Treatment Outcome and Associated Factors Among Under Five Children with Severe Acute Malnutrition Treated in Ethiopia: A Multi- Center Retrospective Cohort Study

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However, there is limited information on the factors influencing treatment outcomes for children admitted with SAM. Objective : : This study aimed to assess treatment outcomes and their associated factors among children under five years of age with severe acute malnutrition admitted to public hospitals in Addis Ababa, Ethiopia. Methods: A retrospective cohort study was conducted using secondary data from medical records of patients enrolled in the therapeutic feeding centre from March 2024 to august 2024. The total sample size was 423. Samples were collected at 3 public hospitals in Addis Ababa, which was selected by simple random sampling. A structured questionnaire was used to collect data from the available individual folders and registers. The data analysis was performed using bivariable and multivariable analysis. In bivariable analysis those predictors whose p value less than 0.25 was entered into multivariable analysis and those whose p value less than 0.05 was considered as statistically significant. The odds ratio with 95% CI was used to identify predictor variables. Results: A total of 418 records of children with a diagnosis of severe acute malnutrition were reviewed. Of these cases of malnutrition, the recovery rate was 53.8%. The deathrate, default rate, and medical transfer were 4.3%, 26.1%, and 15.8% respectively. In multivariable analysis, those participants who experienced oedema were about 4 times have poor treatment outcome (AOR=3.884: CI= 2.160-8.898) as compared to their counter parts. Those participants who has vomiting were about 3.5 times have poor outcome as compared to those who don’t have vomiting (AOR= 3.500: CI=1.265-9.682). Those participants who had fever were about 3 lower treatment outcome as compared to their counterpart (AOR=3.029: CI=2.406-9.133). Those who were vaccinated for their age about 7 times had good treatment outcome as compared to their counter parts (AOR= 6.85CI=3.68–12.76) Conclusion and recommendation : The assessment of severe acute malnutrition (SAM) treatment outcomes in children under five in Addis Ababa identified significant challenges, including a low cure rate, elevated mortality, and a high default rate. Healthcare providers should prioritize SAM cases with complications like vomiting and fever. Emphasis should be given to edematous patients. Addis Ababa Regional Health Bureau should provide community-based health education and counseling for mothers on EPI services. Nutrition & Dietetics Severe Acute Malnutrition children under age 5 treatment outcome Figures Figure 1 Figure 2 INTRODUCTION 1.1. Background of the Study According to the National Centre for Health Statistics, Severe acute malnutrition (SAM) is defined as a weight-for-height measurement that is 70% or more below the median, or three standard deviations (SD) or more below the mean values. It may also be characterized by bilateral pitting oedema caused by malnutrition, or a mid-upper-arm circumference of less than 115 mm in children aged less than 5 years old(3). Third world countries are particularly affected by child malnutrition (4) Severe Acute Malnutrition (SAM) significantly increases a child's risk of death from common infectious diseases such as acute respiratory infections (ARIs), diarrhoea, and measles. Beyond its immediate danger, SAM also has long-term consequences, hindering physical and intellectual development. This impairment can reduce productivity in adulthood.A major reason SAM is so deadly is that it weakens the immune system, making children more susceptible to infections and slowing their recovery from illness. In fact, it is one of the leading contributors to under-five mortality globally. Furthermore, children who survive may not reach their full physical potential as adults, which can limit their physical capacity for work.(1)Childhood malnutrition is the leading cause of mortality in children under five. It compromises brain development and, most critically, weakens the immune system. This heightened susceptibility to infection, combined with a slow recovery from illness, is the primary pathway to fatalities. Furthermore, the resulting impairment of physical growth during childhood can lead to a permanently reduced capacity for physical activity in adulthood.(2). Moreover, severe acute malnutrition adversely affects brain development and heightens susceptibility to infections that significantly contribute to early childhood mortality. Although there have been notable improvements in recent years, current trends suggest that Ethiopia continues to face a serious challenge with child severe acute malnutrition(3).Globally, approximately 60 million children suffer from moderate acute malnutrition, while another 13 million endure the severe acute form. The prevalence is particularly high in certain regions: about 9% of children in sub-Saharan Africa and 15% in South Asia are moderately acutely malnourished. In developing countries overall, severe acute malnutrition affects about 2% of children. The impact is stark at a national level; in India, for instance, 2.8% of children under five—representing over 5 million children—are severely malnourished. In many poor countries, such as Malawi, this condition is a leading cause of pediatric hospital admissions.(3) The 2019 Ethiopian Demographic Health Survey (EDHS) report indicates that Ethiopia has the highest regional prevalence of acute malnutrition. Specifically, 1.2% of children under five were identified as severely wasted, a rate that has remained largely unchanged since the 2011 EDHS(6, 7).Ethiopia suffers from one of the highest under-5 child mortality rates in the region, where malnutrition is implicated in 28% of these deaths(8). The management of Severe Acute Malnutrition (SAM) is thus vital for child survival and represents a key, cost-effective component of efforts to scale up nutritional frameworks aimed at addressing malnutrition(8). Despite the fact that most children with Severe Acute Malnutrition (SAM) are brought to hospitals or health centers for treatment at Therapeutic Feeding Units (TFUs) and Outpatient Therapeutic Programs (OTPs), a significant number still die. This is often due to factors such as late presentation, co-morbidities, and errors in clinical management(9). Several studies from different regions of Ethiopia have reported high rates of death and default among children with Severe Acute Malnutrition (SAM) (10, 14). These alarming national figures indicate a need for further investigation to determine the treatment outcomes of SAM across other hospitals and to identify the underlying contributing factors. Therefore, this study aims to clarify treatment outcomes in SAM stabilization centers and to retrospectively identify the factors associated with them(10, 14). METHODS AND MATERIALS 3.1. Research Area The study was focus on Addis Ababa, the capital city of Ethiopia, which is administratively divided into 11 sub-cities. Covering a total area of 527 square kilometers, the city has 12 government hospitals, approximately 97 public health centers, and a collective workforce of 6,860 health professionals (13). The city has a population density of 5,535.8 inhabitants per square kilometre and occupies an estimated area of 174.4 square kilometres. According to estimates from Ethiopia's Central Statistical Agency, the Addis Ababa Region's total population is estimated to be 5.55 million in 2017. For this research, therapeutic feeding centers was randomly selected from various locations within Addis Ababa. The research was conducted from March 1/2024 to Augest1/2024. 3.2. Research Design A facility record-based retrospective cohort study was conducted over the period of March 1/2024 to Augest1/2024. 3.3. Source Population All under-5 children who were admitted to Addis Ababa public Hospitals for the management of SAM between March 1, 2023 and March 1, 2024. 3.3.1. Study population The study was involved analysing the records of all randomly selected under five children who were admitted at therapeutic feeding centres from March 1, 2023, to March 1, 2024. It aims to capture a comprehensive dataset of children at therapeutic feeding services over the designated period, with examination of the factors related to malnutrition treatment outcomes. 3.3.2. Study unit/element Records of all randomly selected under 5 children who were admitted to therapeutic feeding programs from March 1/2023 to March 1/2024 was included in the study. 3.4. Eligibility criteria 3.4.1. Inclusion criteria The study was include under 5 children who have been admitted to AA public hospitals in Addis Ababa city within the last one year 3.4.2. Exclusion criteria Those who had incomplete data were excluded from the study. 3.5. Sample Size Determination The sample size (n) was an estimate of the recovery rate (assumed to be 52%) of the study subjects was determined and the choice of this value resulted in a larger sample size (11). Based on this assumption, the actual sample size for this study was computed using single population proportion formula indicated below(15). Where; n = minimum sample size z = 95% confidence level (1.96) d 2 = Degree of precision/the margin of sampling error (5%) P = estimate of the prevalence rate (0.52) After addition of 10% of non-response rate, the final sample size was 423 Sample size by the second objective Table 1 Sample size calculation for second objective Variable P1 (%) P2 (%) CI Power Allocation ratio AOR Total sample size Reference Age 75 25 95% 80 1:1 2.43 258 + 10%=374 14 Immunization status 68.7 31.3 95% 80 1:1 2.02 382 + 10%=420 Cough 40 60 95% 80 1:1 0.41 214 + 10%= 228 Note : From the above sample size calculation for the two objectives, the highest sample size is 423 3.6. Sampling Technique and procedure There are 8 hospitals that have SAM management unit in Addis Ababa of those 37.5% were selected by lottery methods. Out of the total under-five children admitted with severe acute malnutrition in each public hospitals from March 1, 2023, to March 1, 2024 423 children was selected using a simple random sampling technique. The selection process was involved proportionally allocating to each selected therapeutic centre based on the size of admitted children during the specified time frame. This approach ensures that the sample adequately represents the population of interest across different centres, allowing for meaningful analysis of findings. 