ARSI UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

DEPARTMENT OF PUBLIC HEALTH TREATMENT OUTCOMES

AND ASSOCIATED FACTORS AMONG UNDER-FIVE CHILDREN
WITH SEVERE ACUTE MALNUTRITION AT THERAPEUTIC FEEDING
UNITS IN BISHOFTU GENERAL HOSPITAL, BISHOFTU, CENTRAL
ETHIOPIA, 2023

BY:
1.HERMELLA LEALEM………………………………….............. 12558/11
2.KALKIDAN SOLOMON……………………………………....... 1107225
3.LIYAT KEBEDE………………………………………… ……. 12548/11
4.SARA SOLOMON…………………………………………….… 1107235
5.TEWODROS TADELE……………………………… …….….. 1107213

ADVISORS: 1. MRS EMNET GETACHEW (MSC, LECTURER)

2. MR TAYE DEBELE (MPH, LECTURER)

A RESEARCH PAPER SUBMITTED TO THE DEPARTEMENT OF PUBLIC HEALTH IN

PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR BACHELOR OF SCIENCE IN
PUBLIC HEALTH OFFICER.

2023, ASELLA,

COLLEGE OF HEALTH SCIENCE DEPARTEMENT OF PUBLIC HEALTH
Name of investigators
Name of Advisor(s)
Title of the research project
Duration of project
Study Area
Address of investigators
Address of primary advisor
A E-mail:emnetgeech88@gmail.com
Address of secondary Advisor
ARSI UNIVERSITY
Hermella Lealem
Kalkidan Solomon
Liyat Kebede
Sara Solomon
Tewodros Tadele
1.Emnet Getachew ( MSC,Lecturer)
2.Taye Debele ( MPH, Lecturer)
Treatment outcomes and its Associated Factors among
Under-Five Children with Severe Acute Malnutrition at
Therapeutic Feeding Units in Bishoftu General Hospital,
Bishoftu,Central Ethiopia, 2023
July to November, 2023
Bishoftu Town
Hermella Lealem:0943072434
Kalkidan Solomon:0961193499
Liyat Kebede: 0933291350
Sara Solomon: 0935007078
Tewodros Tadele: 0953086065
Email:Peanutone2018@gmail.com
Email:so251961@gmail.com
Phone: 0911886883
Phone:0910954078
E-mail:taye.debele@gmail.com
Asella 2023GC.
Acknowledgments

We would like to express our gratitude to Arsi University College of Medicine and Health
Science for giving us the chance of Degree program. Next our great thanks go to the Department
of public health for giving us this chance. We would also like to acknowledge Bishoftu General
Hospital for their support and assistance during our research. We would like to extend our heart-
felt thanks to our advisors for their friendly approach while doing this research project.

I
List of abbreviations and acronyms

 BGH Bishoftu General Hospital

 EDHS Ethiopian Demographic Health Survey
 FMOH Federal Ministry of Health
 MUAC Mid-Upper Arm Circumference
 OTP Outpatient Therapeutic Program
 TFU Therapeutic Feeding Unit
 SAM Severe Acute Malnutrition
 SD Standard Deviation
 RUTF Ready to Use Therapeutic Program
 SOHER Social and Public Health Economics Research Group
 WHO World Health Organization

II
List of tables

Table (1). Socio-demographic, breastfeeding status, and admission type and criteria of children
admitted to the TFU at Bishoftu general hospital, Bishoftu town, Central Ethiopia 2023............17
Table(2). Medical comorbidity among under five children that were admitted to the TFU at
Bishoftu General Hospital, Bishoftu Town, Central Ethiopia 2023..............................................18
Table(3). Routine medication given to SAM patients that were admitted to the TFUat Bishoftu
general hospital, Bishoftu town, Central Ethiopia 2023................................................................20
Table(4) Results of Binary logistic regression analysis of factors associated with treatment
outcomes under-five children admitted with SAM to TFU in Bishoftu General hospital,Bishoftu
town, Central Ethiopia, 2023.........................................................................................................23
Table(5) Multivariate logistic regression analysis for factors associated with treatment outcome
of children admitted with SAM to TFU at Bishoftu general hospital, Bishoftu town, Central
Ethiopia, 2023................................................................................................................................26

III
List of figures

Figure(1) Conceptual frame work of SAM treatment outcome and associated factors among
under-five children admitted to inpatient therapeutic feeding units. Source: Adapted from
previous literature (19)...................................................................................................................10
Figure (2) treatment outcome of SAM patients admitted to the therapeutic feeding unit at
Bishoftu general hospital, Bishoftu town, Central Ethiopia, 2023................................................21
Figure (3) treatment outcome of SAM by type of malnutrition in the TFU at Bishoftu general
hospital, Bishoftu, Central Ethiopia,2023......................................................................................22

