Abstract

Background: Despite the presence standard protocol for the management of severe acute malnutrition case-fatality rates in African hospitals remain unacceptably high. The case in Ethiopia is not different from the others. Assessing survival status and identifying predictors of mortality may help to overcome this problem. Therefore, this study was aimed to assess survival status and predictors of mortality among children with severe acute malnutrition admitted to stabilization centers of general hospitals in Tigray region, northern Ethiopia.

Methods: 24 months retrospective longitudinal study was conducted among 569 randomly selected medical records of children admitted to stabilizing centers. Data were entered into Epi Info7 and analyzed by STATA version 11.A life table was constructed to estimate the probabilities of death over time.  Kaplan–Meier survival curve together with log-rank test was fitted. Both bi-variable and multivariable Cox regression analysis was conducted to identify the independent predictors of mortality.  Proportionality of Hazard assumption was tested. The goodness of fit of the final model was checked by Nelson–Aalen cumulative hazard function against Cox-Snell residual. Association was summarized by using AHR, and statistical significances were declared at 95% CI and P-Value< 0.05.

Results: During follow up, 456 [82% (95% CI=78.6-85.3)] of children had got cured and discharged, 37[6.65 %( 95% CI=4.8-8.8)] were absconded and 21[3.8% (95% CI= 2.2-5.6)] were died. The cumulative probability of survival at the end of the 1^st, 2^nd and 3^rdweek was 98%, 96.4%, and 92.7% respectively. The overall mean survival time was 41.93 [95% CI =40.17- 43.68] days. Impaired conscious level [AHR=6.69, 95%CI = 2.43-19.93], development of comorbidity after admission [AHR 12.71, 95% CI=2.79-57.94] and Being urban in residence [AHR=2.73, 95%CI =1.12-6.64] were the independent predictors of mortality.

Conclusions: Treatment outcomes were in an acceptable level of national and international standards. Impaired consciousness level, development of comorbidity after admission and being urban in residence were the independent predictors of mortality. Interventions to reduce further mortality should focus on children with impaired consciousness level and developed comorbidity after admission.