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Survival Status of Children Treated for Severe Acute Malnutrition In Ethiop. j. public health nutr. Survival status of children treated for severe acute malnutrition in outpatient therapeutic program by season in Kembata Tembaro Zone, Southern Ethiopia Wondwosen Fikreselam1*, Samson Mideksa2 and Sintayehu Abate Temesgen3 1School of nutrition, food science and technology, Hawassa University, Hawassa, Ethiopia 2Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia 3Scientif and Ethical Review Office, Ethiopian Public Health Institute, Addis Ababa, Ethiopia *Corresponding author: [email protected] Abstract Background: Malnutrition is a deficiency state of both macro and micronutrients (under-nutrition) and their over consumption (over-nutrition) causing measurable adverse effects on human body structure and function, resulting in specific physical and clinical outcomes. Nearly 52 million under five children globally are malnourished, and in Africa it is about 14 million. However, there is little information known about seasonal variations of admission. Objective: To assess seasonal variations of admission of children treated for Severe Acute Malnutrition at Outpatient Therapeutic Program in Kembata Tembaro Zone, Southern Ethiopia. Methods: A retrospective facility based cross-sectional study was conducted from records of outpatient therapeutic program from January 01 to December 30, 2017. Four hundred thirty three children represented by their Outpatient Therapeutic Program card were included from three Woredas selected by simple random sampling technique. From these three Woredas, 18 health posts were selected by simple random sampling. Population Proportion to size allocation was used to assign sample for each selected Woredas. Systematic sampling technique was used to assign child card for each selected health posts in the study area. Data entered, cleaned and analyzed using SPSS version 20. Results: Seasonal distribution of Sever Acute Malnutrition admission to outpatient therapeutic program in Kembata Tembaro Zone shows 55.7% at 95% CI were admitted from December to May, 2017. Children survival rate through time was affected in statistically significant figures by distance from home to health posts <30 minutes (AHR=1.28; (95% CI=1.04-1.58)) Conclusions: Large extents of children were admitted to the program in dry season with climax admission at May. The survival rate was higher in wet season. The stakeholders should recognize as food insecurity can happen in dry season and focus on creating the capacity of the OTP providers on proper management of SAM. Keywords: Outpatient therapeutic program, seasonal variations, severe acute malnutrition, Southern Ethiopia, Kembata Tembaro Introduction climate-related hazards are expected to magnify Malnutrition is defined as disorder resulting from a seasonal stresses on livelihoods, food and water deficiency or excess of one or more essential nutrients. security (Sullivan 2013). Seasonal variations in Usually under nutrition is more common in developing temperature and rainfall can significantly impact countries (Alemu 2020). Although the prevalence may public health risks and disease incidence (Patz et al. differ, it is also found in developed countries (WHO 2000). In terms of food security, availability of food and UNICEF 2009). Severe acute malnutrition (SAM) decreases prior to harvest periods for agricultural is defined as a weight-for-height measurement of 70% producers and prior to rains for pastoralists. At the or more below the median, or three SD or more below same time, food prices rise due to limited availability the mean WHO reference values, which is called further impeding access for the majority of households “wasted,” the presence of bilateral pitting oedema of reliant on the market to cover at least some of their nutritional origin, which is called “edematous food needs. This period is commonly known as the malnutrition,” or a mid-upper-arm circumference of ‘lean’ season, or hunger period, when many less than 110 mm in children age 1–5 years (UNICEF households are teetering on the edge of food et al. 2018; Shanka et al. 2015). Under-nutrition and insecurity, and usually coincides with the rainy season, nutritional disorders are major problems, which are when disease strikes hardest. The end result is seasonal resulting from inadequate food intake both in quality peaks in acute malnutrition (Sullivan et al. 2013). In and quantity. Inadequate intake of carbohydrates, some studies conducted in Ethiopia, seasons were protein, vitamins and mineral supply to the cells of the classified into four: spring (September – November), body to satisfy the physiological requirements is one winter (December – February), autumn (March - of the causes for malnutrition (Chamois et al. 