IV
 Table of Contents

Acknowledgments............................................................................................................................I
List of abbreviations and acronyms................................................................................................II
List of tables...................................................................................................................................III
List of figures.................................................................................................................................IV
Summary..........................................................................................................................................1
1. Introduction..................................................................................................................................2
1.1 Background............................................................................................................................2
1.2. Statement of the Problem......................................................................................................3
1.3. Significance of the Study......................................................................................................4
2. Literature review..........................................................................................................................5
2.1 Overview of SAM..................................................................................................................5
2.2 Magnitude of SAM.................................................................................................................5
2.3 Factors associated with treatment outcome of SAM..............................................................7
2.4 Conceptual Framework........................................................................................................10
3. Objectives..................................................................................................................................11
3.1 General Objectives...............................................................................................................11
3.2 Specific Objectives...............................................................................................................11
4.Methodology...............................................................................................................................12
4.1 Study design and period.......................................................................................................12
4.2 Study area.............................................................................................................................12
4.3 Source and study population................................................................................................12
4.4 Eligibility..............................................................................................................................12
4.5 Sample size and sampling technique....................................................................................13
4.6 Study variable.......................................................................................................................13
4.7 Operational definition..........................................................................................................14
4.8 Data collection......................................................................................................................14
4.9 Ethical consideration............................................................................................................15
4.10 Dissemination of finding....................................................................................................15
5.Result..........................................................................................................................................16
 5.1. Socio-demographic, breastfeeding status, admission category and type of severe acute
malnutrition................................................................................................................................16
5.2 Medical comorbidities..........................................................................................................17
5.3.Routine medication..............................................................................................................18
5.4.Treatment Outcome..............................................................................................................20
5.5. Factors associated with treatment outcome.........................................................................21
6.Discussion...................................................................................................................................26
7. Conclusion and recommendation...............................................................................................29
7.1.Conclusion............................................................................................................................29
7.2. Recommendations...............................................................................................................29
References......................................................................................................................................31
Annex I...........................................................................................................................................34
Consent form..............................................................................................................................34
Annex consent form (የአማርኛ ግልባጭ)......................................................................................35
Waliigaltii gaafattamaa (Hiirmattaa) fii qoorattaa wajjiin godhammee (Consent)..................36
Codii Hiirmattaa (gaafattamaa):__________................................................................................36
Annex- II........................................................................................................................................37
Questionnaire.............................................................................................................................37
Information sheet English version..............................................................................................41
Assurance of principal investigators..........................................................................................42
Approval of advisors.................................................................................................................42
Approval of the Department.......................................................................................................42
Abstract
Background: Nearly 17 million children are affected by severe acute malnutrition worldwide.
Ethiopia is one of the countries with highest under five child mortality rates, with malnutrition
underlying to 28% of all children deaths. Overall, 10 percent of children in Ethiopia are wasted,
and 3 % are severely wasted (below -3 SD). This study provides an insight regarding the overall
management of severe acute malnutrition & helps to improve the management of severe acute
malnutrition in hospitals.

Objective: This study aims to assess treatment outcomes and factors associated among children
admitted with severe acute malnutrition at the therapeutic feeding unit in Bishoftu General
Hospital, Bishoftu town, Oromia, Ethiopia.

Methods: Institution based cross sectional study was conducted from July-November 2023 on
291 under 5 children admitted to Bishoftu General Hospital therapeutic feeding unit with severe
acute malnutrition. Data was collected by structured data abstraction/collection format. Data
entry was done by epidata and analysis was carried out using SPSS 27. Statistical tests of
significance for associations between dependent and independent variable was evaluated by
using bi-variate and multivariate analysis.

Result: The overall recovery rate that was found in this study was 59.2%.Breastfeeding
(AOR:2.665; 95%CI: 1.49,4,74; P-value: <0.001), admission type(AOR:0.278; 95% CI:
0.12,0.64; P-value: 0.002), pneumonia (AOR:0.361; 95%CI: 0.18, 0.71; P-value: 0.003), HIV
status(AOR:0.115; 95%CI: 0.04,0.31; P-value: <0.001) and TB (AOR:0.256; 95%CI: 0.12,0.67;
P-value: 0.004) were significant factors of the treatment outcome of SAM.

