Abstract
BACKGROUND: Severe acute malnutrition (SAM) among children under five years of age remains a huge public health and economic burden in Sub-Saharan Africa. We investigated time to recovery and its predictors among children aged 6 to 59 months admitted into Community-based Management of Acute Malnutrition (CMAM) stabilisation centres for complicated severe acute malnutrition and whether the outcomes met the minimum Sphere standards. METHODS: The study was a retrospective cross sectional quantitative review of data recorded in six CMAM stabilization centres registers in four Local Government Areas, Katsina state, Nigeria from September 2010 to November 2016. Records of 6925 children, aged 6-59 months with complicated SAM were reviewed. Descriptive analysis was used to compare performance indicators with Sphere project reference standards. Cox proportional hazard regression analysis was used to estimate the predictors of recovery rate at p < 0.05 and Kaplan-Meier curve to predict the probability of surviving different forms of SAM. RESULTS: Marasmus was the most common form of severe acute malnutrition (86%). Overall, the outcomes met the minimum sphere standards for inpatient management of SAM. Children with oedematous SAM (13.9%) had the lowest survival rate on Kaplan-Meier graph. The mortality rate was significantly higher during the 'lean season'-May to August (Adjusted Hazard Ratio (AHR) = 0.491, 95% CI = 0.288-0.838). MUAC at Exit (AHR = 0.521, 95% CI = 0.306-0.890), marasmus (AHR = 2.144, 95% CI = 1.079-4.260), transfers from OTP (AHR = 1.105, 95% CI = 0.558-2.190) and average weight gain (AHR = 0.239, 95% CI = 0.169-0.340) were found to be significant predictors of time-to-recovery with p values < 0.05. CONCLUSION: The study showed that, despite a high turnover of complicated SAM cases in the stabilization centres, the community approach to inpatient management of acute malnutrition enabled early detection and reduced delays in access to care of complicated SAM cases. In the face of health workforce shortage in rural communities to provide pediatric specialist care for SAM children, we recommend task shifting to community health care workers through in service training could bridge the gap and save more lives of children dying from the complication of SAM in rural communities in Nigeria.