Factors associated with treatment outcomes of severe acute malnutrition among under five children admitted at Queen Elizabeth Central Hospital (QECH) nutrition unit: A retrospective cross-sectional study

Abstract Introduction: SAM affects 17 million under-5 children globally, of which 4.4 million are from sub-Saharan Africa. About 1 million SAM children die every year. Despite Malawi’s efforts to reduce child mortality, inpatient mortality among SAM children has remained high. This study was aimed at assessing factors associated with treatment outcomes among SAM children aged 1 to 59 months admitted to QECH. Methods: This was a retrospective cross-sectional study. A data collection tool was used to collect data from the medical files of the children aged 1 to 59 months admitted at QECH NRU from 2017 to 2020. Systematic random sampling was done to select the medical files. Bivariate and multivariate logistic regressions were conducted to assess associations. The statistical significance was declared when the p-value was less than 0.05 Results: Male SAM children constituted 55%, and the age ranged from 6 to 59 months with a median of 18 months. About 21% of SAM children died, 77% were transferred to OTP, and 2% defaulted. Characteristics that were associated with mortality were stopping breastfeeding [ARRR:3.2 (95%CI: 1.1- 9.3)], pneumonia [ARRR:3.1 (95%CI:1.2-8.1)], dehydration [ARRR:6.6 (95% CI: 2.0-22)], sepsis [ARRR:2.8 (95%CI:1.1-7.0)], unknown breastfeeding status [ARRR:14.9 (95%CI:2.4-91.8)], and unknown hypoglycaemia in the ward [ARRR 0.04 (95% CI 0.02-0.1)]. Conclusion: Early detection of life-threatening conditions, timely management of associated medical comorbidities, and adhering to WHO SAM inpatient management protocols might be effective in reducing SAM case fatality estimates.