Conclusion: The hospital's recovery rate currently stands at 52.6%, falling significantly below
the established standard of 75%. Moreover, the defaulter rate is notably high at 14.8% and .
Contributing factors to poor recovery include readmission cases and the prevalence of
comorbidities such as pneumonia, TB, and HIV. Conversely, admission with a history of
breastfeeding appears to enhance recovery prospects. Consequently, the research suggests a
critical need for the hospital to prioritize comprehensive testing for comorbidities, implement
tailored treatment protocols and measures should be taken to address the defaulter rate.
Key words: severe acute malnutrition, treatment outcome, malnutrition, associated risk factors
1
1. Introduction
1.1 Background
Malnutrition is abnormal physiological condition caused by deficiencies, excesses or
imbalances in energy, protein and/or other nutrients (1). Malnutrition is also defined as a state in
which the physical function of an individual is impaired to the point where he/she can no longer
maintain adequate body performance processes such as growth, pregnancy, lactation, physical
work, and resisting and recovering from disease. Malnutrition is categorized as acute (recent) or
chronic (long term). It can be either under-nutrition or over-nutrition (obesity).
There are four forms of under-nutrition: acute malnutrition, stunting, under-weight and
micronutrient deficiencies. This can also be categorized as either moderate or severe
malnutrition and can appear isolated or in combination, but most often overlap in one person or
population (2).
Severe Acute Malnutrition (SAM) is defined as weight-for-height (W/H) ratio of less than −3
standard deviations (SD), Presence of nutritional edema or by mid-upper arm circumference
(MUAC) value of less than110 mm in children aged 6 - 59 months (3, 4).
There are nearly 800 million people who suffer from hunger worldwide, the vast majority in
developing countries. It is estimated that there are nearly 232.5 million who suffer from hunger
worldwide in 2015 in Africa (5).
The poor nutritional status of children and women continues to be a serious problem in
Ethiopia. Overall, 10 percent of children in Ethiopia are wasted, and 3 percent are severely
wasted (below -3 SD). The health sector has increased its efforts to enhance good nutritional
practices through health education, treatment of extremely malnourished children, and provision
of micronutrients (6).
There are two treatment modalities of SAM in which Patients with failed appetite, and/or with a
major medical complication are initially admitted to an in-patient facility to treat the
complications and stabilize their clinical situation.
Whenever patients have good appetite and no major medical complication or do not have +++
oedema and marasmic kwashiorkor they enter to the out-patient treatment program (OTP)
directly. The children that were initially admitted to in-patient are also transferred to outpatient
once the complications are addressed and appetite is regained (7).

2
 1.2. Statement of the Problem
Childhood under nutrition increases the risk of childhood morbidity and mortality, impairs
cognitive development, adult productivity and may also increase the risk of certain diseases in
adulthood (8). It is clear that SAM is an important global health problem.
Worldwide trends show that malnutrition and lack of sanitation contribute to over half of all
under-five deaths (8). This is so obvious with a visit to almost any hospital in a developing
country where it is likely that severely malnourished children comprise a significant proportion
of pediatrics deaths (4).
According to UNICEF 2015, globally, approximately 2.9 million children accessed treatment
in 65 countries in 2013 that is only about 17 percent of the children needing treatment.
Children with SAM are 9 times more likely to die than well-nourished children (9). Scaling up
access to critical nutrition interventions such as the treatment of SAM is paramount to achieve
the global target of reducing and maintaining childhood wasting to less than 5 percent. This
underscores the urgent need to increase actions to strengthen country-level capacities to scale-
up access to the treatment of SAM alongside preventive actions to protect the nutritional status
of children (9).
Ethiopia is one of the countries with highest under five child mortality rate, with malnutrition
underlying to 28% of all children deaths (10). The management of SAM is critical for child
survival and is a key cost-effective component of the scaling up nutrition framework for
addressing malnutrition. Governments face great challenges in building capacity and providing
sufficient resources to prevent and treat acute malnutrition (9). Majorities of children with
SAM presented to hospital or health center to be treated at TFU and OTP. But, due to many
factors including late presentation of cases, comorbidity and error in management; many
children are dying any way. Moreover, the major determining factors for poor treatment
outcomes are not understood (9).
This study attempts to assess treatment outcomes and factors associated with treatment outcome
among under 5 children with severe acute malnutrition at the therapeutic feeding unit in BGH.

3
1.3. Significance of the Study

Even though there are many studies conducted about treatment outcome of SAM at OTP in
some health centers, there is scarcity of studies on outcome of inpatient SAM treatment at BGH.
Since the hospital and the health center set up and their way of managing SAM is different it is
difficult to generalize health centers studies with hospitals.
It is also difficult to generalize studies conducted in other parts of Ethiopia with Bishoftu since
Bishoftu has different socioeconomic status. The study helps to assess the treatment outcome of
SAM and identify factors associated with treatment outcome among children attending the TFU
of general hospital of Bishoftu.
Hence, the findings from the study help to provide data to health care providers on the success
of treatment and factors associated with treatment outcome of SAM in the TFU program. It also
provides an insight regarding the overall management of SAM and characteristics of patients
attending the TFU of the hospitals.
Therefore, the finding of the study can be used to improve the management of SAM in the TFU
of the hospitals and for policy implementation, program planning and as a base line for further
study.

4
2. Literature review
2.1 Overview of SAM
Acute malnutrition leads to changes in the body related to cellular composition, tissue, and
organ functions and increases vulnerability to infections. A severely malnourished child is
likely to have various health problems (7). SAM can directly cause death or indirectly increase
the fatality rate in children suffering from diarrhea and pneumonia (4).
While a significant number of acutely malnourished children live in countries where cyclical
food insecurity and protracted crises further exacerbate their vulnerability, many more are in
developing countries not affected by emergencies. The result is significant barriers to
sustainable development in these nations (9).