3.7. Data Collection Instrument The primary source of data for the study was record cards obtained from the therapeutic feeding centers in Addis Ababa city. The instrument used for data collection was adopted and modified from different literatures. This instrument is chosen because it closely aligns with the format used at Ethiopian OTP/SC centers, ensuring consistency and comparability of data collection methods. By utilizing a validated instrument from a related study, the research aims to gather relevant and standardized data to effectively address the research objectives and contribute to the existing body of knowledge on severe acute malnutrition among children(8). The record cards contain information of the child's sex, place of residence, age, anthropometric measurements, admission medical history, physical examination findings, and routine medications. Additionally, follow-up data such as anthropometric measurements, clinical features, routine medications administered during treatment, and outcome status are also documented on these cards. All relevant information was extracted from the cards to facilitate efficient data retrieval and analysis, enabling the researcher to systematically examine factors related to malnutrition and its outcomes among the population. 3.8. Data Collection Procedures The data was collected by 3 data collectors with Bachelor's degrees 2 nurses and 1 Public Health were recruited and trained for 2 days. Before departing from the area, all items on the data collection instrument was undergo thorough checks for completeness to ensure accurate data capture. Furthermore, the study participants' record charts were meticulously reviewed to verify their eligibility based on the predefined inclusion criteria. This procedure is useful to the data collectors to maintain the quality of the data collected, enhancing the reliability and validity of the study's findings. 3.10. Operational Definitions Severe acute malnutrition weight-for height ratio of less than minus 3 standard deviations below the median reference population or weight-for-height ratio of below 70% or presence of nutritional oedema (15). Therapeutic feeding centre includes outpatient therapeutic program and nutritional rehabilitation units at hospitals (15). Cured Patient/child that has reached the discharge criteria. Defaulters Are those who is self-referred out and lost for follow up Treatment Outcome grouped as recovered and not recovered from SAM management therapeutic feeding units in this study (15). Recovered children with severe acute malnutrition declared as cured or recovered in the logbook of inpatient therapeutic feeding units (15). Not recovered defined as children discharged from inpatient therapeutic feeding units with outcome other than recovery in this study (death, default, and non-responder). 3.11. Data Quality Assurance The quality of the data was assured through several measures. Firstly, standardized pre-established questions were adopted to ensure the reliability of data collection. Secondly, rigorous training and recruitment processes were implemented for quantitative data collectors, as well as supervisors. These individuals were undergoing a comprehensive 1-day training program focused on data collection procedures, including how to extract information from the record cards and accurately fill out the checklist. And pretest was done among 5% of the total sample size in Sent peter hospital. To ensure the completeness, accuracy, and consistency of information during data collection, the principal investigators and supervisors was check the questionnaire before receiving the filled checklist from each data collector. This process was involved verifying that the questionnaire has been properly completed and cross-checking for any errors. Additionally, to facilitate effective communication with participants, the questionnaire was translated into Amharic (local language) for field use during data collection. Subsequently, it was re-translated into English for data processing and analysis, ensuring consistency in interpretation and analysis of the research. These measures aim to enhance the reliability and validity of the data collected, thereby strengthening the overall quality of the study. 3.12. Data Analysis The collected data was entered into Epi Data software, version 3.1, and then exported to SPSS version 26.0 for further analysis. The summarized data of basic features like calculation of means, medians, modes, standard deviations, and frequencies for demographic and clinical characteristics (e.g., age, weight, height, treatment duration). The results were presented using tables and graphs. Both bivariate and multivariate analyses were conducted. Variables showing association at a p-value < 0.2 in bivariate analysis will undergo further examination through multivariate analysis to identify true predictors of the dependent variable. At 95% confidence intervals was estimated via multivariable logistic regression analysis to identify factors associated with the outcome variable. A level of statistical significance was declared at a p-value ≤ 0.05. Results 4.1 Socio-Demographic Characteristics and Anthropometry of Study Participants This study included a total of 418 participants, yielding a response rate of 98.8%. Of the 418 children with Severe Acute Malnutrition (SAM), 256 (61.2%) were male and 162 (38.8%) were female. Forty-four children (10.5%) were aged below six months. Regarding admission type, the majority of participants (376, or 90%) were new admissions, while the remaining 42 (10%) were readmissions. (Table 2 ). Table 2 socio-demographic characteristics of Under Five Children with Severe Acute Malnutrition Treated at Public Hospitals in Addis Ababa, Ethiopia 2024 (N = 418) Variable Frequency Percent Age category 24 months 178 42.6 Sex Male 256 61.2 Female 162 38.8 Place of residence Urban 381 91.1 Rural 37 8.9 Nutritional information on enrolment of children with SAM Admission criteria Only oedema (kwashiorkor) 20 4.8 Only wasting (W/H) (marasmus) 51 12.2 Both oedema and wasting 285 68.2 MUAC 62 14.8 Grade of edema Grade 1 183 60 Grade 2 100 32.8 Grade 3 22 7.2 SAM with SD < 70% of median 142 34.0 ≥ 70% of median 276 66.0 MUAC < 11.5 cm 189 45.22 ≥ 11.5 cm 229 54.78 Child is referred from Hospital 33 7.9 OPD 176 42.1 Outreach 140 33.5 SFC 48 11.5 Spontaneous 27 6.5 Others 27 6.5 Admission type New admission 376 90.0 Re-admission 42 10.0 4.2. Clinical related factors of the study participants Of the study participants, 153 (36.6%) were enrolled during the spring season. The majority (254, or 60.8%) were age-appropriately vaccinated. Most participants (289, or 69.1%) had a temperature of 38°C or lower ( Table 3 ). Table 3 Clinical characteristics of Under Five Children with Severe Acute Malnutrition Treated at Public Hospitals in Addis Ababa, Ethiopia 2024 (N = 418) clinical related variables Frequency (N = 418) Percent Immunization status Vaccinated for age 254 60.8 Partially vaccinated 89 21.3 Not vaccinated 3 0.7 Unknown 72 17.2 Temperature 37.5 129 30.8 Respiratory rate < 40 217 51.9 ≥ 40 201 48.1 4.3. Medical co-morbidities of the study participants About 343(82.0%) of the study of the study participants were HIV negative. And 175(41.9%) of the participants had fever. Three hundred twenty (76.6%) of the participants had diarrhea.. (Table 4 ). Table 4 Co-morbidity at admission of children from birth up to 59 months of Under Five Children with Severe Acute Malnutrition Treated at Public Hospitals in Addis Ababa, Ethiopia 2024 (N = 418) Characteristics Category Frequency Percent (%) Child HIV status Negative 343 82.0 Positive 3 0.7 Unknown 72 17.3 Presence of TB Yes 2 0.5 No 390 93.3 Unknown 26 6.2 Presence of fever Yes 175 41.9 No 243 58.1 Presence of cough Yes 182 43.55 No 236 56.45 Presence diarrhea Yes 98 23.4 No 320 76.6 Presence of vomiting Yes 254 60.8 No 164 39.2 4.4 Routine medications used by the participants Regarding medications commonly used, about 256 (63.4%) of the study participants took intravenous antibiotics. And majority of the study participants 243 (58.1%) took vitamin A (Table 5 ) Table 5 Routine medication given for SAM children from birth up to 59 months in Addis Ababa public hospitals, Ethiopia, (N = 418). Routine medication Frequency (N = 600) Percent Antibiotic/s Yes 265 63.4 No 153 36.6 Vit A Yes 175 41.9 No 243 58.1 Folic acid Yes 97 23..2 No 321 76.8 Albendazole or Mebendazole Yes 106 25.4 No 312 74.6 4.5 Treatment outcome During the study period, 225(53.8%) with (CI: 48.9–56.4) of SAM children were cured, 4.3% were dead, 26.1% were defaulters.