Time to full recovery and its predictors among children with complicated severe acute malnutrition admitted to inpatient and subsequently to outpatient therapeutic care, Sana'a city, Yemen, a prospective follow-up study.

Abstract

To determine the time to full recovery and its predictors among children with severe acute malnutrition (SAM) admitted to therapeutic feeding centres (TFCs) in Sana'a, Yemen. A prospective cohort study conducted from August 2023 to November 2024. Two public hospitals in Sana'a City (Al-Sabeen and Al-Zubairi hospital) that provide therapeutic feeding services for children with SAM. Children aged 6-59 months who were admitted to TFCs based on WHO SAM criteria and successfully transferred to outpatient therapeutic programmes (OTPs). The primary outcome was time to full recovery from SAM, defined as the normalisation of both weight-for-height z-score (WHZ) and mid-upper arm circumference (MUAC). Secondary outcomes included identification of predictors associated with recovery time. Among 267 children, 51% were aged 6 to <12 months and 56% were female. The median time to full recovery was 14 weeks (IQR: 12-18 weeks). Children admitted with concurrent deficiency in both WHZ <-3 and MUAC<11.5 cm had a 50% lower likelihood of full recovery (adjusted HR (aHR): 0.5; 95% CI: 0.3 to 0.9; p=0.015). Antibiotic use during OTP care nearly doubled the likelihood of recovery (aHR: 2.1; 95% CI: 1.2 to 3.4; p=0.002), while the presence of diarrhoea lowered the likelihood of full recovery by 50% (aHR: 0.5; 95% CI: 0.3 to 0.9; p=0.011). Three months and a half were the median time to full recovery from complicated SAM. Concurrent WHZ and MUAC deficits, antibiotic use and the absence of diarrhoea were the significant predictors. Standardising the use of combined WHZ and MUAC recovery is recommended to improve comparability across programmes and better reflect nutritional outcomes.