2.2 Magnitude of SAM

Globally it was estimated that over 17 million children were affected by SAM and
approximately 875,000 deaths, or 12.6% of all deaths in children under the age of five, can be
attributed to acute malnutrition (8, 9).
Severe acute malnutrition is a common indication for hospital admission among pediatric
patients in sub-Saharan Africa. In Ethiopia, severe acute malnutrition is the primary diagnosis in
20% of pediatric hospital admissions (4), while 41.4% of preschool-aged children are affected
by malnutrition of any degree (12). Overall, 10 % of children in Ethiopia are wasted, and 3 %
are severely wasted (below -3 SD). Regional variations exist, with Somali and Afar having the
highest percentages of children who are wasted, 23 % and 18 %, respectively (6).
Wasting or acute malnutrition is highest in children less than 6 months of age and children age
12-17 months (15 % and 14 %, respectively) and lowest in children age 36-47 months (5 %).
Male children are slightly more likely to be wasted (10 %) than female children (7 %) (6).

2.3 Treatment Outcome of Child with SAM Admitted to Therapeutic Feeding

Unit.
Based on the study conducted in St. Mary’s hospital Lacor, Northern Uganda TFU, from a total
of 251 severely malnourished hospitalized children, 168 (66.9 %) were successfully discharged

5
as cured, 30 (11.9 %) died, and the rest had potentially unsatisfactory outcome comprising
defaulting treatment (8.0 %), transfer out (9.6 %), and non-response (3.6 %) (13).
According to the study conducted in Woldia hospital TFU, from a total of 324 children admitted
with SAM, 275(85%), 21(6%), 15(5%) and 13(4%) cases were cured, died, defaulted and
transferred out respectively (14).
The study conducted in FelegeHiwot referral hospital; BahirDar revealed that the recovery rate
was 58.4%. Among the recovered 234 SAM children, 118 (50.4%) were males and 116(49.6%)
were females. Recovered edematous children had the longest mean length of stay which was
19days (±6.5 days) and the highest mean weight gain of 9.9kg (±2.5Kg). Mean length of stay
for severely wasted children was 17days (±6days). More than half (63.1%) of the children
enrolled into the study had severe wasting and 36.9% had edema (kwashiorkor or marasmic
kwashiorkor) (15).
Based on study conducted in Gondar university tertiary hospital TFU, among 298 children
admitted with severe acute malnutrition reported that 68.5% of children were cured, 19.8% were
defaulters and 11.7% were died (16). The study conducted among admitted SAM cases in
Zewditu memorial hospital revealed that the predominant age group suffered from marasmus
was the infants (75.4%) while kwashiorkor was prevalent during the second and third year and
the difference noted was statistically significant. Death occurred in 21.3% of the cases
suggesting that mortality rate was higher than the acceptable range (17).
According to study conducted in Debre-Markos and Finote-Selam hospitals, out of 253
children whose records were reviewed, 197 (77.9%) were recovered, 14(5.5%) died during
treatment, 31(12.3%) defaulted and 11(4.3%) transferred from treatment centers (18). Study
conducted in Jimma University specialized hospital showed that improvement, death and
defaulter rate were 77.8, 9.3 and 12.9 % respectively. From this 9.3% death rate, 27.3 % was in
the first 48 h and 60.2 % was by the end of the first week). The median duration from admission
to death was 7 days (19).
Regarding the treatment outcome of children admitted in Yirgalem hospital for severe acute
malnutrition clinical management 78% were cured, 16.2% were dead, 3.1% transferred out and
2.6% were defaulted (20).

6
 2.4 Factors associated with treatment outcome of SAM

Study conducted in St. Mary’s hospital Lacor, Northern Uganda TFU showed that, SAM
children who were HIVAIDS infected were 3.1 times more likely to die during treatment
compared to their HIV negative counterparts who were more likely to have a successful
outcome (13).
According to study conducted in Woldiya Hospital, North Ethiopia, admission category of the
child and HIV/AIDS status were significant predictors of recovery and death rate. Edematous
children were less likely ( the probability of recovery was reduced by 73% among edematous
children as compared to wasted children) to be cured than wasted children. Severely
malnourished children comorbid with HIV/AIDS were less likely to be cured as compared to
not comorbid with HIV/AIDS. HIV infection was a predominant factor that compromised
recovery rate and increased mortality rate.
Nevertheless, age of the child, pneumonia, anemia, heart failure and TB infection were showed
association with recovery and death rate but the associations were not statistically significant.
The most common sign of infection at admission was fever (16%), followed by hypothermia
(1.9%). The most common comorbidities accompanied with SAM at admission were diarrhea
(43.2%), pneumonia (29%), HIV infection (6.2%) and TB (4%). Diarrhea (73.6%) was found
with a significantly higher frequency in children with marasmus (14).

