title: Treatment outcome and factors affecting time to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program.
abstract: BACKGROUND
  The outpatient therapeutic care program (OTP) of children with severe acute malnutrition (SAM) has been decentralized to health post level in Ethiopia since 2008-2009. However, there is a lack of evidence regarding treatment outcomes and factors related to the duration of stay on treatment after its decentralization to health post level.
  
  
  OBJECTIVE
  This study was aimed to assess treatment outcome and factors affecting time to recovery in children with SAM treated at OTP.
  
  
  METHODS
  Health facility-based retrospective cohort study was conducted using data from 348 patient cards. The outcome variable was time to recovery. Descriptive analysis was done using percentages for categorical data and mean/median for continuous variables. A robust method of analyzing time to event data, the Cox proportional-hazard regression, was used. All statistical tests in this study are declared significant at p<0.05.
  
  
  RESULTS
  89.1% of children with kwashiorkor and 69.4% of children with marasmus were recovered. Of the total children studied, 22% were readmitted cases. The median time of recovery was 35 days for children with kwashiorkor and 49 days for children with marasmus. Children older than 3 years were 33% less likely to achieve nutritional recovery [adjusted hazard ratio, AHR=0.67, 95% confidence interval, CI (0.46, 0.97)]. Similarly, marasmic children stayed longer on treatment [AHR=0.42, 95% CI (0.32, 0.56)]. However, children who gained Mid-Upper Arm Circumference (MUAC) ≥ 0.24 mm/day were 59% more likely to recover faster [AHR=1.59, 95% CI (1.23, 2.06)].
  
  
  CONCLUSIONS
  Close monitoring of weight and MUAC gain to assess nutritional improvement with due emphasis given to children with lower admission weight, children of age 3 years and above and marasmic children will have a positive effect on treatment duration and outcome.
authors.affiliation: Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; melkamumrd@gmail.com.
authors.forename: Melkamu Merid
authors.initials: MM
authors.lastname: Mengesha
authors.affiliation: Department of Preventive Medicine, School of Public health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Negussie
authors.initials: N
authors.lastname: Deyessa
authors.affiliation: Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
authors.forename: Balewgizie Sileshi
authors.initials: BS
authors.lastname: Tegegne
authors.affiliation: Department of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
authors.forename: Yadeta
authors.initials: Y
authors.lastname: Dessie
keywords: Southern Ethiopia; health post; outpatient therapeutic care; severe acute malnutrition; time to recovery