention and outcome.ResultsTen studies fulfilled the inclusion criteria, recruiting 39-1781 participants in 7 countries between 1975 and 2015. Studies evaluated provision of zinc (2 studies), probiotics or synbiotics (2 studies), antibiotics (1 study), pancreatic enzymes (1 study), and psychosocial stimulation (4 studies). Six studies had unclear or high risk of bias in ≥2 domains. Compared with standard care, pancreatic enzyme supplementation reduced inpatient mortality (37.8% compared with 18.6%, P < 0.05). In meta-analysis there was some evidence that prebiotics or synbiotics reduced mortality (RR: 0.72; 95% CI: 0.51, 1.00; P = 0.049). Psychosocial stimulation reduced mortality in meta-analysis of the 2 trials reporting deaths (RR: 0.36; 95% CI: 0.15, 0.87), and improved neurodevelopmental scores in ≥1 domain in all studies. There was no evidence that zinc reduced mortality in the single study reporting deaths. Antibiotics reduced infectious morbidity but did not reduce mortality.ConclusionsSeveral biological and psychosocial interventions show promise in improving outcomes in children following hospitalization for SAM and require further exploration in larger randomized mortality trials. This study was registered with PROSPERO as CRD42018111342 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=111342).

Project description:BACKGROUND:Severe forms of malnutrition have drastic effects on childhood morbidity and mortality in sub-Saharan countries, including Ethiopia. Although few studies have previously estimated treatment outcomes of severe acute malnutrition (SAM) in Ethiopia, the findings were widely varied and inconsistent. This study thus aimed to pool estimates of treatment outcomes and identify predictors of mortality among children with SAM in Ethiopia. METHODS:A systematic review was carried out to select 21 eligible articles from identified 1013 studies (dating from 2000 to 2018) that estimated treatment outcomes and predictors of mortality among SAM children. Databases including PubMed, CINHAL, Web of Sciences; Cochrane, Psych INFO and Google Scholar were comprehensively reviewed using medical subject headings (MESH) and a priori set criteria PRISMA guideline was used to systematically review and meta-analyze eligible studies. Details of sample size, magnitude of effect sizes, including Hazard Ratio (HRs) and standard errors were extracted. Random-effects model was used to calculate pooled estimates in Stata/se version-14. Cochran's Q, I2, and meta-bias statistics were assessed for heterogeneity and Egger's test for publication bias. RESULT:Twenty-one studies were included in the final analysis, which comprised 8057 under-five children with SAM in Ethiopia. The pooled estimates of treatment outcomes, in terms of death, recovery, defaulter and transfer out and non-response rates were 10.3% (95% CI: 8.3, 12.3), 70.5% (95% CI: 65.7, 72.2), 13.8% (95% CI: 10.8, 16.9) and 5.1% (95% CI: 3.3, 6.9), respectively. Diarrhea (HR: 1.5, 95% CI: 1.1, 2.2), dehydration (HR: 3.1, 95% CI: 2.3, 4.2) and anemia (HR: 2.2, 95% CI: 1.5, 3.3) were statistically significant predictors of mortality among these children. No publication bias was detected. CONCLUSION:Treatment outcomes in under-five children with SAM are lower than the World Health Organization (WHO) standard, where mortality is being predicted by comorbidities at admission. Children with SAM need to be treated for diarrhea, dehydration and anemia at the primary point of care to reduce mortality.

Project description:BACKGROUND:In spite of the availability of guidelines for the management of severe acute malnutrition (SAM) in Ethiopia, high comorbidity and poor treatment outcomes are still observed in therapeutic feeding centers among under -five children with SAM. The aim of this study was to assess comorbidity, treatment outcomes and factors affecting the recovery rate of children aged 1-59?months with SAM admitted into Therapeutic Feeding Centers (TFCs). METHODS:A total of 413 records of children with SAM admitted in three selected hospitals from July 2013 to July 2015?G.C were retrospectively reviewed. Descriptive analysis was used to compare performance indicator values with SPHERE project reference standards (the minimum standard to be attained during nutritional therapy). Cox-proportional hazard regression analysis was performed to estimate the predictors of recovery rate at p-value <?0.05. RESULT:The mean age of children was 16?months (95% CI, 15.0, 17.0). Out of 413 children with SAM, 231 (55.9%) recovered, 24 (5.8%) died and 16.3% were defaulted from TFCs. The mean weight gain (in gram per weight of kilogram per day) for recovered children was 15.61?g/kg/day (95% CI, 14.15, 17.07). The overall median recovery time for these children was 12?days (95% CI, 11.22, 12.78). Moreover, most (77.5%) of children admitted with SAM were marasmic followed by Kwash (16%). Pneumonia (54.8%), diarrhea (41.8%) and rickets (21.4%) were co-morbidities which affected SAM children. A child being admitted at Mehal Meda Hospital (Adjusted Hazard Ratio (AHR)?=?2.01; 95% CI: 1.34, 2.91), edematous form of malnutrition (AHR?=?0.59; 95% CI: 0.39, 0.90) and being a child infected with pneumonia (AHR?=?0.71; 95% CI: 0.51, 0.98) were predictors of nutritional recovery rate. CONCLUSION:Under five pneumonia, diarrhea and rickets were co-morbidities that should be prevented. Recovery rate was poor when compared to SPHERE project reference value (which is >?75%). Predictors, namely presence of pneumonia and edematous form of malnutrition reduced nutritional recovery rate. Whereas, being admitted at Mehal Meda Hospital improved recovery rate. Therefore, hospitals should work in collaboration with health extension workers to prevent co-morbidities and strengthen screening and referral of malnutrition cases at community level. Moreover, Zonal Health Department and District Health Offices should facilitate experience sharing among health facilities.