Based on the study conducted in Felege-Hiwot referral hospital, those children who were fully
vaccinated for age and partially vaccinated for age 4.1 times and 7.2 times respectively better
recovery rate than those children who hadn’t been vaccinated. Edematous children were 0.46
times less likely to be recovered than wasted children. The overall length of stay for the entire
cohorts of children with SAM was significantly associated with recovery rate; for a one day
increase in stay in the therapeutic feeding units, the recovery rate would increase by 1.1 times.
At admission, children who were presented with co-morbidity were 84% times less likely to be
recovered than children without co-morbidities at admission. Severely malnourished children
co-morbid with HIV/AIDS and tuberculosis were less likely to be recovered. Lastly, children
who did take vitamin-A as routine medication were 2.8 times more likely to be recovered as
7
compared to those who did not take vitamin-A. The most commonly administered routine
medications were ampicillin and gentamycin (75.6%), vitamin-A (71%), and folic acid (95%).
Children who presented with diarrhea were also received Zinc (28.8%) in addition to routine
medications (15).
Results from multivariate analysis in Gondar university tertiary hospital showed that children
with severe acute malnutrition who had acute gastroenteritis and HIV/AIDS comorbidities were
about 2.8 and 9.6 times more likely to die respectively as compared to their counterparts (16).
Zewditu memorial hospital study showed that presence of diarrhea (AOR= 3.5), edema (AOR=
0.2), stunting (AOR= 3.3) and short mean duration of hospital stay (AOR= 4.4) were predictors
of death outcome (17).
Based on the study conducted in Debre-Markos and Finote-Selam hospitals, those children age
from 24 to 35 months had 34% lower probability of recovery from SAM compared to 6– 11
months old children (AHR = 0.66). Children whose ages from 36 to 59 months had 47% lower
probability of recovery from SAM compared to 6–11 months old children (AHR = 0.53). HIV
negative children had 2.48 times higher probability of getting recovered from SAM compared to
HIV positive children. Children who didn’t take folic acid supplement had 65% lower
probability of recovery from SAM compared to children who took folic acid supplement (AHR
= 0.35) (18).
According to the study conducted in Jimma university, the main predictors of earlier hospital
deaths were age less than 24 months (AHR = 1.9), hypothermia (AHR = 3.0), impaired
consciousness level (AHR = 2.6), dehydration (AHR = 2.3), palmar pallor (AHR = 2.1) and co-
morbidity/complication at admission (AHR = 3.7) (19).
Based on the study conducted Yirgalem hospital, presence of dermatosis (χ2=5.13), admission
body temperature (χ2=8.12), tuberculosis coinfection (χ2=4.15) and multi-chart completeness
(χ2=5.42) were found associated with treatment outcome of SAM clinical management (20).
According to study conducted in Sekota hospital, children with severe anemia (<4 gm/dl) had
more than 6.71 times hazard of death when compared to those with no anemia. Moreover,
children with moderate anemia were more than 4.71 times hazard of death when compared to
children with no anemia. Furthermore, the hazard of death due to TB was about 2.88 times
higher as compared to children with no TB (21).

8
Rickets is often considered a rare disease in tropical regions because of the role of sunlight in
synthesis of vitamin D (22). Available evidence suggests an association between vitamin D
deficiency and risk of pneumonia, acute lower respiratory tract infections, and diarrhea among
children and mortality among adults (23). Rickets is common among children with complicated
SAM and associated with stunting. It is associated with 1.61 times increased risk of death and
hospital admissions with severe pneumonia (24).
In general studies that were conducted in different parts of Ethiopia show some factors that
show significant association with recovery of SAM children including, HIV/AIDS, TB,
presence of edema, stunting and history of vaccination. In this study the above variables and
additional variables like history of being orphan, sunlight exposure and attachment of follow up
chart to the individual folder was assessed to identify factors that associated with recovery.

9
 2.5 Conceptual Framework

Type of malnutrition
at admission
Marasmus
 kwashiorkor
Admission
Demographic  marasmic-kwash
category
characteristics of
 New
the child
 Readmission
 Age
 Sex

TREATMENT
OUTCOMES

Immunizations Routine medication

measles at admission
vaccine Antibiotics
vitamin A
Co-morbidity at admission
 HIV/AIDS
 Pneumonia
 Dehydration
 Gastroenteritis
 Anemia
 Malaria

Figure(1) Conceptual frame work of SAM treatment outcome and associated factors among
under-five children admitted to inpatient therapeutic feeding units. Source: Adapted from
previous literature (19)

10
3. Objectives
3.1 General Objectives
To determine treatment outcome and associated factors among under-five children with severe
acute malnutrition at the therapeutic feeding unit in BGH during the period of September 2020 -
August 2023.

3.2 Specific Objectives

 To assess treatment outcome among under-five children with severe acute malnutrition at
BGH during the period of September 2020 - August 2023.

 To identify factors associated with recovery among under-five children with severe acute
malnutrition at BGH during the period of September 2020 - August 2023.

11
4.Methodology
4.1 Study design and period
Institution based cross sectional study was conducted using document review on inpatient
therapeutic feeding units in BGH, East shewa Zone, Oromia region, Ethiopia, July-November,
2023.

4.2 Study area

The study was conducted in Bishoftu town, East Shewa zone, Oromia regional state,Ethiopia.
Bishoftu is located 47.9 km southeast of Addis Ababa . The city has an estimated total
population of around 99,928 of whom 47,860 were men, 52,068 were women and the number of
children under 5 years of age is 16,806(25). Concerning health facilities, Bishoftu general
hospital is providing therapeutic feeding service for children with SAM. The study was
conducted in BGH.

4.3 Study population

4.3.1 Study population

The study population was all Under-five children participated in the study among whom were
admitted to inpatient therapeutic feeding units in BGH during study period and who fulfills
inclusion criteria.

