Recovery rate and predictors of treatment outcomes among hospitalized under five children with severe acute malnutrition: a prospective cohort study

Aim: This study aimed to identify the predictors of treatment outcomes among children under five years of age hospitalized with severe acute malnutrition. Methods: A hospital-based prospective cohort study was conducted among children under five years diagnosed with severe acute malnutrition. A total of 143 children were recruited using a consecutive sampling method. Univariable and multivariable logistic regression analyses were utilized to identify predictors of treatment outcomes. Survival analyses, including life-table analysis, Kaplan-Meier survival curves, the log-rank test, and the Cox proportional hazards model, were employed to estimate survival probabilities, recovery rates over time, and predictors of time to recovery. Results: Of the 143 enrolled children, 55.2% were male, and 58% were between 6 and 24 months of age. During a total of 1,802 child days of follow-up, the treatment outcomes were as follows: 60.8% of children recovered, 32.9% transferred out for other medical reasons, 4.2% defaulted, and 2.1% died. Key predictors of poor treatment outcomes included hypothermia [adjusted odds ratio (AOR) = 0.17; 95% confidence interval (CI): 0.03–0.94; p = 0.042], diarrhea (AOR = 0.28; CI: 0.12–0.66; p = 0.004), edema (AOR = 0.21; CI: 0.07–0.64; p = 0.006), and feeding with ready-to-use therapeutic food (RUTF) [recovery (AOR = 2.01, 95% CI: 0.92–4.96; p = 0.098)]. The median recovery time was 14 days (95% CI: 12.9–15.1). Conclusions: The study highlighted suboptimal recovery rates and average daily weight gain among children treated for severe acute malnutrition. Diarrhea, hypothermia, and edema on admission were associated with lower nutritional recovery rates. These findings underscore the need for targeted interventions to address these factors and improve treatment outcomes in children with severe acute malnutrition.