Treatment outcomes and factors associated with recovery among children aged 6-59 months with severe acute malnutrition admitted to therapeutic feeding units in Central Tanzania: a longitudinal descriptive study.

Abstract

The objective of this study was to investigate treatment outcomes and identify factors associated with recovery among children aged 6-59 months with severe acute malnutrition who were admitted to therapeutic feeding units in Tanzania's central zone. Hospital-based longitudinal descriptive study. The study was conducted in the therapeutic feeding units of Dodoma Regional Referral Hospital and Singida Regional Referral Hospital, Tanzania, between 1 April and 30 June 2024. A total of 166 children aged 6-59 months admitted with severe acute malnutrition were consecutively enrolled and followed from admission until recovery, death, default, non-response or the end of the study period. The primary outcome was recovery from severe acute malnutrition according to the Tanzanian Integrated Management of Acute Malnutrition guidelines. Time to recovery was assessed using Kaplan-Meier survival analysis and Cox proportional hazards regression. Secondary outcomes included mortality, defaulting, non-response, average weight gain, length of hospital stay and factors associated with recovery. Of the 166 enrolled children, 123 recovered, yielding a recovery rate of 74.1% (95% CI 67.5% to 80.7%). The mortality rate was 17.5%, exceeding the Sphere standard threshold of <10%. The default and non-response rates were 5.4% and 1.8%, respectively. The median time to recovery was 10 days (95% CI 9.0 to 11.0). In multivariable Cox regression, urban residence (Adjusted Hazard Ratio(AHR)=1.615, 95% CI 1.231 to 2.031), breastfeeding (AHR=1.332, 95% CI 1.101 to 1.970), caregiver occupation as a housewife (AHR=1.921, 95% CI 1.408 to 2.078) or food server (AHR=6.727, 95% CI 1.324 to 34.179), mebendazole supplementation (AHR=1.927, 95% CI 1.136 to 3.267) and folic acid supplementation (AHR=1.459, 95% CI 1.222 to 1.950) were independently associated with a higher likelihood of recovery. Recovery rate among children with severe acute malnutrition was influenced by place of residence, breastfeeding status, caregiver occupation and the use of mebendazole and folic acid supplementation. However, mortality remained a concern, highlighting the need for improved management of severe acute malnutrition in therapeutic feeding units. Further research is needed to explore additional factors affecting recovery and treatment outcomes.