Short Term Outcomes of Children Aged 6 to 59 Months With Severe Acute Malnutrition Managed in Outpatient Therapeutic Program (Otp) in Kwale County,kenya

Abstract

Background and Rationale Acute malnutrition, is associated with increased frequency and severity of infections, contributing to delayed recovery from illnesses as well as an increased risk of death. Under-5 mortality rate stands at 41 deaths per 1,000 live births worldwide as recorded by UNICEF in 2016 with 1 million deaths estimated to occur annually due to malnutrition associated complications. Integrated Management of Acute Malnutrition (IMAM) Kenya guidelines incorporate Outpatient Therapeutic Program (OTP) for continued care for children with severe acute malnutrition in the absence of life-threatening complications. The guidelines outline parameters for defining a successful Outpatient Therapeutic Program which include rate of weight gain, proportion of those who recover, default or die as well as duration of follow up at nutrition clinic. Kwale county has continued to record high prevalence of wasting and severe wasting documented at 4.4% and 0.8% respectively in the Kenya Demographic and Health Survey of 2014. Regular nutritional surveys by the Ministry of Health still report high prevalence in the county. However, there are no studies evaluating the outcomes of Outpatient Therapeutic Program undertaken in Kwale County despite the continued high prevalence of wasting. This study is a step in covering the void. Objectives The primary objective of the study was to estimate the proportion of children who recover (achieve WHZ more than – 3 SD and / or MUAC above 11.5cm) following nutritional rehabilitation at Outpatient Therapeutic Programs in three (3) major hospitals in Kwale county. Secondary objectives were to evaluate the rate of weight gain (g/kg/day) at OTP centres, and the proportion of children who are admitted for inpatient care, default from follow up, or die within the first 28 days of follow up at the nutrition clinics. Methodology By employing a prospective longitudinal study design, children were enrolled as they were booked in at the nutrition clinic and followed up 2 weekly at the OTP centers for the first 28 days to determine their outcomes. A sample size constituted 161 children aged between 6 months to 59 months with non-complicated severe acute malnutrition. Data was collected using a pre-tested semi structured questionnaire administered to the caregivers capturing information on demographic, socioeconomic, socio cultural factors relating to child nutrition, and medical histories of the children. Nutritional evaluation of the children included physical examination, anthropometric measurements (weight, height, WHZ score, MUAC) and administration of the appetite test. Results Among the 161 children enrolled into the study and followed up for 28 days 70 (43.48%) recovered, 55 (34.16%) defaulted from follow up, 5 (3.11%) got admitted, 5 (3.11%) died and 3 (1.86%) were transferred to other OTP centers. Twenty-three (14.29%) failed treatment remaining at WHZ score of – 3 SD and below. The average rate of weight gain was 5.8g/kg/day. Conclusion and Recommendations This study recorded a low recovery rate at 43.5%. Factors associated with recovery were appropriate breastfeeding practices, residence within 10 km radius from the clinic, good uptake of RUTF, administration of amoxicillin and administration of vitamin A. Poor outcomes were associated with several factors including age above 12 months, initiation of complementary feeding before age 6 months, inappropriate breastfeeding status, distance more than 10 km, presence of diarrhea, poor uptake of ready to use therapeutic food (RUTF), lack of routine administration of amoxicillin and or vitamin A to the children at OTP.

Improved access to nutrition services and follow up for children with severe acute malnutrition, including adoption of community health volunteers (CHVs), sensitizing the community on infant and young child nutrition (IYCN) and health seeking behavior, as well as improving the application of IMAM guidelines at the OTP centres including routine use of amoxicillin may improve outcomes of children undergoing nutritional rehabilitation at the OTP centers