Outcomes of severely malnourished children aged 6 – 59 months on outpatient management program in kitui county hospital

Abstract

Background: Children suffering from severe acute malnutrition (SAM) have a 5–20 times greater risk of death than well-nourished children (UNICEF, 2012). Traditionally, children with SAM were rehabilitated within inpatient services. Advent of ready to use therapeutic food (RUTF) made it possible to treat majority of these children in their homes. Most studies have highlighted prevalence rates and case fatality rates without describing the outcomes of severely malnourished children on outpatient management. Objectives: The broad objective was to assess the outcomes of severely malnourished children aged 6-59 months on outpatient therapeutic program at Kitui County Hospital. The specific objectives were to determine the outcome (recovery, default and non-response rates) and to establish the association between socio-demographic and socio- cultural factors and outcomes of severely malnourished children aged 6-59 months enrolled in outpatient therapeutic program (OTP). Methodology: This study adopted a longitudinal prospective study design and 104 children with SAM were enrolled in the study consecutively. Data was collected by use of pre tested structured questionnaire. Information was obtained from caretakers regarding demographic, socio-economic and socio-cultural factors. Anthropometric measurements, physical examination and appetite test of the children under study was conducted in a private room within the OTP clinic. Descriptive analysis using means, frequency and proportions was computed. Chi-square test (p<0.05) and odds ratio with corresponding 95% confidence interval was used to determine the association between dependent and independent variables. Binary logistic regression analysis was performed to determine the significant factors associated with recovery from SAM. Paired t test (0.05) was also computed for continuous variables. Results: The findings of the study revealed that the recovery rate was 73.3%, weight gain rate of 5.1g/kg/day and defaulter rate was 2.8%. Significant predictors of recovery were being a house wife {AOR=5.26; 95%CI=1.33-20.87; P=0.018}. Introduction of complementary food at the age of 6 months {AOR=8.86; 95%CI=2.20-35.68; P=0.002}. Children of Mothers/guardians who thought there was no differences in feeding between boys and girls {AOR=12.37; 95%CI=1.87-81.76; P=0.009}. Not suffered any sickness in the last one month {AOR=5.23; 95%CI=1.36- xvi 20.10; P=0.016} and giving antibiotics (Amoxicillin) {OR=13.06; 95%CI=3.01- 56.65; P=0.001}. Conclusion: The findings of the study revealed that the overall recovery rate (73.3%) and rate of weight gain (5.1g/kg/day) were below acceptable standards; but, the defaulter rate (2.8%) was within the acceptable international standards. Special focus should be given on predictors of recovery rate like administering routine antibiotics, prompt and appropriate management of co-morbidities and advising mothers to initiate complementary feeding at the age of 6 month Recommendations: Special focus should be given on predictors of recovery rate like administering routine antibiotics, prompt and appropriate management of comorbidities and advising mothers to initiate complementary feeding at the age of 6 months. Moreover, Kitui County Hospital should establish a tracking system among all SAM children on OTP to monitor on RUTF consumption/ potential sharing, taking weight weekly and give RUTF according to body weight