4.4 Eligibility

4.4.1 Inclusion criteria

Records of under-five children who have been admitted in pediatric ward based on Federal
Ministry of Health of Ethiopia admission criteria for SAM from September 2020- August 2023
G.C.

4.4.2 Exclusion criteria

Transferred cases, and records with incomplete information was excluded from the study.

12
4.5 Sample size and sampling technique

4.5.1 Sample size determination

The sample size was calculated based on a single population proportion formula by using
recovery percentage of(p=77.8%), considering baseline from a previous study done in Jimma
University specialized hospital Ethiopia [19]. With expected margin of error (d) taken at 5% and
confidence interval (z) of 95% and 10% contingency for the non-respondent and unknown
circumstance was used:

The sample size n= (Zα/2)2 p (1-p)/d2

=1.96x1.96 x 0.778 (1-0.778) /0.05x0.05

=265 people
10% non-response rate=26, so the total sample size (n) become
n=265+26=291

4.5.2 Sampling technique

Study population was selected by using systematic random sampling. All medical records for
patients who attended in BGH inpatient therapeutic feeding unit from September 2020-August
2023 was listed based on the sequence of their card numbers.To use systematic sampling, the
population (N), sample size (n), and list of the population from 1 to N are identified to determine
K, the sampling interval or fraction, where k equal to N divide by 'n'. The case reports found for
children who were admitted to the therapeutic feeding unit at BGH over the last three years was
found to be 989 among these 622 were under five children.
K=N/n
K=622/291=2.13
the final Kth value was 2.1.The first card we took was the first under five case report of
September 2020 and then every second card was reviewed to contribute to the required or
desired sample size.

13
4.6 Study variable

4.6.1 Dependent variable

Treatment outcome (recovered) of SAM

4.6.2 Independent variable

Socio-demographic variable ( age, sex,)
Immunization (measles vaccine,vitamin A)
Medical co-morbidity (HIV,pneumonia,TB,dehydration,gastroenteritis,anemia,malaria)
Type of malnutrition (marasmus, kwashiorkor, marasmic-kwash)
Routine medication (antibiotics)

4.7 Operational definition

Treatment Outcome: Evaluation under taken to access the result or consequence of

management and procedure used in combating disease in order to determine the efficiency,
effectiveness, safety and practicability of these interventions in individual case or series (27).
Recovered: weight for height of more than or equal to 85% of the median WHO growth
reference, absence of bilateral pitting edema and no medical complication (26).
New admission: patient that are directly admitted to therapeutic feeding center to start a
nutritional treatment (26).
Readmission after defaulting: if the patient previously absconded before reaching the
discharge criteria and is re admitted to be therapeutic feeding center (26).
Defaulter: patient left the therapeutic feeding center before completing the treatment (26).
Death: Patient that has died while he/she was in the program in a facility (26).
Co-morbidity: additional medical problem with severe acute malnutrition (26).
Kwashiorkor: is severe under nutrition or malnutrition in children resulting from a diet
excessively high in carbohydrates and low proteins (26).
Marasmic-Kwashiorkor: (W/H<70% with edema or MUAC<11cm with edema) (26).
Medical transfer: patient that is referred to a health facility /hospital for medical reasons (26).
Severe wasting or marasmus: W/H less than -3 SD (z scores) or less than 70% of the median
WHO growth standard, or MUAC less than 110mm in children aged 6-59 months (26).
Stunting: Individual whose height is below the average expected height for their age (26).

14
 4.8 Data collection

4.8.1 Data collection instrument

A data abstraction format was used to collect the necessary information from patients’ medical
record (annex II).

4.8.2 Data collection technique

A medical record review was performed and data collection form was developed from inpatient
therapeutic feeding registration book; individual follow up chart was used in the stabilization
unit and baseline previous study (15-18). Then a data collection format was completed for each
eligible patient card. Information regarding demographic characteristics of the patients, clinical
characteristics of children at admission, other medical complication at admission and other
related data was gathered from the sampled individual patient’s card.

4.8.3 Data analysis and interpretation

Data was coded and entered using epidata, and analyzed using Statistical Package for Social
Science (SPSS) version 27. Descriptive analysis was carried out to describe the patient’s baseline
characteristics and summarized as frequencies, proportions, (for categorical variable) means and
SD (continuous variable). Bi-variate Logistic regression analysis was conducted primarily to
check the association of each independent variable with the dependent variable at P value less
than 0.05 was considered statistically significant.

4.8.4 Data quality

To ensure the data quality, pretest was conducted on 14 (5%) of the total sample BGH to ensure
the agreement of the data abstraction format with need of the study. Any error found during the
process of pretest was corrected and modification was made into the final version of the data
abstraction format. Data was cleaned by using SPSS version 27 through sorting and running
frequency.

15
4.9 Ethical consideration
The study was cleared ethically by college of health sciences and medicine, institutional research
ethical committee, Arsi University. Then formal letter of cooperation was written to Bishoftu
General Hospital administration. The objective of the study was explained to the hospital. The
letter of agreement was attached to ensure confidentiality of data. The information taken from
patients’ recorded data was kept confidential. Only codes were used to identify the study groups.