2007). May), and summer (June –August) to identify the Seasonality refers to any regular pattern or variation prevalence of infectious diseases. The first two that is correlated with the seasons. It is well known that classifications above are predominantly dry seasons Volume 4 Issue 2 January 2021 ISSN 2709-1341 136 https://ejphn.ephi.gov.et/ Ethiop. j. public health nutr. while the second two are wet seasons (Egata et al. posts, six sites per each Woreda were selected through 2013). In this study, seasons were reclassified into two systematic random sampling technique. A total of 18 major categories: the dry season winter and autumn OTP sites were selected for the study. Finally, OTP (December to May) and the wet season summer and card of children aged 6-59 months were selected by spring (June to November) because they are believed systematic random sampling method from each HP to have an association with the nutritional status of based on their unique identification number. To use children as the Zonal agriculture and health this method, K value was determined at each health department report indicated. post. There were little studies conducted to elucidate the Structured and pretested data collection checklist was effectiveness of Outpatient Therapeutic Program used to collect all the necessary information. The (OTP) in Ethiopia. But as indicated, SAM was checklists were used to collect data from both children identified as public health problem in Southern Nation OTP cards and registration books. The checklist was Nationalities People Region (SNNPR) particularly in initially prepared in English language and translated to Kembata Tembaro Zone. This study is designed to Amharic, and then retranslated back to English to investigate the seasonal variation of admission of check for clarity, consistency and completeness. The children treated for SAM at OTP among children aged main sources of data were children cards and some 6-59 months through time in Kembata Tembaro Zone, variables missing in cards were checked from Southern Ethiopia, 2017. registration book. Materials and Methods Pilot study was done with 5% of the sample size of the A retrospective institutional based cross-sectional study children’s OTP cards in Kedida Gamela study was conducted over the period from February Woreda, which is one of the Woredas found in the 21st to March 10th, 2018 at Kembata Tembaro Zone and its weather condition, people’s life style and administrative Zone, Southern Nation Nationalities the other things are almost proximal to the study areas People Region. The annual report of zonal health of the Zone. Based on the findings of the pilot study, department indicates nearly 1600 under five SAM amendments were conducted and incorporated to the children were managed at OTP in 2017. All SAM checklist prior to actual survey. Survival status (cured children who were following their treatment at 135 or censored) was the dependent variable while socio- Health Posts (HPs) of Kembata Tembaro Zone, in demographic (age and sex of child, distance from 2017 were the source population. All selected SAM home to HPs), weather related factors (seasons of children OTP cards from the 18 specific HPs in 2017 admission) were the independent variables of this were study populations. All SAM children who were study. The collected data were checked for admitted to OTP from January 01 to December 30, completeness and consistency, carefully entered, 2017 were included. Children cards that contain thoroughly cleaned, coded and analyzed using SPSS incomplete information were excluded from the study. version 20. To decide significance, p value <0.05 was considered. The outcome was coded as survived or Representative sample size of 433 was calculated censored and multivariate Cox-regression was used to based on assumptions of single population proportion, determine the average hazard ratio by controlling the 95% confidence level or 5% margin of error and confounding effect of each factors. expected frequencies from study done in Wolaita Zone, SNNPR. Seasonal variation of admission: P = Results 40.3% (0.4), 1-P= 59.7% (0.6), Z= 1.96, and d= 0.05 Socio-demographic characteristics: All the 433 of the (Kabalo and Shanka 2016) were accordingly children’s cards found out to be correctly identified as considered for sample size calculation. Assuming 5% SAM and their socio-demographic characteristics are for the cards or registration books that were not well presented (Table 1). There was greater representation registered or ineligible, the adjusted sample size was of 6 to 23 months old children (53.1%), and females calculated as 412 x 5%= 433. There are seven Woredas (54.7%). Mean and SD of the children’s age at (Kedida Gamela, Kacha Birra, Doyogena, Angecha, admission were 23.28
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