Burden and correlates of complicated severe acute malnutrition relapse among children under five at Mwanamugimu: Secondary analysis of hospital data in Uganda
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Background
Confronted with the triple burden of malnutrition including in low- and middle-income country settings (LMICs), effort has been made to tackle child wasting especially to improve treatment outcomes of complicated severe acute malnutrition (cSAM). However, some children relapse after recovery and are retaken through the elaborate management criteria which not only strains the system, but also puts a toll on their health.
Objective
We assessed the proportion of cSAM relapses and the associated socioeconomic, anthropometric, and clinical factors.
Method
This was a comparative cross-sectional study using secondary data of children under 5 with cSAM admitted at Mwanamugimu nutrition unit between May 2015 to April 2017. Multiple logistic regression analysis was used to assess for the correlates of cSAM.
Results
We included 1098 children with mean age 13.8 ±9.8 months, over two-thirds were male, and ∼50% hailed from Kampala. On analysis, 5.7% were cSAM relapses, 0.7% were multiple relapses, and it took them ∼36 weeks on average to relapse. Increased age, number of siblings, and children with unemployed mothers had 0.05 (95%CI: 0.02; 0.08), 0.3 (95%CI: 0.09; 0.51), and 2.63 (95%CI: 0.61; 4.65) higher odds of relapsing with cSAM respectively. There was no observed association with any anthropometric or clinical factor.
Conclusion
Despite lack of a standard definition and set threshold, a compelling proportion of children relapse with cSAM seemingly unnoticed across CMAM programs in LMICs but this may be at a cost. Treatment programs need to ensure they establish readmissions and also reinforce their community leakages so that poor, large households are benefactors of livelihood support to cater for underlying factors and mitigate risk of cSAM relapse.
