Abstract:
Background: Severe acute malnutrition (SAM) is the leading cause of child mortality in
developing nations. In Ethiopia, despite the presence of clinical management protocols, under five mortality is still high. Moreover, many of the predictors for mortality during inpatient care
were not well addressed. Therefore, the aim of the current study was to determine the time to
death and its predictors among children under five with severe acute malnutrition.
Patients and Methods: A 48-month retrospective cohort study was carried out among 346
children under five from 6 to 59 months of SAM. Data were collected from patient charts by
using simple random sampling and entered in EpiData 3.1 and analyzed with STATA 14. A
Kaplan–Meier curve and long rank test were used to estimate the survival time and compare
survival curves between variables. A Cox proportional hazard model was fitted to identify
predictors. Variable with P-value < 0.05 with 95% confidence interval was considered as
significant for this study.
Results: A total of 346 children were followed with an incidence rate of 5.5 deaths per 1000
person-day observation (95%CI: 3.5– 8.5). During the follow-up, 212 (61%) were males, 20
(5.8%) had died. This study also showed that males were nearly twice as likely to die than
females. Sepsis (AHR: 1.62; 95%CI: 1.10– 2.37), hospital admission (AHR: 2.29; 95%CI: 1.43–
3.65), presence of edema, (AHR: 1.81; 95%CI: 1.2– 2.19), TB (AHR: 1.62; 95%CI: 1.10– 2.37)
and breast feeding (AHR: 0.41; 95%CI: 0.29– 2.37) were predictors of mortality.
Conclusion: The overall mean survival time and death was in line with the minimum SPHERE
standard. The main predictors of death were having edema, sepsis, hospital admission and breast
feeding status at admission. Therefore, it should be better to treat patients with TB, sepsis, edema
according to SAM national protocol and promote breast feeding practice.
