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

INTRODUCTION: Severe acute malnutrition (SAM) affects 17 million under-5 children globally, of which 4.4 million are from Sub-Saharan Africa. About 1 million severely malnourished children die every year. Despite Malawi’s efforts to reduce child mortality, inpatient mortality among children with SAM has remained high. This study was aimed at assessing factors associated with treatment outcomes of SAM among children aged 1 to 59 months admitted at Queen Elizabeth Central Hospital (QECH) nutrition unit. METHODS: This was a retrospective cross-sectional study. Systematic random sampling was done to select medical files. Exposure variables were sociodemographic characteristics, clinical characteristics and medical comorbidities associated with malnutrition while outcome variables were died, transfer to outpatient therapeutic program (OTP) and defaulted. Multivariable logistic regression was used to assess associations and significance was considered at a p-value less < 0.05. RESULTS: About 55% of the children with SAM were males, and the age ranged from 6 to 59 months. About 21% of children with SAM died, 77% were transferred to Outpatient Therapeutic Program (OTP), and 2% defaulted. Characteristics associated with mortality were dehydration [ARRR:6.47, (95%CI:1.5-26.6)], pneumonia [ARRR 4.04, (95%CI:1.1-14.9)], anaemia [ARRR:4.5, (95%CI:1.5-13.8)], hypoglycemia [ARRR:10.8, (95%CI:1.6-69.5)]. Malaria [ARRR:0.07, (95%CI:0.01-0.9)], and cerebral palsy [ARRR 0.11, 95% CI: (0.01-0.9)] had 93% and 89% reduced risk of death respectively. CONCLUSION: Mortality was high as compared to the World Health Organization (WHO) and Community Management of Acute Malnutrition (CMAM) recommended standards of