Determinants of severe acute malnutrition relapse among children aged 6–59 months attending outpatient treatment programmes at selected public health facilities in Gode city and district, Somali region, Eastern Ethiopia: a case-control study

Abstract

OBJECTIVES: This study aimed to identify the determinants of severe acute malnutrition (SAM) relapse among children aged 6-59 months. DESIGN: Case-control study. SETTING: Selected public health facilities in Gode city and district, Somali region, Eastern Ethiopia, from April 1-30, 2024. PARTICIPANTS: 394 (131 cases and 262 controls) children aged 6-59 who were treated for SAM and discharged. OUTCOME MEASURES: 387 (129 cases and 258 controls) participated, resulting in an overall response rate of 98.2%. A logistic regression model with an OR of 95% CI was used to estimate the strength of the association, and a p value <0.05 was considered statistically significant. RESULT: The mean age of mothers/caretakers for cases and controls was 30.0 (±6.9) and 29.2 (±6.2) years, respectively, with over half (51.9% cases and 54.3% controls) falling in the 25-34 age range. Significantly associated factors with SAM relapse were food-insecure households (adjusted (AOR)=2.26; 95% CI 1.39 to 3.65), poor hand-washing practices (AOR=3.11; 95% CI 1.90 to 5.08), duration of treatment stay <8 weeks (AOR=2.03; 95% CI 1.25 to 3.30), mid-upper arm circumference (MUAC) at discharge <12.5 cm (AOR=2.45; 95% CI 1.37 to 4.39) and not receiving vitamin A supplementation in the 6 months (AOR=3.89; 95% CI 2.35 to 6.44). CONCLUSION: This study shows the important determinant factors associated with SAM relapse among 6-59-month-old children after discharge from outpatient therapeutic programmes in Godey City and district in Eastern Ethiopia. The significantly associated factors, including household food insecurity, inadequate hand-washing practices, shorter treatment duration, low MUAC at discharge and lack of vitamin A supplementation, indicate the multifaceted nature of this public health problem.Enhancing household food security through community-based programmes, promoting health education on proper hand washing and hygiene practices, extension of outpatient treatment duration to prevent premature discharge, ensuring that MUAC threshold for discharge is properly attained, and integrating postdischarge Vitamin A supplementation into primary healthcare services.