Incidence and Association Factors and Clinical Outcomes of Diarrhea Among Children Admitted With Sam at Tertiary Hospitals Uganda

Background: Diarrhea remains a major cause of morbidity and mortality among under-five children worldwide, and its burden is particularly high among those with Severe Acute Malnutrition (SAM). The coexistence of diarrhea and SAM worsens the clinical condition of affected children, leading to dehydration, electrolyte imbalance, prolonged hospital stay, and increased risk of death. Despite this, there is limited data on the incidence, associated factors, and clinical outcomes of diarrhea among hospitalized children with SAM in Uganda. Objective: To determine the incidence, associated factors, and clinical outcomes of diarrhea among children admitted with Severe Acute Malnutrition at Mbarara Regional Referral Hospital (MRRH). Methods: A hospital-based prospective cohort study was conducted among 200 children aged 6–59 months admitted with SAM at MRRH. Data were collected using a structured questionnaire and clinical record review, and participants were followed throughout hospitalization. Data were analyzed using SPSS version 26. Logistic regression identified factors independently associated with diarrhea, and statistical significance was set at p < 0.05. Results: The incidence of diarrhea among children with SAM was 38%, with an incidence rate of 11.2 per 100 person-days. Diarrhea occurred more frequently among children with Kwashiorkor (69%) and those aged 12–24 months. Multivariate analysis revealed that Kwashiorkor (AOR = 2.6, 95% CI: 1.3–5.4, p = 0.004), HIV-positive status (AOR = 3.1, 95% CI: 1.4–6.8, p = 0.002), and severe anemia (AOR = 2.2, 95% CI: 1.1–4.2, p = 0.01) were independent predictors. Diarrhea was associated with a longer hospital stay (16.8 ± 5.6 vs 11.3 ± 4.2 days) and higher mortality (22% vs 8%, p = 0.01). Conclusion: Diarrhea is a common and severe complication among children with SAM at MRRH. Early identification and management of HIV, anemia, and Kwashiorkor are crucial to improving outcomes and reducing diarrhea-related deaths.