Time to Recovery From Severe Acute Malnutrition and Its Predictors Among Under-5 Children Admitted to Sheik Hassan Yebere Referral Hospital, Somali Region Eastern Ethiopia: A Retrospective Study

Background In Ethiopia, malnutrition causes 28% of underfive deaths, making it a leading health issue. The World Health Organization and the Supporting People and Communities to Help Emergency Response Project recommend that 75% of children with SAM should recover within 28 days. Despite numerous problems determining the time to recovery from severe acute malnutrition (SAM), scarce information is available in the Somali region's pastoralist community. Objective This study aimed to determine the time to recovery from severe acute malnutrition and its predictors among underfive children admitted to the stabilization center of Sheik Hassan Yebere Referral Hospital. Methods A four-year retrospective cohort study was conducted among 535 underfive children admitted to the SAM in the Therapeutic Feeding Unit of Sheik Hassan Yebere Referral Hospital due to severe acute malnutrition from January 1, 2020, to December 31, 2023. Data were extracted from patient records via a structured data abstraction checklist and collected electronically via the Open Data Kit (ODK) tool. The collected data were exported from Google Drive in Excel and then transferred to STATA version 17 for analysis. Kaplan‒Meier survival analysis was used to estimate the time to recovery from severe acute malnutrition. Cox proportional hazards regression was performed to identify predictors of recovery time. The proportional hazards assumption was assessed. Variables with an AHR at the 95% CI and a P value less than 0.05 in the multivariable Cox regression analysis were considered significant predictors of recovery time. Results Among the 535 records of children with SAM included in the study, 78.88% (95% CI: 69.9, 89.9) recovered at the conclusion of the follow-up period, with a median recovery time of 12 days. The recovery rate was 7 per 100 child days, with a total of 7,645 person-days. Pneumonia (AHR = 0.80; 95% CI: 0.75–0.85), malaria (AHR = 0.79; 95% CI: 0.65–0.90), nonimmunization (AHR = 0.71; 95% CI: 0.59–0.84), partial immunization (AHR = 0.82; 95% CI: 0.74–0.91), hypoglycemia (AHR = 0.80; 95% CI: 0.69–0.93), and congenital heart disease (AHR = 0.80; 95% CI: 0.69–0.93) were independent predictors of delayed recovery time. Conclusions The median time to recovery and cure rate for children with severe acute malnutrition were within the acceptable ranges recommended by the WHO and Sphere standards, and recovery was significantly influenced by the presence of specific comorbid conditions. Pneumonia, malaria, incomplete or lack of immunization, hypoglycaemia, and congenital heart disease were identified as independent predictors of delayed nutritional recovery. Compared with those without comorbidities, children admitted with these conditions experienced prolonged recovery periods. Therefore, strengthening the early identification and management of these conditions at admission, alongside improving routine immunization coverage and comprehensive clinical care within therapeutic feeding programs, is essential to enhance recovery outcomes and reduce malnutrition-related morbidity.