(Fig. 2 ) 4.7. Bivariate and multivariate analysis of Factors associated with overall treatment outcome of the study participants In the bivariate logistic regression analysis of malnutrition, the presence of fever, presence diarrhea, presence cough, presence vomiting, immunization status were associated with treatment outcome of SAM. Those variables that have a p-value less than or equal to 0.2 were entered into a multi- variable logistic regression model to adjust for possible confounders. In multivariable analysis, those predictors which showed statistical significance in bivariate analysis and p value less than 0.2 were used to run multivariate analysis. In multivariable analysis, those participants who experienced edema were about 4 times have poor treatment outcome (AOR = 3.884: CI = 2.160–8.898) as compared to their counter parts. Those participants who has vomiting were about 3.5 times have poor outcome as compared to those who don’t have vomiting (AOR = 3.500: CI = 1.265–9.682). Those participants who had fever were about 3 lower treatment outcome as compared to (AOR = 3.029: CI = 2.406–9.133). Those who were vaccinated for their age about 7 times had good treatment outcome as compared to their counter parts (AOR = 6.85 CI = 3.68–12.76) (as shown in Table 6 ) Table 6 Treatment outcome of SAM and associated factors among under-five children in Addis Ababa public hospitals, 2024 Variable Treatment outcome 95% CI P-value Recovered Not Recovered COR AOR Type of malnutrition Non-edematous 65 45 1.00 1.00 Oedematous 149 159 1.541(1.134–5.104) 3.884(2.160–8.898) ** 0.000 Presence of vomiting No 205 170 1.00 1.00 Yes 19 24 1.523(1.015–8.421) * 3.500(1.265–9.682) 0.008 Age 24 months 57 59 1.00 1.00 Presence diarrhea No 146 173 1.00 1.00 Yes 48 51 1.115(1.001–4.508) * 2.216(1.073–9.643) ** 0.037 Presence of fever Yes 111 110 1.507(1.104–7.203) * 3.029(2.406–9.133)** 0.001 No 83 124 1.00 1.00 Immunization status Vaccinated for age 19 57 0.58(1.232–4.206) 6.85(3.68–12.76) 0 .001 Partially vaccinated 41 280 0.303(0.137–0.673)* 0.75(0.14–1.34) Not vaccinated 12 21 1.00 1.00 Discussion This study assessed the treatment outcomes and associated factors for under-five children with Severe Acute Malnutrition (SAM) treated at public hospitals in Addis Ababa, Ethiopia. The cure, mortality, and defaulter rates were determined to be 53.8%, 4.3%, and 26.1%, respectively. (16). (17, 21). The recovery rate among SAM children admitted to these hospitals was 53.8% (95% CI: 48.9–56.4). It is also lower than the recovery rates of 76.8% and 80% reported in studies from Tigray and Zambia, respectively. However, the finding is comparable to rates of 64.9% and 62.4% reported from a study conducted in the Wolaita Zone (17, 21). These disparities may be attributed to differences in the settings where SAM management was implemented. This study's finding is higher than the rate of 48% reported in a previous Nigerian study. This discrepancy may be attributed to the Ethiopian government's intensified efforts to enhance maternal and child nutrition through its community-based Health Extension Program, as well as differences in the study settings. Conversely, several institutional factors may contribute to a slower recovery rate. These include high staff turnover, excessive caseloads, insufficient training, a lack of quality assurance procedures, shortages of medical supplies, and poor ward infrastructure—particularly the absence of isolation rooms for malnourished children(17,21). This study reported a lower mortality rate (4.3%) than previous findings from the Tigray region (15, 17). This figure is also below the Sphere standard minimum recommendation of < 10%. The lower mortality rate observed in this study can be primarily attributed to children receiving care earlier, before complications developed. Another contributing factor was the appropriate clinical management of patients, including the timely prescription of routine medications.(15, 17). The analysis of factors associated with SAM treatment outcome (recovered/not recovered) revealed that children with complications like vomiting and edema had significantly higher odds of a poor outcome. Specifically, the presence of these complications was associated with nearly a four-fold increase in the odds of a poor outcome (Adjusted Odds Ratio [AOR] = 3.884; 95% Confidence Interval [CI]: 2.160–8.898) compared to children without them. Participants who experienced vomiting had approximately 3.5 times higher odds of a poor outcome compared to those who did not (AOR = 3.500; 95% CI = 1.265–9.682). Similarly, the presence of fever was associated with roughly three times lower odds of a positive treatment outcome (AOR = 3.029; 95% CI = 2.406–9.133). Vaccinated children had approximately seven times higher odds of recovery compared to unvaccinated children. This finding is consistent with a study conducted at Bahirdar Felege Hiwot hospital, which reported 4.4 times higher odds (14). The most probable explanation is that immunization prepares the body's immune system to fight the specific disease-causing microorganism, thereby facilitating recovery. Overall, vaccination was a positive predictor of recovery. Furthermore, attaching a follow-up chart to each child's folder and closely monitoring their progress significantly contributed to improving recovery rates for children with severe acute malnutrition. Conclusion This study analyzed the treatment outcomes and influencing factors for children under five with severe acute malnutrition (SAM) at public hospitals in Addis Ababa, Ethiopia. The cure, mortality, and defaulter rates were 53.8%, 4.3%, and 26.1%, respectively. The recovery rate fell below the internationally accepted standard. Multivariable analysis identified several significant predictors of outcomes: the presence of edema and vomiting was associated with poorer results, with edema corresponding to a four-fold increase in the risk of a poor outcome. Conversely, vaccination for age was linked to better outcomes, while fever was associated with a three-fold reduction in the risk of a poor outcome. 8. Recommendation For health care providers Health care providers should emphasize those SAM cases with comorbidity like cough and readmission case which require strict follow up according to the protocol and increased use of SAM management follow up chart for all SAM patients. Strong attention should be given to those who are Edematous patients For Addis Ababa Regional health bureau It is also recommended to give community-based health education and counseling for mothers to enhance child immunization. Strict follow up to be fully immunization of under 5 children is recommended Abbreviations AACAHB Addis Ababa City Administration Health Bureau AOR Adjusted Odds Ratio CI Confidence Interval COR Crudes Odds Ratio EDHS Ethiopian Demographic and Health Survey OTP Outpatient Therapeutic Program SAM Severe Acute Malnutrition SC Stabilization centre UTIs urinary tract infections WFH weight-for-height WHO World Health Organization Declarations This is the approval number A|A|732|227 Ethical approval and consent to participate; the ethical clearance was obtained from Institutional Review Board of menlik II Medical and Health Sciences college and official letters was submitted to each respective health facility to collect data from the therapeutic feeding centres. After explaining the objectives of the study, informed written consent was obtained from all mothers and caregivers, and anonymity and confidentiality of the data were kept. Respondents have the right not to participate or withdraw from the study at any stage, and all study methods were performed in accordance with the Declaration of Helsinki. Ethical approval and consent to participate ;Ethical clearance and approval was required from the Research Review Committee of Minilik II medical and Health Science College prior to beginning the study. Then letter was received from Addis Ababa public health and emergency management directorate. Additionally, permission letters was obtained from the Addis Ababa City Administration Health Bureau (AACAHB) and the respective public hospitals to collect data from the therapeutic feeding centres. Confidentiality of all collected information was maintained, and the privacy of participants was respected throughout the study process and all study methods were performed in accordance with the Declaration of Helsinki. Consent for publication ; Not applicable. Competing interests ; The authors declare that they have no conflicts of interest Funding ; Not applicable. Author contributions; C.G; Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Visualization, Writing – original draft Availability of data and materials ; The data used to support the findings of this study are available from the corresponding author upon request References Mezemir M, Girma M, Bekele D. Treatment Outcome and Associated Factors of Acute Malnutrition Among Children in the Therapeutic Feeding Center of Public Hospitals in Addis Ababa, Ethiopia: An Institutional-Based Cross-Sectional Study. Pediatr Heal Med Ther. 2022;Volume 13(April):145–54. Ma’Alin A, Birhanu D, Melaku S, Tolossa D, Mohammed Y, Gebremicheal K. Magnitude and factors associated with malnutrition in children 6-59 months of age in Shinille Woreda, Ethiopian Somali regional state: A cross-sectional study. 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Federal, HIV Prevention, AIDS Control Office Multi-sectoral HIV AIDS response: annual monitoring and evaluation report 2008. Yebyo HG, Kendall C, Nigusse D, Lemma W. Outpatient therapeutic feeding program outcomes and determinants in treatment of severe acute malnutrition in Tigray, northern Ethiopia: a retrospective cohort study. Plos one. 2013; 8(6). Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":54509,"visible":true,"origin":"","legend":"\u003cp\u003eProportional Allocation of the sample in AA public hospitals\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7766421/v1/4905f370f90e7948f163c16c.jpg"},{"id":93570109,"identity":"1d3ca512-6cb8-419e-a0e1-f6f76f7fd9bf","added_by":"auto","created_at":"2025-10-15 08:55:50","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38345,"visible":true,"origin":"","legend":"\u003cp\u003etreatment outcome of SAM children from birth up to 59 months in Addis Ababa public hospitals, Ethiopia, (N = 418).\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7766421/v1/6ab9e7613f240bd4c8c99582.jpg"},{"id":93573548,"identity":"75859c45-f851-444e-9eb0-d6f8e2ecf1e6","added_by":"auto","created_at":"2025-10-15 09:11:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1407668,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7766421/v1/685e8337-371c-4776-8d5e-cb6ffec6ab3b.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eTreatment Outcome and Associated Factors Among Under Five Children with Severe Acute Malnutrition Treated in Ethiopia: A Multi- Center Retrospective Cohort Study\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e1.1. Background of the Study\u003c/h2\u003e\u003cp\u003eAccording to the National Centre for Health Statistics, Severe acute malnutrition (SAM) is defined as a weight-for-height measurement that is 70% or more below the median, or three standard deviations (SD) or more below the mean values. It may also be characterized by bilateral pitting oedema caused by malnutrition, or a mid-upper-arm circumference of less than 115 mm in children aged less than 5 years old(3). Third world countries are particularly affected by child malnutrition (4)\u003c/p\u003e\u003cp\u003eSevere Acute Malnutrition (SAM) significantly increases a child's risk of death from common infectious diseases such as acute respiratory infections (ARIs), diarrhoea, and measles. Beyond its immediate danger, SAM also has long-term consequences, hindering physical and intellectual development. This impairment can reduce productivity in adulthood.A major reason SAM is so deadly is that it weakens the immune system, making children more susceptible to infections and slowing their recovery from illness. In fact, it is one of the leading contributors to under-five mortality globally. Furthermore, children who survive may not reach their full physical potential as adults, which can limit their physical capacity for work.