Time to Death and its Predictor Among Children Under Five Years of Age with Severe Acute Malnutrition Admitted to Inpatient Stabilization Centers in North Shoa Zone, Amhara Region, Ethiopia

Abstract

Background:

Severe acute malnutrition (SAM) is the leading cause of child mortality in developing nations. In Ethiopia, despite the presence of clinical management protocols, under-five mortality is still high. Moreover, many of the predictors for mortality during inpatient care were not well addressed. Therefore, the aim of the current study was to determine the time to death and its predictors among children under five with severe acute malnutrition.

Patients and Methods:

A 48-month retrospective cohort study was carried out among 346 children under five from 6 to 59 months of SAM. Data were collected from patient charts by using simple random sampling and entered in EpiData 3.1 and analyzed with STATA 14. A Kaplan–Meier curve and long rank test were used to estimate the survival time and compare survival curves between variables. A Cox proportional hazard model was fitted to identify predictors. Variable with P-value <0.05 with 95% confidence interval was considered as significant for this study.

Results:

A total of 346 children were followed with an incidence rate of 5.5 deaths per 1000 person-day observation (95%CI: 3.5– 8.5). During the follow-up, 212 (61%) were males, 20 (5.8%) had died. This study also showed that males were nearly twice as likely to die than females. Sepsis (AHR: 1.62; 95%CI: 1.10–2.37), hospital admission (AHR: 2.29; 95%CI: 1.43–3.65), presence of edema, (AHR: 1.81; 95%CI: 1.2–2.19), TB (AHR: 1.62; 95%CI: 1.10–2.37) and breast feeding (AHR: 0.41; 95%CI: 0.29–2.37) were predictors of mortality.

Conclusion:

The overall mean survival time and death was in line with the minimum SPHERE standard. The main predictors of death were having edema, sepsis, hospital admission and breast feeding status at admission. Therefore, it should be better to treat patients with TB, sepsis, edema according to SAM national protocol and promote breast feeding practice.

Keywords:

• censored
• malnutrition
• predictors
• time to death
• Ethiopia

Abbreviations

MUAC, mid upper arm circumference; SAM, severe acute malnutrition, SC, stabilization center.

Data Sharing Statement

Data will be available upon request from the corresponding author.

Ethics Approval and Consent to Participate

This study was conducted in accordance with the Declaration of Helsinki. Ethical clearance was obtained from the Institutional Review Board of the School of Graduate Studies, College of Health Science, Wollo University. Following this, the study setting (SC clinic) was informed about the objectives. Written consent was obtained from each participant (from their parent or guardian before the start of interview) and participant’s anonymity and confidentiality were kept. Privacy and confidentiality was also assured. After obtaining informed consent (written) data were collected.

Acknowledgments

The authors would like to express their appreciation to Wollo University for funding this research project. They would like to extend their deepest gratitude to all study participants and data collectors for their willingness and cooperation in this study.

Author contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Funding

This study was funded by Wollo University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclosure

The authors report no conflicts of interest in this work.