Factors associated with treatment outcomes of children with severe acute malnutrition managed on outpatient therapeutic care programs in Gulu district

Abstract

Background: Globally in 2019, over 47 million children under 5 years were wasted of which 14.3 million were severely wasted respectively. Globally, wasting accounts for 4.7% of all deaths of children aged less than 5 years. Severely wasted children are 11 times more likely to die than their healthy counterparts. Children with SAM with medical complications are managed on Inpatient Therapeutic Care (ITC) programs and those with SAM without medical complication are managed on Outpatient Therapeutic Care (OTC) programs. OTC programs bring the services for management of SAM closer to the community and if well managed reduces on case fatality rates .In 2008, OTC programs were scaled up to lower health facilities in Gulu district to bring services close to people at community level, however treatment outcomes from these health facilities are poor as indicated in health facility reports. The factors contributing to this poor treatment outcomes remain unknown. This provided rationale why this study was conducted to establish the causes of such poor performance. Methods: Retrospective cross-sectional study was done. A total of 337 children less than five years were selected using systematic random sampling technique. Questionnaires were used to collect data. Frequency distribution of treatment outcomes were calculated using descriptive analysis. Person chi square, significance level p<0.05 was used to identify factors associated with treatment outcomes. Odd ratio was used to establish the strength of association between factors and treatment outcomes. The qualitative data analysis was done using thematic analysis approach understand the perceptions on the performance and sustainability OTC programs. Results: The adoption of IMAM 2016 guidelines in management of SAM not satisfactory. Gaps were identified in key health system domains to support OTC services in area of leadership and governance, Health Management Information Systems (HMIS), medicines and nutrition supplies, quality of care and Health Facility- Community Linkages. Among the children admitted (n=337), 70% were cured, 3% were dead,24% defaulted and 3% did not respond to treatment.. HIV status at admission (p=0.010, OR 3.087) and type SAM diagnosis at admission (P=0.017, OR: 4.94) were found to be statically significant Conclusion: IMAM 2016 guidelines adoption was not satisfactory. Key gaps were identified in the health systems domain to support OTC services which significantly affected the treatment outcomes. Cure rate and default rate are not acceptable. Death rate and non-response rates are acceptable. However, death rate and non-response rate were within internationally accepted standards. Diagnosis with SAM at admission and HIV status at admission were statically significant. There is need to establish mechanism to follow up defaulters in the community and develop policies to scale up treatment of severe acute malnutrition at community level.