(1)Childhood malnutrition is the leading cause of mortality in children under five. It compromises brain development and, most critically, weakens the immune system. This heightened susceptibility to infection, combined with a slow recovery from illness, is the primary pathway to fatalities. Furthermore, the resulting impairment of physical growth during childhood can lead to a permanently reduced capacity for physical activity in adulthood.(2).\u003c/p\u003e\u003cp\u003eMoreover, severe acute malnutrition adversely affects brain development and heightens susceptibility to infections that significantly contribute to early childhood mortality. Although there have been notable improvements in recent years, current trends suggest that Ethiopia continues to face a serious challenge with child severe acute malnutrition(3).Globally, approximately 60\u0026nbsp;million children suffer from moderate acute malnutrition, while another 13\u0026nbsp;million endure the severe acute form. The prevalence is particularly high in certain regions: about 9% of children in sub-Saharan Africa and 15% in South Asia are moderately acutely malnourished. In developing countries overall, severe acute malnutrition affects about 2% of children. The impact is stark at a national level; in India, for instance, 2.8% of children under five—representing over 5\u0026nbsp;million children—are severely malnourished. In many poor countries, such as Malawi, this condition is a leading cause of pediatric hospital admissions.(3)\u003c/p\u003e\u003cp\u003eThe 2019 Ethiopian Demographic Health Survey (EDHS) report indicates that Ethiopia has the highest regional prevalence of acute malnutrition. Specifically, 1.2% of children under five were identified as severely wasted, a rate that has remained largely unchanged since the 2011 EDHS(6, 7).Ethiopia suffers from one of the highest under-5 child mortality rates in the region, where malnutrition is implicated in 28% of these deaths(8). The management of Severe Acute Malnutrition (SAM) is thus vital for child survival and represents a key, cost-effective component of efforts to scale up nutritional frameworks aimed at addressing malnutrition(8).\u003c/p\u003e\u003cp\u003eDespite the fact that most children with Severe Acute Malnutrition (SAM) are brought to hospitals or health centers for treatment at Therapeutic Feeding Units (TFUs) and Outpatient Therapeutic Programs (OTPs), a significant number still die. This is often due to factors such as late presentation, co-morbidities, and errors in clinical management(9). Several studies from different regions of Ethiopia have reported high rates of death and default among children with Severe Acute Malnutrition (SAM) (10, 14). These alarming national figures indicate a need for further investigation to determine the treatment outcomes of SAM across other hospitals and to identify the underlying contributing factors. Therefore, this study aims to clarify treatment outcomes in SAM stabilization centers and to retrospectively identify the factors associated with them(10, 14).\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003ch2\u003e3.1. Research Area\u003c/h2\u003e\u003cp\u003eThe study was focus on Addis Ababa, the capital city of Ethiopia, which is administratively divided into 11 sub-cities. Covering a total area of 527 square kilometers, the city has 12 government hospitals, approximately 97 public health centers, and a collective workforce of 6,860 health professionals (13). The city has a population density of 5,535.8 inhabitants per square kilometre and occupies an estimated area of 174.4 square kilometres. According to estimates from Ethiopia's Central Statistical Agency, the Addis Ababa Region's total population is estimated to be 5.55\u0026nbsp;million in 2017. For this research, therapeutic feeding centers was randomly selected from various locations within Addis Ababa. The research was conducted from March 1/2024 to Augest1/2024.\u003c/p\u003e\u003cp\u003e\u003cb\u003e3.2. Research Design\u003c/b\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eA facility record-based retrospective cohort study was conducted over the period of March 1/2024 to Augest1/2024.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003e3.3. Source Population\u003c/b\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAll under-5 children who were admitted to Addis Ababa public Hospitals for the management of SAM between March 1, 2023 and March 1, 2024.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003ch2\u003e3.3.1. Study population\u003c/h2\u003e\u003cp\u003eThe study was involved analysing the records of all randomly selected under five children who were admitted at therapeutic feeding centres from March 1, 2023, to March 1, 2024. It aims to capture a comprehensive dataset of children at therapeutic feeding services over the designated period, with examination of the factors related to malnutrition treatment outcomes.\u003c/p\u003e\u003ch2\u003e3.3.2. Study unit/element\u003c/h2\u003e\u003cp\u003eRecords of all randomly selected under 5 children who were admitted to therapeutic feeding programs from March 1/2023 to March 1/2024 was included in the study.\u003c/p\u003e\u003ch2\u003e3.4. Eligibility criteria\u003c/h2\u003e\u003ch2\u003e3.4.1. Inclusion criteria\u003c/h2\u003e\u003cp\u003eThe study was include under 5 children who have been admitted to AA public hospitals in Addis Ababa city within the last one year\u003c/p\u003e\u003ch2\u003e3.4.2. Exclusion criteria\u003c/h2\u003e\u003cp\u003eThose who had incomplete data were excluded from the study.\u003c/p\u003e\u003ch2\u003e3.5. Sample Size Determination\u003c/h2\u003e\u003cp\u003eThe sample size (n) was an estimate of the recovery rate (assumed to be 52%) of the study subjects was determined and the choice of this value resulted in a larger sample size (11). Based on this assumption, the actual sample size for this study was computed using single population proportion formula indicated below(15).\u003c/p\u003e\u003cp\u003e\u003cimg 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vitaeUxMTOgeFcabmZnBBx98gLq6OmUkWWdnpzLyrKqqCsFgUPs0RU9Pj2rdSCQCl8sFi8WS8nnZIB99L+Vyg3TNzc1hZmZGW6xreHgYk5OTePrppxEKhZQRpKb5EajJjrpTtRYW+zmnqpNYLIYHDx4ASS7RkMsePHiAWCymXaxit9sxOzuLcDiMjo4OrF+/HgDQ0dGB/fv3a1dPamZmBnNzc6iurtbdp2R1k2o/V1qh1XOyOqbMYRguQjgcxujoqLYYANDS0pJ2l1sqPp8PJSUl2L17N27cuIHKykq0t7dj8+bNmJ2dhd/vx+TkJF544YWE4dqRSARVVVX49a9/jffeew+SJOGTTz7BpUuXEAgEUFFRAZvNpnpONomiiP7+fgiCgNLSUu3ijIlGo5iamtIW65K7TL/99lv88Ic/RCgUQiwWg9PpxMWLF7Fz586kgbhx40YAWNYF9bmqk3iPPfYYDh06hOHhYbS1tQEAuru7k3bjak1NTSEajSrdznq0dbMS+7nSsl3P2jqmzGIYLsLHH3+M7u7uhFZAOBxOaBUu1fbt2yFJEpxOJwRBwIcffoiWlhbU1NQAAJ566ilUVFQktIYikQiqq6sxOTmJW7duobGxEQBgs9nwgx/8AJOTk2lf+5Yp8tF3snN6y1VSUoLq6mpg/pyN9gdC/nFZt24dioqKlHOMgiCgq6sL27ZtA+aPuk+cOAGr1YqBgQF0dXWptiNbTGshmYXqRG4dZIPZbEZrays8Hg+gcy5VjyiKOHPmDJxOp3I+VI+2bhbaz5VWiPWsrWPKLIbhIni9XuUHVHb//v2M/2cPBoPw+/0AgN///vcJXSZaoijilVdeweTkJC5fvgy73a5afu/ePQiCoJyEz5Vs/uDI4kOstbVVCcS+vj789re/BYCEARJ6SkpK0NzcDKRx5K09EFmMhepk7dq1KC4u1hZn1K5du2C1WhEIBBJ6F7S+/PJLPHjwACdOnNAu0iXXzUL7udIKuZ6X8/2j5BiGyzA0NIS1a9cu+EO7WPK5lqNHjyYEm94Rd1dXFwYGBnSPKuXWUK67SHOlpKQEY2Nj2LNnDzo6OlBUVISqqioAwKOPPgrEjSqVJWut1NbWQhCEvD7yDoVCAKC0dpcivkWdSiQSwYEDB/Duu+8ueECWC16vN+E8/UKPpfbYGLmejYphuET379+H3W7PeBBigZacPABEPskeiURw7tw5CIKAgwcPalfHp59+uiJdpLlkNptx4cIFpdv673//O0pKSvCXv/wFDocjYVh/Ph9ZFxUVYd26dUDcD7KedFq7qcjnn5KRexuam5sTDrBWit5ApYUeyc7js55Ji2G4BDMzM1lpESKNlpx8/kFu7cjhqLd+MBjE8ePHkwZrtsldUSsRPmfOnEE0GsXBgweVz0n+AVxowM1CrYFkLct0LFQnZrMZdXV12mLFvXv3gDR+ZNORaj9bW1uV0cyLIdfNQvu50gq5npfz/aPkGIaLFA6HYTabVUEYDAbx1VdfqdZbKjnc9Fpy8ReLy0eR8lGt9ghWnL/gORqNrth/nvij71zyer3o7u6Gx+NRHW3H/wCmag3o1T0y1HWWTp3I3bXac5eiKGJqaiojBzf37t1THSjEk7sW9X6gZ2ZmdM+nausmnf1caYVWz9o6psxiGC7CzMwMSkpKEkLniy++SGiVLdW1a9d0/xMGg0G8+uqrcDgcOHv2rFIujzDTHsG2trbCbrdDEATd65ZyQQ6fhVpimeT1enH48OGkl7rIgxrOnTuXMKjhzJkzKC4uxq5du1TlWsnCMh3p1Indbkd9fT1GR0dVM5nIl/bU19cnnEtORvuDivnvksVi0e2W83q9mJ6eVu7PGK+vrw+nT59Oue9y3aSznyutUOt5Od8/SkF7FT7pSzbLRLqzVKQjfnYU+Q4MkiRJV65ckQRB0L0bQvwsK/Ks+y0tLVJvb68yi0YuZ/bQkt+fdvLheCMjI8pkzXqzgUhx29GbgSMWi0l+v1+qrKxMqDs98rYc83cqkOLmfkxWV5mcASSdOpG/C/J3S74Th953Ta9u4mdYiZ8Jxe/3S4cPH07YhpRkJh3tQ69+ktVNOvuZzmefTYVSz8nqmDKHYZgG+T+B9gsrPzL1n7h3/lZE2tfaunWr5Pf7tasr5LAEIO3Zs0d1Kxq9qZ1ySX4fej8u8T8k8Q+9//B6P0RS3OTG69evlzo6OhJeI5nx8XGpsrJSec34uwjo0f5oLkeqOokXm5/UWa6TZNN7JaubkfnJo+P3Mdn36MqVKwmfg/aR7LuUrG5S7ediPvtsK4R6TlbHlDkMwzyS6i4Li5XOUXmuyO8lE/u1UuSWY6Z+qFdDnchS1c1q2s+VlKqOKTMYhnki1SS9S5EPXaTxPCnuaZfv5M8mUz0AskKuE1k6dbMa9nMlpVPHtHwcQJMn5Bk7MjHYRZyfF9JqtWLTpk3axSvC7XajtLQ05dyf+UgURbz55ptYt24d9u7dq128LIVaJ7J066bQ93MlpVvHtHwMwzwgiiJ+97vfpZykN12iKMLr9WJgYCAjwZpJZ8+eRXl5OWpra5Pe7y2fhMNh7Ny5ExaLBdevX8/KCL5CqxPZYuumUPdzJS22jml5TJIkSdpCyh2fz4cdO3aoygRBwK1bt9Ie1o35ENy5cycGBgZU5fLciPkUin19fQiFQjh06JB2UV5xu92orKxUJj3PpkKpE9lS66bQ9nMlLbWOaWnyMgyDwSC+/PJL/OlPf8LPf/5z5eLUvr4+tLW14c6dO3A4HPjoo4/y6keeiIgKU951k7pcLjzxxBNoaWnBjRs38Mtf/hIAcOnSJYRCIdy+fRstLS0YGBjA8PCw9uk5ncx3tWHdEZFR5WXLUL43HwAEAgH4/X6sXbtWmcnB5XLB7/cvuiuRiIhIT961DKEZWakNwoUmsiYiIlqsvAxD+X5+//nPfzA3N6ea2y/VRNZERERLkXfdpPGjIh0OR8KQ4lx2kZpMJm1RwcvVx70a644oH+Xq//Rql3ctQ3nGeEEQEmZuT6eLNJODQLQ3Cl0Nj1RYd3zwUXgPyoy8axnK1905nU58+OGHuss8Ho/u7XmIiIiWIu9ahvL9/A4ePKhdpLrX39DQEKd2IiKijMirMEzVDRq/LBKJQJIkDqAhIqKMyKswTDVSVG4FfvvttwCAp556SrV8tfH5fMp5OZfLpV1MVLD43aZ8lFdhuH37dkiSpHs+0GazYWJiAqFQCNu2bdMuXlWCwSAGBwchSRJGRkbg9/uTDlQhKiT8blO+yqswpP8jiiLa29sBAHa7HUePHkV/fz/PkVLB43eb8hXDcIXdv38fH3zwARobG9HQ0ABRFFFTU6PqJt6wYYPqObT69fT06PaQ5KvOzk709fVpixPwu035imG4grxeL2w2G3bv3o2rV6+iqqoq4VwpAIRCId3zqLT6iKIIt9uNzz//HK+//rruMvl8m9vtXlKLainbcblcCdeYlpWVIRKJAPOnONra2tLaVjx+tylfMAxXkNvthiRJcDqdQJKj5EgkglAoxLtcG4A8+9Ls7CyuXr2qGlEdiURQW1uLsbExjI+PIxaLYWxsbNF3j1/KdoLBIPx+v7ZYdfNom82G27dvY2xsDPv379euqovfbcorEq2oWCwmORwOyWq1StPT09rFUltbm245rT4ej0dyOBxSLBbTLpKcTqckCII0MjKilI2MjEiCIEhOp1O1bipL2Y7T6ZQ8Ho+2WNf09LRktVrTWp/fbconbBmuMHn6ufijbJnX68WmTZsSymn1CQaDOH78OA4ePJjQZSi3zLTX39psNlRUVMDv9yMYDKqeo2cp2wkGg/jHP/6BXbt2qcqTKSkpQXNzM44fP56wrXj8blO+YRiuMPkOHS+++KKq3OfzAfPnYuS/5TJaXURRxJEjR1BRUYFnnnlGu1j5jpSWlqqC0mw2o7S0FNFoFLdv31Y9R89StnPmzBncuXMHjz/+OJqamhAOh1XL9dTW1gIAjhw5otv1yu825SVtU5FyJ1kXqcfjkQCoHtp1aPWQuyn1uhbl7wgA3eXydyVZ96psKduR35f2u9jS0pLWa2m7YyV+tymPsWWYI+FwGE1NTaoRfMm6SOWBNfGPiYkJdimtUnKLTW8AVSwWw4MHD4AkA6zksgcPHiAWi2kXK5ayHbvdjtnZWYTDYXR0dGD9+vUAgI6OjpSDZFK1NPndpnzFMMwy+SLj9evXo7S0FLFYDJIk4Sc/+QkaGxt1u0jJOERRRH9/PwRBQGlpqXZxXnjsscdw6NAhDA8Po62tDQDQ3d2dsmtz48aNAMAL6qlgMAyzSBRF7N+/H21tbejt7UVra6tyrmbXrl3473//m9c/gpR9coutuLgYa9eu1S7GzMwM5ubmtMWLlontmM1mtLa2wuPxAPN3kUlGr6VJlM8Yhlm0f/9+dHd3w+PxKIMFtLQj+8hYFgqptWvXori4WFu8aJnaDuYP5KxWKwKBgHLRfTJzc3OYmZnRFhPlHYZhlvh8PnR3d8PhcOheVJzqDh1E6QqFQgCAdevWoaioSLs4bYvZTklJCaqrq7XFRAWNYZgFoijizJkzEAQBp0+fTgi7+OXyMHQiPUVFRVi3bh0QF1h6tJdLaGVqOzL5nCDRasEwzAJ5lGiyLtCuri4MDAwkXU7GIXdfJutONJvNqKur0xYr7t27B6QRTpnaTrx0WpHJzoUS5RuGYRZMTU3pXtyM+e7TP//5zwDALlJStdiSqa2thSAICSMzRVHE1NRU2j0MmdoO5sNTb7Yc2WK6XYnyAcMwi7RH2cFgEMPDw3jkkUeUHx691gAZh9xii0ajmJqa0i4G5q/3q6+vx+joqGoGGLkHor6+Hna7XfUcPUvZjt5lEcFgEBaLJemgsHg84KOCob0Kn5ZPnrnDarVK4+PjkiRJ0pUrV6SLFy+qZp25evVqwgwdZDwLTZQtxU2ALc8QMz4+LjkcDt2ZZ+Tt6c0Ak+524mesiZ9xxu/3S4cPH054zXipZqAhyldsGWaB3W7He++9h7m5Oaxfvx5VVVXYtGkTdu/erawzNzcHm82WcCROxiNPlD01NaXbEsP8CM6xsTFYrVYUFRXhySefRHl5Oa5fv76olle62zGbzTh9+jQqKyvR0dGBoqIiVFVVAYDuoLB48rWTPCdOhcQkSZKkLSSi3AoGg9iyZQsuX76cVvdjPvN6vTh+/Dhu3brFgz0qGAxDojzh9XrR39+f0EorJJFIBNXV1Whubobb7dYuJspbDEOiPOJyuTA1NVWQgShPP1io75+MjecMifLI2bNnUV5ejtra2rTuHZgvwuEwdu7cCYvFwiCkgsSWIVEe6uvrQygUwqFDh7SL8pLb7UZlZSUaGxu1i4gKAsOQiIgMj92kRERkeAxDIiIyPIYhEREZHsOQiIgMj2FIRESGxzAkIiLDYxgSEZHhMQyJiMjwGIZERGR4DEMiIjI8hiERERkew5CIiAyPYUhERIbHMCQiIsNjGBIRkeExDImIyPAYhkREZHgMQyIiMjyGIRERGR7DkIiIDI9hSEREhscwJCIiw2MYEhGR4TEMiYjI8BiGRERkeAxDIiIyPIYhEREZHsOQiIgMj2FIRESGxzAkIiLDYxgSEZHhMQyJiMjwGIZERGR4DEMiIjI8hiERERkew5CIiAyPYUhERIbHMCQiIsNjGBIRkeExDImIyPAYhkREZHgMQyIiMjyGIRERGR7DkIiIDI9hSEREhscwJCLKkK1bt8JkMiU8enp6tKvi1KlTCeuZTCbtahnV09ODyspK5bUqKyt13xsARKNRnDp1SrX+Y489hubmZkxOTmpX1zU2NgaTyYStW7dqF+UfiYiIMmZiYkJqaGiQACiPNWvWSKOjo9pVpdnZWWnfvn3SmjVrJL/fr12cMbOzs9LmzZtV7yn+cezYsaTrl5WVKe993759Kfcn3uzsrFRWViYBkJ577jnt4rzDMCQiyrChoaGEwFmzZo00OzurXVUaGhrKelg0NDRIV65cUV5/aGhIWrNmjer9xZNDD4B08uRJ1TL5eQ0NDapyrfgDgmzvXyawm5SIKAuOHTuGNWvWKH8/fPhwxboLz549i8bGRgiCAACorq7Gm2++qSwvKyuLW/v/ulNlc3NzqmVVVVUAgH//+9+q8ng9PT24evWqtjivMQyJiLKguLgYg4ODqrK7d++iublZVZYLcgjG++abb5R//+EPf1Ati3f+/HlEo1Hl7/v37wMAfvSjH8Wt9f+NjY3h8uXL2Lx5s3ZRXmMYEhFlSXl5Oa5cuaIqO3/+fNJBK6kEAoGEwTYLPU6dOqXdDAKBAJqbm3H+/HkAwNDQELZt26Zap7GxUfm33KIdGxtDIBDAxMQE1qxZg6NHj6qeg/lBN7/5zW9w8uRJ3QDOZwxDIqIsamxsxLFjx1RlL730EgKBgKosF06dOoWamholCAGgpqYmIZzffvttVRfv3bt3UVFRgeeffx6bN2/G4OAgysvLVc8BgLfeeguvvvqq7rJ8xzAkIsqyd955B88995yq7Pnnn0/7EgXMn+ebH/SY9uONN95QbeONN96A3+9HQ0ODqlwbzoIgIBwOJ3R1Pnz4EADw05/+VFUOAH19ffjXv/6lalUWEoYhEVEOfPLJJ6pwefjwIRoaGvDdd9+p1su2bdu2oaenJ6H79tNPP1X9LQgC3G63qgzzrcStW7eqziNOTk6itbUVZ8+eVa1bSBiGREQ5IAgCLl26lND92NraqlovmUydM5Q1Njbi5MmTyt/xrdRoNIqtW7fipZdewvvvv4/R0dGE9/3WW28pfzc0NODSpUsFd54wHsOQiChHysvL8cUXX6jK7t69q/o7l1577TVtEQDg5Zdfxs2bNwEAL7zwAsrLyzE4OKgKRPm8YyAQUM4pxgex/HwAuHnzJkwm04qcJ00Xw5CIKIeqq6vx/vvva4sXlIlzhlrxLblNmzYB8y1EOcg2b96srFNeXq66NnG1YRgSEeXY3r17sW/fPm1xVgQCAfz4xz/G1q1bEwbsxJ/3q6urAwDEYjGlTNvt+Ytf/EL1N1KEdPyAoeeeew6SJKG6ulr13HzCMCQiyrB0BsWcO3cuYbRmNvz1r3/Fw4cPcfPmTWzevBldXV2IRqOIRqPKeb9jx44pQVVeXq7MSHPz5k1VYMbvV67CPFcYhkREGSSPrLxw4cKC58hu3LihOg+XDcXFxcq/Hz58iNdffx0WiwUWiwXnz5/Hvn378M4776ieEz8jzVtvvYVoNKrsF+a7T99+++24ZxQ+hiERUYacOnUKZWVluHv3LiYmJlBTU5NyPlJBEDA4OJh0arNM2Lt3L06ePKlqhZaVlWHfvn0YGhrCuXPnVOtj/vKL0dFR7Nu3Dz09PbBYLEpr8eTJk7hx40ZCF2qhM0mSJGkLiYiIjIQtQyIiMjyGIRERGR7DkIiIDI9hSEREhscwJCIiw2MYEhGR4TEMiYjI8BiGRERkeAxDIiIyPIYhEREZHsOQiIgMj2FIRESGxzAkIiLDYxgSEZHhMQyJiMjwGIZERGR4DEMiIjI8hiERERkew5CIiAyPYUhERIbHMCQiIsNjGBIRkeExDImIyPAYhkREZHgMQyIiMrz/BcgpmgPVYiKRAAAAAElFTkSuQmCC\" width=\"309\" height=\"179.508\" style=\"width: 309px; height: 179.508px;\"\u003e\u003c/p\u003e\u003cp\u003eWhere; n = minimum sample size\u003c/p\u003e\u003cp\u003ez = 95% confidence level (1.96)\u003c/p\u003e\u003cp\u003ed\u003csup\u003e2\u003c/sup\u003e = Degree of precision/the margin of sampling error (5%)\u003c/p\u003e\u003cp\u003eP = estimate of the prevalence rate (0.52)\u003c/p\u003e\u003cp\u003e\u003cb\u003eAfter addition of 10% of non-response rate, the final sample size was\u003c/b\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e423\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size by the second objective\u003c/b\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"+\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSample size calculation for second objective\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP1\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAllocation ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003esample\u003c/p\u003e\u003cp\u003esize\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1:1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"+\" colname=\"c8\"\u003e\u003cp\u003e258 + 10%=374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImmunization status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1:1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e2.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"+\" colname=\"c8\"\u003e\u003cp\u003e382 + 10%=420\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCough\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1:1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"+\" colname=\"c8\"\u003e\u003cp\u003e214 + 10%= 228\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cb\u003eNote\u003c/b\u003e: From the above sample size calculation for the two objectives, the highest sample size is \u003cb\u003e423\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003ch2\u003e3.6. Sampling Technique and procedure\u003c/h2\u003e\u003cp\u003eThere are 8 hospitals that have SAM management unit in Addis Ababa of those 37.5% were selected by lottery methods. Out of the total under-five children admitted with severe acute malnutrition in each public hospitals from March 1, 2023, to March 1, 2024 423 children was selected using a simple random sampling technique. The selection process was involved proportionally allocating to each selected therapeutic centre based on the size of admitted children during the specified time frame. This approach ensures that the sample adequately represents the population of interest across different centres, allowing for meaningful analysis of findings.\u003c/p\u003e\u003ch2\u003e3.7. Data Collection Instrument\u003c/h2\u003e\u003cp\u003eThe primary source of data for the study was record cards obtained from the therapeutic feeding centers in Addis Ababa city. The instrument used for data collection was adopted and modified from different literatures. This instrument is chosen because it closely aligns with the format used at Ethiopian OTP/SC centers, ensuring consistency and comparability of data collection methods. By utilizing a validated instrument from a related study, the research aims to gather relevant and standardized data to effectively address the research objectives and contribute to the existing body of knowledge on severe acute malnutrition among children(8).\u003c/p\u003e\u003cp\u003eThe record cards contain information of the child's sex, place of residence, age, anthropometric measurements, admission medical history, physical examination findings, and routine medications. Additionally, follow-up data such as anthropometric measurements, clinical features, routine medications administered during treatment, and outcome status are also documented on these cards. All relevant information was extracted from the cards to facilitate efficient data retrieval and analysis, enabling the researcher to systematically examine factors related to malnutrition and its outcomes among the population.\u003c/p\u003e\u003ch2\u003e3.8. Data Collection Procedures\u003c/h2\u003e\u003cp\u003eThe data was collected by 3 data collectors with Bachelor's degrees 2 nurses and 1 Public Health were recruited and trained for 2 days. Before departing from the area, all items on the data collection instrument was undergo thorough checks for completeness to ensure accurate data capture. Furthermore, the study participants' record charts were meticulously reviewed to verify their eligibility based on the predefined inclusion criteria. This procedure is useful to the data collectors to maintain the quality of the data collected, enhancing the reliability and validity of the study's findings.\u003c/p\u003e\u003ch2\u003e3.10. Operational Definitions\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eSevere acute malnutrition\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eweight-for height ratio of less than minus 3 standard deviations below the median reference population or weight-for-height ratio of below 70% or presence of nutritional oedema (15).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTherapeutic feeding centre\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eincludes outpatient therapeutic program and nutritional rehabilitation units at hospitals (15).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCured\u003c/strong\u003e\u003c/p\u003e\u003cp\u003ePatient/child that has reached the discharge criteria.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDefaulters\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eAre those who is self-referred out and lost for follow up\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTreatment Outcome\u003c/strong\u003e\u003c/p\u003e\u003cp\u003egrouped as recovered and not recovered from SAM management therapeutic feeding units in this study (15).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eRecovered\u003c/strong\u003e\u003c/p\u003e\u003cp\u003echildren with severe acute malnutrition declared as cured or recovered in the logbook of inpatient therapeutic feeding units (15).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eNot recovered\u003c/strong\u003e\u003c/p\u003e\u003cp\u003edefined as children discharged from inpatient therapeutic feeding units with outcome other than recovery in this study (death, default, and non-responder).\u003c/p\u003e\u003ch2\u003e3.11. Data Quality Assurance\u003c/h2\u003e\u003cp\u003eThe quality of the data was assured through several measures. Firstly, standardized pre-established questions were adopted to ensure the reliability of data collection. Secondly, rigorous training and recruitment processes were implemented for quantitative data collectors, as well as supervisors. These individuals were undergoing a comprehensive 1-day training program focused on data collection procedures, including how to extract information from the record cards and accurately fill out the checklist. And pretest was done among 5% of the total sample size in Sent peter hospital.