Time of recovery and associated factors of children with severe acute malnutrition treated at outpatient therapeutic feeding program in Dire Dawa, Eastern Ethiopia
Time of recovery and associated factors of children with severe acute malnutrition treated at outpatient therapeutic feeding program in Dire Dawa, Eastern Ethiopia
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DOI：
10.1371/journal.pone.0217344
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发表时间：
2019-06-13
期刊：
影响因子：
3.7
通讯作者：
Dingeta, Tariku
中科院分区：
文献类型：
--
作者：
Atnafe, Binyam;Roba, Kedir Teji;Dingeta, Tariku
背景门诊治疗性喂养计划是急性营养不良社区管理 (CMAM) 的一个方面，为患有严重急性营养不良 (SAM) 的儿童提供筛查、诊断和治疗服务。然而，对计划结果和影响恢复时间的因素知之甚少。目的确定2013年1月1日至2016年12月31日在埃塞俄比亚东部德雷达瓦门诊治疗性喂养单位接受治疗的5岁以下SAM儿童的中位恢复时间和相关因素。方法进行了一项以设施为基础的回顾性队列研究并辅以定性调查，分析了从四个卫生中心随机抽取的713名5岁以下SAM儿童的记录。以及德雷达瓦的一家医院。对五名卫生专业人员进行了深入访谈。使用结构化检查表从营养登记日志中收集数据。将收集的数据输入EPI-data 3.1版软件并导出至SPSS 23版，使用Kaplan Meir和Cox比例风险回归进行分析。结果总体回收率为569（79.8％）。 80 人（11.2%）违约，27 人（3.8%）无响应，4 人（0.6%）死亡，15 人（2.1%）转出。中位恢复时间为 8.7 周（IQR：5.0-14 周）。入院体重≥7kg的儿童（AHR = 1.73，95% CI：（1.41-2.14）、已驱虫的儿童（AHR = 1.44，95% CI：（1.01-2.06））和体重增加≥ 8g/kg/天的儿童（AHR = 5.76，95% CI：（4.51-7.38））有较高的概率然而，消瘦儿童的治疗时间较长（AHR = 0.51，95% CI：（0.37-0.71），并且较低的 Plumpy Nut 摄入率（克/天）（AHR = 0.79）与较长的治疗时间相关。结论 恢复率在 Sphere 国际标准规定的水平内，即 > 75%。入院时体重较高，服用驱虫且体重稳定增加。与快速恢复时间呈正相关，按照国家方案进行适当的营养治疗和 SAM 管理将有助于克服较低的体重增加和较长的治疗住院时间。
BackgroundThe outpatient therapeutic feeding program is one dimension of the Community Based Management of Acute Malnutrition (CMAM) that provides screening, diagnostic and treatment services for children with Severe Acute Malnutrition (SAM). However, little is known about the program outcomes and factors affecting time to recovery.ObjectivesTo determine median time of recovery and associated factors among under-five children with SAM treated at outpatient therapeutic feeding unit in Dire Dawa, Eastern Ethiopia from January 1st, 2013 to December 31st, 2016.MethodsA facility-based retrospective cohort study supplemented with qualitative inquiry was conducted to analyze the records of 713 under-5 children with SAM that were randomly selected from four health centers and one hospital in Dire Dawa. In-depth interviews were conducted with five health professionals. Data was collected from the nutrition registration log book by using structured check lists. The collected data were entered into EPI-data version 3.1 software and exported to SPSS version 23 for analysis using Kaplan Meir and Cox proportional hazard regression.ResultsThe overall recovery rate was 569 (79.8%). Eighty (11.2%) defaulted, 27 (3.8%) were non-responders, 4 (0.6%) died and 15 (2.1%) were transferred-out. The median recovery time was 8.7 weeks (IQR: 5.0-14 weeks). Children with an admission weight of >= 7kg (AHR = 1.73, 95% CI: (1.41-2.14), children who were dewormed (AHR = 1.44, 95% CI: (1.01-2.06) and children with weight gain of >= 8g/kg/day (AHR = 5.76, 95% CI: (4.51-7.38) had higher probability of recovering faster. However, marasmic children stayed longer in treatment (AHR = 0.51, 95% CI: (0.37-0.71) and a low Plumpy Nut consumption rate (g/day) (AHR = 0.79) was associated with longer time of stay on treatment.ConclusionThe recovery rate was within the level specified in the Sphere International standards which is > 75%. A higher weight at admission, taking deworming and a steady weight gain were positively associated with a fast recovery time. Appropriate nutritional therapy and management of SAM as per the national protocol will be helpful to overcome lower weight gain and higher length of stay on treatment.