Abstract

Background: Globally, Severe Acute Malnutrition (SAM)  has been reduced by only 11% over the past 20 years and continuing to be an important cause of morbidity and mortality. So far, in Sub-Saharan Africa, several primary studies have been conducted on recovery rate and determinants of severe acute malnourished in under-five children. However, comprehensive reviews which would have a strong evidence for designing interventions are lacking. So, this review and meta-analysis was  conducted to bridge this gap.

Methods: A systematic review of observational studies published in the years between 1/1/2000 to 12/31/2018 was conducted in accordance tothe Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement. Two reviewers have been searched and extracted data from CINAHL(EBSCO), MEDLINE (via Ovid), Emcare, PubMed databases, and Google scholar databases. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers and only studies with fair to good quality were considered for the final analysis. The review presented the pooled recovery rate from SAM and an odds ratio of risk factors affecting recovery rate after checking for heterogeneity and publication bias. The review protocol has been registered in PROSPERO with registration number CRD42019122085.

Result: Children with SAM from 54 primary studies (n=140,148)were finally included. A pooled rate of recovery  was 71.2% (95% CI: 68.5-73.8; I²=98.9%).  Children who received  routine medication (Pooled Odds ratio (POR):1.85;95% CI: 1.49 -2.29; I²=0.0%), older age (POR: 1.99;95% CI: 1.29 -3.08; I²=80.6%) and absence of co-morbidity (POR:3.2;95% CI: 2.15 -4.76; I2=78.7%) increased the odds of recovery rate whereas being HIV infected (POR; 0.19 ;95% CI: 0.09 -0.39; I²=42.9%) reduced the odds of  recovery rate.

Conclusion: The meta-analysis decipher that the pooled recovery rate did not achieve the standard and further works would be needed to improve the recovery rate. So, factors that were identified might help to revise the plan that set by the countries and further research might be required to explore fidelality to WHO SAM management protocol.