\u003c/p\u003e\u003cp\u003eTo ensure the completeness, accuracy, and consistency of information during data collection, the principal investigators and supervisors was check the questionnaire before receiving the filled checklist from each data collector. This process was involved verifying that the questionnaire has been properly completed and cross-checking for any errors. Additionally, to facilitate effective communication with participants, the questionnaire was translated into Amharic (local language) for field use during data collection. Subsequently, it was re-translated into English for data processing and analysis, ensuring consistency in interpretation and analysis of the research. These measures aim to enhance the reliability and validity of the data collected, thereby strengthening the overall quality of the study.\u003c/p\u003e\u003ch2\u003e3.12. Data Analysis\u003c/h2\u003e\u003cp\u003eThe collected data was entered into Epi Data software, version 3.1, and then exported to SPSS version 26.0 for further analysis. The summarized data of basic features like calculation of means, medians, modes, standard deviations, and frequencies for demographic and clinical characteristics (e.g., age, weight, height, treatment duration).\u003c/p\u003e\u003cp\u003eThe results were presented using tables and graphs. Both bivariate and multivariate analyses were conducted. Variables showing association at a p-value \u0026lt; 0.2 in bivariate analysis will undergo further examination through multivariate analysis to identify true predictors of the dependent variable. At 95% confidence intervals was estimated via multivariable logistic regression analysis to identify factors associated with the outcome variable. A level of statistical significance was declared at a p-value ≤ 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Socio-Demographic Characteristics and Anthropometry of Study Participants\u003c/h2\u003e\u003cp\u003eThis study included a total of 418 participants, yielding a response rate of 98.8%. Of the 418 children with Severe Acute Malnutrition (SAM), 256 (61.2%) were male and 162 (38.8%) were female. Forty-four children (10.5%) were aged below six months. Regarding admission type, the majority of participants (376, or 90%) were new admissions, while the remaining 42 (10%) were readmissions. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003esocio-demographic characteristics of Under Five Children with Severe Acute Malnutrition Treated at Public Hospitals in Addis Ababa, Ethiopia 2024 (N\u0026thinsp;=\u0026thinsp;418)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;6 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;24 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;24 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePlace of residence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNutritional information on enrolment of children with SAM\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAdmission criteria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnly oedema (kwashiorkor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnly wasting (W/H) (marasmus)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBoth oedema and wasting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e285\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMUAC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eGrade of edema\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrade 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSAM with SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;70% of median\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;70% of median\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMUAC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;11.5 cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;11.5 cm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54.78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eChild is referred from\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOutreach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSFC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpontaneous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAdmission type\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNew admission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e376\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e90.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRe-admission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e4.2. Clinical related factors of the study participants\u003c/span\u003e\u003c/h2\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOf the study participants, 153 (36.6%) were enrolled during the spring season. The majority (254, or 60.8%) were age-appropriately vaccinated. Most participants (289, or 69.1%) had a temperature of 38\u0026deg;C or lower (\u003c/span\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e).\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical characteristics of Under Five Children with Severe Acute Malnutrition Treated at Public Hospitals in Addis Ababa, Ethiopia 2024 (N\u0026thinsp;=\u0026thinsp;418)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eclinical related variables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;418)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eImmunization status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVaccinated for age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePartially vaccinated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot vaccinated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTemperature\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt; = 37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eRespiratory rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e4.3. Medical co-morbidities of the study participants\u003c/span\u003e\u003c/h2\u003e\u003cp\u003eAbout 343(82.0%) of the study of the study participants were HIV negative. And 175(41.9%) of the participants had fever. Three hundred twenty (76.6%) of the participants had diarrhea.. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCo-morbidity at admission of children from birth up to 59 months of Under Five Children with Severe Acute Malnutrition Treated at Public Hospitals in Addis Ababa, Ethiopia 2024 (N\u0026thinsp;=\u0026thinsp;418)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eChild HIV status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNegative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e343\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e82.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePositive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePresence of TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e390\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e93.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePresence of fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e243\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePresence of cough\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePresence diarrhea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePresence of vomiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Routine medications used by the participants\u003c/h2\u003e\u003cp\u003eRegarding medications commonly used, about 256 (63.4%) of the study participants took intravenous antibiotics. And majority of the study participants 243 (58.1%) took vitamin A (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRoutine medication given for SAM children from birth up to 59 months in Addis Ababa public hospitals, Ethiopia, (N\u0026thinsp;=\u0026thinsp;418).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRoutine medication\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;600)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAntibiotic/s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e63.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVit A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e243\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFolic acid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23..2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e321\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e76.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAlbendazole or Mebendazole\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e312\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e74.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e4.5 Treatment outcome\u003c/h2\u003e\u003cp\u003eDuring the study period, 225(53.8%) with (CI: 48.9\u0026ndash;56.4) of SAM children were cured, 4.3% were dead, 26.1% were defaulters.(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e4.7. Bivariate and multivariate analysis of Factors associated with overall treatment outcome of the study participants\u003c/h2\u003e\u003cp\u003eIn the bivariate logistic regression analysis of malnutrition, the presence of fever, presence diarrhea, presence cough, presence vomiting, immunization status were associated with treatment outcome of SAM. Those variables that have a p-value less than or equal to 0.2 were entered into a multi- variable logistic regression model to adjust for possible confounders.