SURVIVAL STATUS AND PREDICTORS OF MORTALITY AMONG SEVERE ACUTE MALNOURISHED UNDER FIVE CHILDREN ADMITTED TO STABILIZATION CENTERS IN GEDEO ZONE FROM JUNE 2013 TO DECEMBER 2015: 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 survival status and predictors of mortality among under five children with severe acute malnutrition admitted to stabilization centers in Gedeo Zonefrom June 2013 to December 2015 Methods: A 30 month retrospective cohort study was conducted among 545 under five children admitted to stabilization centers in Gedeo Zone between June 2013 and December 2015. The data was collected from a randomly selected chart from hospital and Health centers 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 545 children were followed for 7623 person-day of observation; During the follow up period 326(59.7%) children were get cured and 51(9.3) died making overall incidence density rate of 6.69 (CI=5.01-8.67) per 1000 Person day. Survival at the end of 1 st, 2 nd and 3 rd weak was 95.3%, 90% and 85% respectively and overall mean survival time was 79.6 day. Age less than 24 month [AHR=2.841, 95 % CI =1.101-7.329], altered pulse rate [AHR=3.926, 95 % CI =1.579-9.763], altered temperature [AHR= 7.173, 95 % CI =3.05-16.867], Shock[AHR= 3.805, 95 % CI =1.829-7.919], anemia[AHR= 2.618, 95 % CI =1.148-5.97], NG tube [AHR= 3.181, 95 % CI =1.18-8.575], hypoglycemia [AHR= 2.74, 95 % CI =1.279-5.87] and Hospital SC [AHR= 4.772, 95 % CI =1.638-13.9] 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 young children with comorbidities and altered general conditions.