Treatment Outcome and Predictors of Severe Acute Malnutrition using the WHO Guideline at a Referral Hospital in Southern Ethiopia

Abstract

Background: Management of severe acute malnutrition (SAM) is a challenge in the developing world
because it is a common problem which consumes the majority of the scarce resources. Despite the marked
progress in improving mortality of SAM through implementation of the WHO protocol in well resourced
settings, the reported mortality from institution based management ofSAM in the developing world
remained high. This article reports on the outcome predictors of management of SAM at a developing
country setting; Methods, From September 2006 to August 2009, a total of 151 cases who fulfilled the
inclusion criteria were included for final analysis at the paediatric ward of Hawassa University Referral
Hospital (HURH). Data were abstracted from the clinical records on structured data retrieval forms. The
data were analyzed using SPSS for windows version 16.0. Bivariate and multivariable logistic regression
wasused to identify predictor variables; Results: Of the reviewed 151cases, 84(55.6%) had oedematous
malnutrition. In response to the treatment provided, 105(70%), 23(15.2%) and 23(15.2%) of the cases had
improved/ been discharged, defaulted and died respectively. The non-oedematous cases of SAM were more
likely to default from the course of treatment (COR: 2.8[95%CI: 1.0-7.68], P <0.05). Most deaths of
children with SAM occurred in the early course of treatment:8(35%) of the deaths occurred in the first
48hours while 11(48%) occurred within the first week of admission (P<0.05).On multivariable logistic
regression, fluid or blood transfusion (AOR: 8.73 [95%CI: 2, 06-37, 02]) and age of the child (AOR: 1.05
[95%CI: 1, 00-1.09]) were the independent predictors of death while on treatment. Presence of HIV
infection and severe anaemia doubled the mortality rate; Conclusion, The treatment success of SAM against
the WHO protocol at HURH is below the standard. Various predictors of death of children while of
treatment based on the WHO protocol have been identified. Addressing these risk factors for death is vital
to decreasing the child mortality due to malnutrition