\u003c/p\u003e\u003cp\u003eIn multivariable analysis, those predictors which showed statistical significance in bivariate analysis and p value less than 0.2 were used to run multivariate analysis. In multivariable analysis, those participants who experienced edema were about 4 times have poor treatment outcome (AOR\u0026thinsp;=\u0026thinsp;3.884: CI\u0026thinsp;=\u0026thinsp;2.160\u0026ndash;8.898) as compared to their counter parts. Those participants who has \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003evomiting\u003c/span\u003e were about 3.5 times have poor outcome as compared to those who don\u0026rsquo;t have vomiting (AOR\u0026thinsp;=\u0026thinsp;3.500: CI\u0026thinsp;=\u0026thinsp;1.265\u0026ndash;9.682). Those participants who had fever were about 3 lower treatment outcome as compared to (AOR\u0026thinsp;=\u0026thinsp;3.029: CI\u0026thinsp;=\u0026thinsp;2.406\u0026ndash;9.133). Those who were vaccinated for their age about 7 times had good treatment outcome as compared to their counter parts (AOR\u0026thinsp;=\u0026thinsp;6.85 CI\u0026thinsp;=\u0026thinsp;3.68\u0026ndash;12.76) (as shown in Table \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTreatment outcome of SAM and associated factors among under-five children in Addis Ababa public hospitals, 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eTreatment outcome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRecovered\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot Recovered\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAOR\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eType of malnutrition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNon-edematous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOedematous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.541(1.134\u0026ndash;5.104)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.884(2.160\u0026ndash;8.898) **\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePresence of vomiting\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.523(1.015\u0026ndash;8.421) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.500(1.265\u0026ndash;9.682)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;6 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.84(1.175\u0026ndash;8.581) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.315(1.214\u0026ndash;7.826)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u0026ndash;24 month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.75(1.35,2.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.83(1.35,2.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;24 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePresence diarrhea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.115(1.001\u0026ndash;4.508) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.216(1.073\u0026ndash;9.643) **\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.037\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePresence of fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.507(1.104\u0026ndash;7.203) *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.029(2.406\u0026ndash;9.133)**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eImmunization status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVaccinated for age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58(1.232\u0026ndash;4.206)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.85(3.68\u0026ndash;12.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0 .001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePartially vaccinated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e280\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.303(0.137\u0026ndash;0.673)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.75(0.14\u0026ndash;1.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot vaccinated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the treatment outcomes and associated factors for under-five children with Severe Acute Malnutrition (SAM) treated at public hospitals in Addis Ababa, Ethiopia. The cure, mortality, and defaulter rates were determined to be 53.8%, 4.3%, and 26.1%, respectively.\u003c/p\u003e\u003cp\u003e(16). (17, 21).\u003c/p\u003e\u003cp\u003eThe recovery rate among SAM children admitted to these hospitals was 53.8% (95% CI: 48.9\u0026ndash;56.4). It is also lower than the recovery rates of 76.8% and 80% reported in studies from Tigray and Zambia, respectively. However, the finding is comparable to rates of 64.9% and 62.4% reported from a study conducted in the Wolaita Zone (17, 21). These disparities may be attributed to differences in the settings where SAM management was implemented.\u003c/p\u003e\u003cp\u003eThis study's finding is higher than the rate of 48% reported in a previous Nigerian study. This discrepancy may be attributed to the Ethiopian government's intensified efforts to enhance maternal and child nutrition through its community-based Health Extension Program, as well as differences in the study settings. Conversely, several institutional factors may contribute to a slower recovery rate. These include high staff turnover, excessive caseloads, insufficient training, a lack of quality assurance procedures, shortages of medical supplies, and poor ward infrastructure\u0026mdash;particularly the absence of isolation rooms for malnourished children(17,21).\u003c/p\u003e\u003cp\u003eThis study reported a lower mortality rate (4.3%) than previous findings from the Tigray region (15, 17). This figure is also below the Sphere standard minimum recommendation of \u0026lt;\u0026thinsp;10%. The lower mortality rate observed in this study can be primarily attributed to children receiving care earlier, before complications developed. Another contributing factor was the appropriate clinical management of patients, including the timely prescription of routine medications.(15, 17).\u003c/p\u003e\u003cp\u003eThe analysis of factors associated with SAM treatment outcome (recovered/not recovered) revealed that children with complications like vomiting and edema had significantly higher odds of a poor outcome. Specifically, the presence of these complications was associated with nearly a four-fold increase in the odds of a poor outcome (Adjusted Odds Ratio [AOR]\u0026thinsp;=\u0026thinsp;3.884; 95% Confidence Interval [CI]: 2.160\u0026ndash;8.898) compared to children without them.\u003c/p\u003e\u003cp\u003eParticipants who experienced vomiting had approximately 3.5 times higher odds of a poor outcome compared to those who did not (AOR\u0026thinsp;=\u0026thinsp;3.500; 95% CI\u0026thinsp;=\u0026thinsp;1.265\u0026ndash;9.682). Similarly, the presence of fever was associated with roughly three times lower odds of a positive treatment outcome (AOR\u0026thinsp;=\u0026thinsp;3.029; 95% CI\u0026thinsp;=\u0026thinsp;2.406\u0026ndash;9.133).\u003c/p\u003e\u003cp\u003eVaccinated children had approximately seven times higher odds of recovery compared to unvaccinated children. This finding is consistent with a study conducted at Bahirdar Felege Hiwot hospital, which reported 4.4 times higher odds (14). The most probable explanation is that immunization prepares the body's immune system to fight the specific disease-causing microorganism, thereby facilitating recovery.\u003c/p\u003e\u003cp\u003eOverall, vaccination was a positive predictor of recovery. Furthermore, attaching a follow-up chart to each child's folder and closely monitoring their progress significantly contributed to improving recovery rates for children with severe acute malnutrition.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study analyzed the treatment outcomes and influencing factors for children under five with severe acute malnutrition (SAM) at public hospitals in Addis Ababa, Ethiopia. The cure, mortality, and defaulter rates were 53.8%, 4.3%, and 26.1%, respectively. The recovery rate fell below the internationally accepted standard. Multivariable analysis identified several significant predictors of outcomes: the presence of edema and vomiting was associated with poorer results, with edema corresponding to a four-fold increase in the risk of a poor outcome. Conversely, vaccination for age was linked to better outcomes, while fever was associated with a three-fold reduction in the risk of a poor outcome.\u003c/p\u003e\u003cp\u003e\u003cb\u003e8. Recommendation\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFor health care providers\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eHealth care providers should emphasize those SAM cases with comorbidity like cough and readmission case which require strict follow up according to the protocol and increased use of SAM management follow up chart for all SAM patients.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eStrong attention should be given to those who are Edematous patients\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFor Addis Ababa Regional health bureau\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eIt is also recommended to give community-based health education and counseling for mothers to enhance child immunization.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eStrict follow up to be fully immunization of under 5 children is recommended\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAACAHB Addis Ababa City Administration Health Bureau\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAOR Adjusted Odds Ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI Confidence Interval\u003c/p\u003e\n\u003cp\u003eCOR Crudes Odds Ratio\u003c/p\u003e\n\u003cp\u003eEDHS\u0026nbsp; Ethiopian Demographic and Health Survey\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOTP \u0026nbsp;Outpatient Therapeutic Program\u003c/p\u003e\n\u003cp\u003eSAM Severe Acute Malnutrition\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSC Stabilization centre\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUTIs\u0026nbsp; urinary tract infections\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWFH weight-for-height\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp;World Health Organization\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThis is the approval number A|A|732|227\n\nEthical approval and consent to participate; the ethical clearance was obtained from Institutional Review Board of menlik II Medical and Health Sciences college and official letters was submitted to each respective health facility to collect data from the therapeutic feeding centres. After explaining the objectives of the study, informed written consent was obtained from all mothers and caregivers, and anonymity and confidentiality of the data were kept. Respondents have the right not to participate or withdraw from the study at any stage, and all study methods were performed in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003cp\u003e;Ethical clearance and approval was required from the Research Review Committee of Minilik II medical and Health Science College prior to beginning the study. Then letter was received from Addis Ababa public health and emergency management directorate. Additionally, permission letters was obtained from the Addis Ababa City Administration Health Bureau (AACAHB) and the respective public hospitals to collect data from the therapeutic feeding centres. Confidentiality of all collected information was maintained, and the privacy of participants was respected throughout the study process and all study methods were performed in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003e; Not applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003e; The authors declare that they have no conflicts of interest\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003e; Not applicable.