4.10 Dissemination of finding

The result of this study was presented to the department of Public Health. Copies of the original
finding was disseminated to Zonal health department, BGH and other stake holders.

16
5.Result
5.1. Socio-demographic, breastfeeding status, admission category and type of
severe acute malnutrition

The research included 291 under five children at the therapeutic feeding center at Bishoftu
general hospital. Among these children 149(51.2%) of them are male while the remaining
142(48.8%) are females. The ages of the admitted children range from less than one month to
five years. A majority (78.4%) of the children that were admitted was new admissions and the
remaining (21.6%) were re-admissions.

Table (1). Socio-demographic, breastfeeding status, and admission type and criteria of
children admitted to the therapeutic feeding unit at Bishoftu general hospital, Bishoftu
town, Central Ethiopia 2023.
Frequency Percent
Child's age > one month 11 3.8
One to six months 47 16.2
Six months to one year 84 28.9
One year to five years 149 51.2
Child's sex Male 149 51.2
Female 142 48.8
Breastfeeding on Yes 126 43.3
admission No 165 56.7

Place of residence Urban 120 41.2

Rural 171 58.8
Admission type New admission 228 78.4
Readmission 63 21.6
Admission criteria Edema (Kwashiorkor) 16 5.5
Wasting (marasmus) 153 52.6
Edema and wasting 59 20.3
(marasmic kwash)
MUAC 63 21.6
Type of Edema Grade one 10 13.3
Grade two 30 40.0
Grade three 35 46.7
Total 75 100.0

17
5.2 Medical co-morbidities

Among the children that were admitted to the therapeutic feeding unit at BGH 85.9% of them
had at least one medical comorbidity and out of 291 children that were admitted a majority
(81.4%) of them had a poor appetite.

Table(2). Medical comorbidity among under five children that were admitted to the therapeutic
feeding unit at Bishoftu General Hospital, Bishoftu Town, Central Ethiopia 2023.

Frequency Percent

Comorbidity Present 250 85.9

Absent 41 14.1

Fever (>37.5) Present 116 39.9

Absent 175 60.1

Hypothermia(<35) Present 24 8.2

Absent 267 91.8

Appetite Good 54 18.6

Poor 237 81.4

Pneumonia Present 108 37.1

Absent 183 62.9

Vomiting Present 128 44.0

Absent 163 56.0

Diarrhea Present 159 54.6

Absent 132 45.4

18
 HIV status of the Positive 38 13.1
child
Negative 253 86.9

TB Yes 38 13.1

No 253 86.9

Malaria Yes 27 9.3

No 264 90.7

Anemia Present 62 21.3

Absent 229 78.7

Superficial infection(ear Present 63 21.6

discharge or skin
Absent 228 78.4
ulceration)

19
5.3.Routine medication

Admitted cases with severe acute malnutrition to TFU were managed in

accordance with federal ministry of health of Ethiopia guideline protocol for
treatment of severe acute malnutrition. Out of 291 children whose medication
records were available for review, the most prescribed medications were IV
antibiotics (95.9%).

Table(3). Routine medication given to SAM patients that were admitted to the therapeutic
feeding units at Bishoftu general hospital, Bishoftu town, Central Ethiopia 2023.

20
 Frequency Percent

IV antibiotics Yes 279 95.9

No 12 4.1

Amoxcillin Yes 72 24.7

No 219 75.3

IV fluids Yes 34 11.7

No 257 88.3

Vitamin A Yes 23 7.9

No 268 92.1

Folic acid Yes 48 16.5

No 243 83.5

Albendazole/ Yes 115 39.5

Mebendazole
No 176 60.5

Paracetamol Yes 46 15.8

tab/syrup
No 245 84.2

Measeles Vaccine Yes 98 33.7

No 193 66.3

Fully immunized Yes 87 29.9

No 204 70.1

5.4.Treatment Outcome
Among the admitted 291 patients 173(59.2%) of them were recovered, 43(14.8%) were
defaulters, 26(8.9%) of them were non responsive, and 49(16.8%) of them died (118(40.5%)
were not recovred).

21
 16.8%

8.9%
59.2%

14.8%

Figure (2) treatment

outcome of
SAM patients
admitted to
the therapeutic feeding unit at Bishoftu general hospital, Bishoftu town, Central Ethiopia, 2023.

5.4.1Treatment outcome of SAM by type of diagnosis

The predominant form of malnutrition in this study was marasmus 153 (52.6%), followed by
marasmic kwash 59 (20.3%). Among the children who presented with marasmus, 86(29.6%) of
them were recovered while 31(10.7%) died. While among the patients presented with marasmic
kwash, 36(12.3%) of them were recovered while 6(2.1%) of them died.

Figure (3) treatment outcome of SAM by type of malnutrition in the TFU at Bishoftu general
hospital, Bishoftu, Central Ethiopia,2023.

22
5.5. Factors associated with treatment outcome
The socio-demographic of children, medical co-morbidities, and routine medication were tested
for their association with treatment outcome of severe acute malnutrition among under-five
children by bivariate logistic regression analysis. First the association of each variable with
treatment outcome among under-five children was assessed by the binary logistic regression and
then variables which were significant at the level of 0.25 were entered into the final model
(multivariate analysis) to control confounding factors.

