Treatment Outcomes of Severe Acute Malnutrition and Its Determinants Among Paediatric Patients in Quetta City, Pakistan

Nazir Ahmed,1 Fehmida Umar,2 Fahad Saleem,1 Qaiser Iqbal,1 Sajjad Haider,1 Mohammad Bashaar3 1Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Baluchistan, Pakistan; 2Gynecology & Obstetrics Unit 1, Sandeman Provincial Hospital Quetta, Quetta, Baluchistan, Pakistan; 3Research Services Division, SMART Afghan International Trainings & Consultancy, Kabul, AfghanistanCorrespondence: Mohammad Bashaar, SMART Afghan International Trainings & Consultancy, Kabul, Afghanistan, Tel +93 788233865, Email dr.mbashaar@gmail.comPurpose: Severe acute malnutrition (SAM) is the most prevalent reason for admission to a paediatric unit, and it is a leading cause of mortality in many countries, including Pakistan. This study aimed to assess treatment outcomes and associated factors among children aged 6– 59 months with severe acute malnutrition.Patients and Methods: A retrospective cohort study was conducted at the Outpatient Therapeutic Feeding Program Centre established at the Sheikh Khalifa bin Zayed Al Nahyan Medical Complex Quetta. Out of 225 patients’ records, data from 182 (80.8%) records were analysed based on the inclusion criteria. The SAM logbook was used as a source of data. Predictors of treatment outcomes were identified by applying a regression model with p< 0.05 taken as significant.Results: One hundred and twenty (65.9%) of the children were diagnosed with SAM, while the remaining 34.1% had Moderate Acute Malnutrition. Ninety-five (52.2%) children were included in the marasmus, while 47.8% were included in the Kwashiorkor cohort. The recovery rate was 68.6%; 22.5% were non-responsive, 11% defaulted on the program, and 3.5% died during management. The multivariate logistic regression identified the presence of diarrhea and the use of amoxicillin as significant prognosticators of treatment outcomes. Consequently, the odds of recovery on SAM among children with diarrhea [AOR = 0.60, 95% CI: (0.35– 0.75)] were lower than those without diarrhea. Likewise, children on PO amoxicillin had higher chances of recovery [AOR = 2.45, 95% CI: (2.21– 4.68)].Conclusion: This study found that the recovery rate among children treated for SAM was poor based on the established Sphere Standard recommendation. In addition to community-based educational campaigns, capacity enhancement of OTP and frequent monitoring of services as well as program evaluation based on the management protocol is recommended to reduce the frequency of SAM among children.Keywords: treatment outcomes, severe acute malnutrition, determinants, paediatric patients