\u003c/p\u003e\u003ch2\u003eAuthor contributions;\u003c/h2\u003e\u003cp\u003eC.G; Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Visualization, Writing \u0026ndash; original draft\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\u003cp\u003e; The data used to support the findings of this study are available from the corresponding author upon request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMezemir M, Girma M, Bekele D. Treatment Outcome and Associated Factors of Acute Malnutrition Among Children in the Therapeutic Feeding Center of Public Hospitals in Addis Ababa, Ethiopia: An Institutional-Based Cross-Sectional Study. Pediatr Heal Med Ther. 2022;Volume 13(April):145\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eMa\u0026rsquo;Alin A, Birhanu D, Melaku S, Tolossa D, Mohammed Y, Gebremicheal K. Magnitude and factors associated with malnutrition in children 6-59 months of age in Shinille Woreda, Ethiopian Somali regional state: A cross-sectional study. BMC Nutr [Internet]. 2019;2(1):1\u0026ndash;12. Available from: http://dx.doi.org/10.1186/s40795-016-0079-1\u003c/li\u003e\n\u003cli\u003eCollins S, Dent N, Binns P, Bahwere P, Sadler K, Hallam A. Management of severe acute malnutrition in children. Lancet. 2006;368(9551):1992\u0026ndash;2000. \u003c/li\u003e\n\u003cli\u003eCathcart EP. Food and nutrition. Br Med J. 2021;1(3973):435\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eKebede MA. Determinants of treatment outcomes of severe acute malnutrition among under-5 children in Yekatit 12 Hospital , Addis Ababa , Ethiopia : a retrospective cohort study. 2020; \u003c/li\u003e\n\u003cli\u003eFMOH. Ethiopian Hospital Services. Guideline. 2016;1(September,2016):133. \u003c/li\u003e\n\u003cli\u003eAlemneh K, Sintayehu A, Dejene H, Getenesh B. Intestinal parasitic infections and nutritional status of pre-school children in Hawassa Zuria District, South Ethiopia. African J Microbiol Res. 2017;11(31):1243\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eRaru TB, Mamo Ayana G, Bahiru N, Deressa A, Alemu A, Birhanu A, et al. Quality of antenatal care and associated factors among pregnant women in East Africa using Demographic and Health Surveys: A multilevel analysis. Women\u0026rsquo;s Heal. 2022;18. \u003c/li\u003e\n\u003cli\u003eMengesha MM, Roba HS, Ayele BH, Beyene AS. Level of physical activity among urban adults and the socio-demographic correlates: A population-based cross-sectional study using the global physical activity questionnaire. BMC Public Health. 2019;19(1):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eModule 6: Dietary Diversity Score [Internet]. Available from: http://www.fao.org/food/nutrition-assessment/food-basedindicators/en/\u003c/li\u003e\n\u003cli\u003eDarsene H, Geleto A, Gebeyehu A, Meseret S. Magnitude and predictors of undernutrition among children aged six to fifty nine months in Ethiopia: A cross sectional study. Arch Public Heal. 2017 Jul 10;75(1). \u003c/li\u003e\n\u003cli\u003eEwart S, Langfeld Layout M, Sadki R, Bonita R, Reddy S, Galbraith S, et al. WHO Library Cataloguing-in-Publication Data. 2023;1\u0026ndash;187. \u003c/li\u003e\n\u003cli\u003eTosheno D, Mehretie Adinew Y, Thangavel T, Bitew Workie S. Risk Factors of Underweight in Children Aged 6-59 Months in Ethiopia. J Nutr Metab. 2017;2017. \u003c/li\u003e\n\u003cli\u003eTibebu NS, Emiru TD, Tiruneh CM, Getu BD, Azanaw KA. \u0026lt;p\u0026gt;Underweight and Its Associated Factors Among Children 6\u0026ndash;59 Months of Age in Debre Tabor Town, Amhara Region of Ethiopia, 2019: A Community-Based Cross-Sectional Study\u0026lt;/p\u0026gt;. Pediatr Heal Med Ther. 2020 Nov;Volume 11:469\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eFletcher K. Sustainable fashion and textiles: Design journeys. Sustain Fash Text Des Journeys. 2022;(January):1\u0026ndash;237. \u003c/li\u003e\n\u003cli\u003eAdmasu Amare . Survival Status and Its Associated Factors among Under-Five Children Admitted with Complicated Severe Acute Malnutrition in Hospitals of Wolaita Zone, South Ethiopia: Retrospective Cohort Study. J Nutr Heal Food Sci. 2017;5(4):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eHassen SL, Astatkie A, Mekonnen TC, Bogale GG. Survival Status and Its Determinants among Under-Five Children with Severe Acute Malnutrition Admitted to Inpatient Therapeutic Feeding Centers in South Wollo Zone, Amhara Region, Ethiopia. J Nutr Metab. 2019;2019. \u003c/li\u003e\n\u003cli\u003eMengesha MM, Deyessa N, Tegegne BS, Dessie Y. Treatment outcome and factors affecting time to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program. Global health action. 2016; 9(1):30704.\u003c/li\u003e\n\u003cli\u003eMaleta K, Amadi B. Community-based management of acute malnutrition (CMAM) in sub-Saharan Africa: case studies from Ghana, Malawi, and Zambia. Food and nutrition bulletin. 2014; 35(2_suppl1): S34\u0026ndash;S8.\u003c/li\u003e\n\u003cli\u003eGolden M, Grellety Y. Protocol for the management of severe acute malnutrition. Ethiopia: MOH. 2007.\u003c/li\u003e\n\u003cli\u003eYebyo HG, Kendall C, Nigusse D, Lemma W. Outpatient therapeutic feeding program outcomes and determinants in treatment of severe acute malnutrition in tigray, Northern Ethiopia: a retrospective cohort study. \u003c/li\u003e\n\u003cli\u003eChamois S, Golden M, Grellety Y. Ethiopia Protocol for the management of Severe Acute Malnutrition (2007). 2007.\u003c/li\u003e\n\u003cli\u003eOrganization WH. Guideline: updates on the management of severe acute malnutrition in infants and children: World Health Organization; 2013.\u003c/li\u003e\n\u003cli\u003eFHAPCO. Federal, HIV Prevention, AIDS Control Office Multi-sectoral HIV AIDS response: annual monitoring and evaluation report 2008.\u003c/li\u003e\n\u003cli\u003eYebyo HG, Kendall C, Nigusse D, Lemma W. Outpatient therapeutic feeding program outcomes and determinants in treatment of severe acute malnutrition in Tigray, northern Ethiopia: a retrospective cohort study. Plos one. 2013; 8(6).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Menlik II Medical and Health Sciences College ","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Severe Acute Malnutrition, children under age 5, treatment outcome","lastPublishedDoi":"10.21203/rs.3.rs-7766421/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7766421/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Severe acute malnutrition (SAM) remains a major obstacle to achieving millennium development goals and is a leading cause of child mortality. However, there is limited information on the factors influencing treatment outcomes for children admitted with SAM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: \u003cstrong\u003e:\u003c/strong\u003e This study aimed to assess treatment outcomes and their associated factors among children under five years of age with severe acute malnutrition admitted to public hospitals in Addis Ababa, Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective cohort study was conducted using secondary data from medical records of patients enrolled in the therapeutic feeding centre from March 2024 to august 2024. The total sample size was 423. Samples were collected at 3 public hospitals in Addis Ababa, which was selected by simple random sampling. A structured questionnaire was used to collect data from the available individual folders and registers. The data analysis was performed using bivariable and multivariable analysis. In bivariable analysis those predictors whose p value less than 0.25 was entered into multivariable analysis and those whose p value less than 0.05 was considered as statistically significant. The odds ratio with 95% CI was used to identify predictor variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 418 records of children with a diagnosis of severe acute malnutrition were reviewed. Of these cases of malnutrition, the recovery rate was 53.8%. The deathrate, default rate, and medical transfer were 4.3%, 26.1%, and 15.8% respectively. In multivariable analysis, those participants who experienced oedema were about 4 times have poor treatment outcome (AOR=3.884: CI= 2.160-8.898) as compared to their counter parts. Those participants who has vomiting were about 3.5 times have poor outcome as compared to those who don’t have vomiting (AOR= 3.500: CI=1.265-9.682). Those participants who had fever were about 3 lower treatment outcome as compared to their counterpart (AOR=3.029: CI=2.406-9.133). Those who were vaccinated for their age about 7 times had good treatment outcome as compared to their counter parts (AOR= 6.85CI=3.68–12.76)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and recommendation\u003c/strong\u003e: The assessment of severe acute malnutrition (SAM) treatment outcomes in children under five in Addis Ababa identified significant challenges, including a low cure rate, elevated mortality, and a high default rate. Healthcare providers should prioritize SAM cases with complications like vomiting and fever. Emphasis should be given to edematous patients. Addis Ababa Regional Health Bureau should provide community-based health education and counseling for mothers on EPI services.\u003c/p\u003e","manuscriptTitle":"Treatment Outcome and Associated Factors Among Under Five Children with Severe Acute Malnutrition Treated in Ethiopia: A Multi- Center Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 08:55:45","doi":"10.21203/rs.3.rs-7766421/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd29b658-5134-42da-87a7-3cad0a249d5b","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56295957,"name":"Nutrition \u0026 Dietetics"}],"tags":[],"updatedAt":"2025-12-01T14:23:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 08:55:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7766421","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7766421","identity":"rs-7766421","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}