Project description:Background:Severe acute malnutrition is one of the major public health problems in developing countries having a devastating effect on the lives of many children under 5 years of age. In Ethiopia, there has been isolated studies conducted on malnutrition with no study attempting to identify the determinants of severe acute malnutrition in the rural district of Enebsie Sarmidr.This study intends to identify the determinants of severe acute malnutrition in rural district located in North West Ethiopia. Methods:A Community based un matched case -control study was carried on 311 (64 cases and 247 controls) children aged between birth-59 months with their respective mothers or care takers from March 1-30/ 2016. Odds Ratio along with 95% confidence interval was estimated to identify determinants of severe acute malnutrition using the multivariable logistic regression. Results:The response rate was 97.8%. Severe acute malnutrition was significantly associated with age groups birth-24 months (AOR?=?2.64, 95% CI 1.17-5.95), late initiation of breast feeding greater than an hour after birth (AOR?=?4.26, 95% CI 1.74-10.42), nonexclusive breast feeding (AOR =5.81, 95% CI 1.80-18.79), diarrheal disease in the preceding 2 weeks before SAM (AOR?=?7.98, 95% CI 2.57-24.74), febrile illnesses preceding 2 weeks before SAM (AOR?=?2.87 95% CI 1.13-7.63), decreased or maintained mealing of the mother compared to the regular during pregnancy or lactation (AOR?=?8.15, 95% CI 3.70-17.98) and birth interval less than 2 years (AOR?=?3.34, 95% CI 1.55-7.20) after controlling other variables effect. Conclusion:A child's age, late initiation of breast feeding, nonexclusive breast feeding, diarrheal diseases and febrile illnesses preceding 2 weeks before SAM, decreased or maintained mealing compared to the regular during pregnancy and lactating of the mother and narrow birth interval were identified as determinants of SAM. Therefore, collaborative efforts are needed to improve promotion of better child caring practices specifically, child and maternal feeding practices and prevention and treatment of acute illnesses.

Project description:BackgroundMalnutrition underlies 45% of under-5 deaths globally. Severe acute malnutrition (SAM) is the most serious form of undernutrition, characterized by wasting with or without edema. Mortality remains high (10%-40%) among children requiring hospitalization for complicated SAM.ObjectivesWe aimed to systematically document the factors independently associated with inpatient mortality in children with SAM.MethodsEmbase, Ovid MEDINE, the Cochrane Library, and clinicaltrials.gov were searched for articles published between January 2000 and January 2020, using a prespecified protocol. Eligible studies included children aged ≤59 mo hospitalized with SAM and used multivariable analysis to assess the baseline factors independently associated with inpatient mortality. Random-effects meta-analysis, stratified by the stated measure of effect, was used where >20% of studies included the same factor in analyses.ResultsTwenty-eight of 1432 studies fulfilled inclusion criteria: 19 studies included all children with SAM and 9 included specific subgroups of children with SAM. All 19 main studies were from 8 countries across Africa, with a median of 400 children/study. The mean inpatient mortality was 15.7% (95% CI: 10.4%, 21.0%) and HIV prevalence ranged from 2.1% to 51%. Nine factors were included in the meta-analysis, stratified by HR and OR. HIV infection (HR: 4.32; 95% CI: 2.31, 8.08), weight-for-height z score (WHZ) (OR: 0.44; 95% CI: 0.24, 0.80), diarrhea (HR: 2.84; 95% CI: 1.40, 5.75), pneumonia (HR: 1.89; 95% CI: 1.19, 3.02), presence of shock (HR: 3.67; 95% CI: 2.24, 6.03), and lack of appetite (HR: 2.16; 95% CI: 1.48, 3.16) were associated with increased mortality, whereas child age and sex were not. The association between edema and mortality was difficult to ascertain from the available studies.ConclusionsHIV infection, diarrhea, pneumonia, shock, lack of appetite, and lower WHZ are independent predictors of inpatient mortality in children with SAM. These factors may help to risk-stratify children being hospitalized with complicated SAM.This systematic review/meta-analysis protocol was registered at www.crd.york.ac.uk/prospero as CRD42019152267.

Project description: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. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-023-04269-7.

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Recovery rate and determinants of severe acute malnutrition children treatment in Ethiopia: a systematic review and meta-analysis.

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Recovery rate and determinants of severe acute malnutrition children treatment in Ethiopia: a systematic review and meta-analysis.

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