Treatment Outcomes and Predictors of Length of Stay in Outpatient Therapeutic Programs for Severe Acute Malnutrition in East Hararghe, Ethiopia: A Retrospective Follow-up study

Abstract

Background: In Ethiopia, severe acute malnutrition affects 7% of under-five children, posing a major public health challenge. Length of stay in treatment programs impacts patient outcomes, resource use, and healthcare costs. How­ever, evidence on treatment outcomes and predictors of length of stay in outpatient therapeutic programs (OTPs) is limited. Therefore, this study aimed to assess treatment outcomes and identify predictors of length of stay among under-five children with severe acute malnutrition in East Hararghe Zone, Oromia Region, Eastern Ethiopia.

Methods: A facility-based retrospective follow-up study was conducted in drought-affected Eastern Ethiopia among 240 randomly selected under-five children with severe acute malnutrition from 18 outpatient therapeutic sites across three woredas. Data were extracted from logbooks using structured checklists. Multivariable Poisson regression anal­yses were performed using STATA 17 to identify predictors of length of stay. Associations were reported as Incidence Rate Ratios (IRR) with 95% CIs, and statistical significance was defined as p < 0.05.

Results: Of 240 children, 83.33% recovered, with 7.50% default, 5.42% deaths, and 3.75% transferred. The mean length of stay was 41.7 (±18.3) days (range: 4–111 days). Multivariable Poisson regression revealed that significantly shorter stays were associated with age ≥24 months (IRR = 0.994; 95% CI: 0.924, 0.996), higher mid-upper arm circumference (IRR = 0.897; 95% CI: 0.876, 0.918), a positive appetite test at admission (IRR = 0.918; 95% CI: 0.845, 0.997), vitamin A supplementation (IRR = 0.864; 95% CI: 0.784, 0.952), folic acid supplementation (IRR = 0.787; 95% CI: 0.658–0.963), and antibiotic treatment (IRR = 0.642; 95% CI: 0.552, 0.861). In contrast, the presence of edema sig­nificantly increased the length of stay (IRR = 1.083; 95% CI: 1.031, 1.138).

Conclusion: The treatment outcomes (83.33% recovery) and mean length of stay (41.7 days) met global humanitarian Sphere standards. Key factors influencing recovery duration included edema, age, mid-upper arm circumference, and appetite test results. Clinical management such as antibiotics, vitamin A, and folic acid significantly reduced length of stay. To optimize outcomes in resource-limited emergency settings, the Ministry of Health should strengthen mi­cronutrient supplementation programs, enhance early mid-upper arm circumference-based detection, and implement tailored protocols for children with edematous malnutrition