Survival Status and Predictors of Mortality among Children Aged 0-59 Months Admitted with Severe Acute Malnutrition in Dilchora Referral Hospital, Eastern Ethiopia.

Abstract

Background: The mortality rate of children admitted to hospital with complicated severe acute malnourishment is as high as 35 %. In Ethiopia, this ranges from 6 % to 29 %, and its predictors vary contextually.
Objective: To assess the survival status and the predictors of mortality among 0-59 months children with severe and acute malnutrition and admitted to Dilchora Referral Hospital, Eastern Ethiopia.
Methods: A retrospective cohort study was conducted on children with Severe Acute Malnutrition (SAM) treated in Dilchora Referral Hospital. The data were collected from medical records from March 07 to 16, 2016. Six hundred seventeen children were randomly selected from all eligible records of 0-59 month’s children admitted to the center from September 2011 to August 2015. The data were collected using a pretested data extraction format and entered into EpiData software and exported to SPSS Version 20 for analysis. Survival curve was used to display the survival status among different characteristics. The Cox proportional hazard model was done to identify independent predictors of mortality. Associations were declared as statistically significant with p<0.05.
Results: It was found that 47 (7.6 %) study participants had died, most of whom had died within the first week of admission to hospital, 431 (69.9 %) had been cured, and the rest were defaulted and transferred out. The mean survival of the children with HIV/AIDS, pneumonia, diarrhea, dehydration, and those who took intravenous antibiotics and fluid were significantly lower than that of their counter parts. The significant predictors of the mortality of the SAM children were loss of appetite (AHR=2.75; 95%CI: 1.08, 6.99), malaria (AHR=12.69, 95%CI: 4.57, 35.27), lower Waist for Height % (WFH %) (AHR=0.95, 95%CI: 0.9, 0.99), and HIV sero-positivity (AHR=11.57, 95%CI: 2.34, 57.2). Also, not taking Formula-100 (F-100) (AHR=3.26; 95%CI: 1.32, 8.07) and Formula-75 (F-75) (AHR=2.56, 95%CI: 1.06, 6.15) significantly increased the risk of death.
Conclusion: The level of the mortality was high. Presence of co-morbidities, intravenous fluid and antibiotics intake and not supplemented with nutritional therapy significantly increased the risk of death. Therefore, an appropriate nutritional therapy and management of co-morbidities as per the national SAM management protocol is recommended.