Incidence and Predictors of Mortality among Severe Acute Malnourished Under Five Children Admitted to Dilla University Referal Hospital: A Retrospective Longitudinal Study

Abstract

Background: Many developing countries continue to experience high mortality of children with severe acute malnutrition that receive treatment in inpatient set ups associated to either co-morbidity or due to poor adherence to the World Health Organization therapeutic guidelines for the management of severe acute malnutrition. Objective: To assess incidence and predictors of mortality among severe acute malnourished under five children admitted to Dilla university referral hospital from 2013 to 2015 Methods: A 36 month retrospective cohort study was conducted among 450 under five children admitted to stabilization centers in Dilla university referral hospital between 2013 and 2015. The data was collected from a randomly selected chart after getting ethical clearance from the Institutional review board of Arba Minch University by trained professionals. Data was entered and cleaned by Epi Info version 7 and analyzed by STATA version 11. Life table was used to estimate the cumulative incidence of death and Log rank tests to compare probability of hazard between variables. Bivariate and multivariate Cox proportional hazards model were used to identify predictors. Significance was considered at P-value < 0.05 in the multivariate analysis. Model was built by forward step wise procedure; compared by likely hood ratio test and Harrell’s concordance and fitness checked by cox-snell residual plot.Result: A total of 450 children were followed for 7389 person-day of observation; during the follow up period 56(12.4) died making overall incidence density rate of 7.57 (CI=5.83-9.84) per 1000 Person day. Survival at the end of 1^st, 2^nd and 3^rd week was 95%, 88% and 84% respectively and overall mean survival time was 47(95%CI=45-48.6) day. Presence of Altered pulse rate [AHR =5.85, 95% CI= 2.55-13.4], altered body temperature [AHR= 6.94 (95 % CI [2.94-16.4], Shock (AHR=3.15 (95 % CI [1.5-6.5]), IV infusion (AHR=3.24 (95 % CI [1.54-6.8]) and septicemia/meningitis (AHR=2.88(95 % CI [1.413-5.9]) were independent predictors of mortality. Conclusion and recommendation: The incidence of death and treatment outcomes was in acceptable ranges. Intervention to further reduce deaths has to focus on children with comorbidities and altered general conditions.

Key words: Severe acute malnutrition, Incidence, Under-five children, Dilla, Hospital