Table(4) Results of Binary logistic regression analysis of factors associated with treatment
outcomes under-five children admitted with SAM to TFU in Bishoftu General
hospital,Bishoftu town, Central Ethiopia, 2023

Treatment response of the COR P-

child (95%CI) value
Cured/ Not
recovered recovered
Child'sage < one month 5 1.70 6 2.06 0.292(0.05,1. 0.001
% % 43)
One to six 26 8.90 21 7.20 0.629(0.28,1.
months % % 43)

Six months to 48 16.50 36 12.40 0.779(0.47,1.

one year % % 30)

One year to 94 32.30 55 18.90 1

five years % %

Child's sex Male 85 29.20 64 21.90 0.815(0.51,1. 0.332

% % 30)
Female 88 30.20 54 18.60 1
% %
Breastfeeding on Yes 85 29.20 41 14.10 1.814(1.12,2. 0.001
admission % % 93)
No 88 30.20 77 26.50 1
% %
Place of residence Urban 77 26.50 43 14.80 1.399(0.86,2. 0.354
% % 26)

23
 Rural 96 32.90 75 25.80 1
% %
Admission type New admission 13 46.00 94 32.30 0.877(0.49,1. 0.009
4 % % 55)

Readmission 39 13.40 24 8.20 1

% %
Admission criteria Edema 11 3.80% 5 1.70% 1.265(0.39,4. 0.276
(Kwashiorkor) 09)

Wasting 86 29.60 67 23.00 0.738(0.40,1.

(marasmus) % % 35)

Edema and 36 12.40 23 7.90% 0.900(0.43,1.

wasting % 87)
(marasmic
kwash)

MUAC 40 13.70 23 7.90% 1

%
Type of Edema Grade one 5 1.70% 5 1.70% 0.667(0.16,2. 0.541
73)
Grade two 21 7.20% 9 3.00% 1.556(0.55,4.
37)
Grade three 21 7.20% 14 4.80% 1

Comorbidity Present 14 48.10 11 37.80 0.309(0.14,0. 0.989

0 % 0 % 69)
Absent 33 11.30 8 2.70% 1
%
Fever (>37.5) Present 61 20.90 55 18.90 0.624(0.39,1. 0.381
% % 01)
Absent 11 38.50 63 21.60 1
2 % %
Hypothermia(<35) Present 16 5.50% 8 2.70% 1.401(0.58,3. 0.917
39)
Absent 15 53.90 11 37.80 1
7 % 0 %
Appetite at admission Good 29 9.90% 25 8.60% 0.786
Poor 14 49.50 93 31.90 0.749(0.41,1.
4 % % 36)
Pneumonia Present 47 16.10 61 20.90 0.349(0.21,0. 0.002
% % 57)

24
 Absent 12 43.20 57 19.60 1
6 % %
Vomiting Present 71 24.40 57 19.60 0.745(0.57,1. 0.541
% % 19)
Absent 10 35.10 61 20.90 1
2 % %
Diarrhea Present 51 17.50 39 13.40 0.847(0.51,1. 0.236
% % 4)
Absent 12 41.90 79 27.10 1
2 % %
HIV status of the Positive 9 3.10 29 9.90 0.878(0.76,0. 0.002
child % % 37)
Negative 16 56.40 89 30.60 1
4 % %
Is TB present Yes 15 5.20 23 7.90 0.392(0.19,0. 0.002
% % 79)
No 15 54.30 95 32.70 1
8 % %
Is malaria present Yes 17 5.80% 10 3.40% 1.177(0.52,2. 0
67) 0.335
No 15 53.60 10 37.10 1
6 % 8 %
Anemia (pallor or Present 39 13.40 23 7.90 1.202(0.67,2. 0
hemoglobin count % % 14) 0.129
<11g/dl) Absent 13 46.00 95 32.60 1
4 % %
Superficial Present 43 14.80 20 6.90% 1.621(0.89,2. 0
infection(ear % 92) 0.566
discharge or skin Absent 13 44.60 98 33.70 1
ulceration) 0 % %
IV fluids given Yes 23 7.90 11 3.80 1.49(0.69,3.1 0
% % 9) 0.123
No 15 51.50 10 36.80 1
0 % 7 %
IV antibiotics given Yes 17 58.80 10 37.10 0.731(0.06,8. 0
1 % 8 % 15) 0.98
No 8 2.70% 4 1.40% 1
Amoxicillin Yes 47 16.20 25 8.60% 1.388(0.79,2. 0
% 42) 0.884
No 12 43.30 93 31.90 1
6 % %
Vitamin A Yes 13 4.50% 10 3.40% 0.122(0.37,2. 0
07) 0.534
No 16 54.90 10 37.10 1
0 % 8 %

25
Measles Vaccine Yes 59 20.30 39 13.40 1.048(0.64,1. 0
% % 72) 0.344
No 11 39.20 79 27.10 1
4 % %
Fully immunized Yes 57 19.60 30 10.30 1.441(0.86,2. 0
% % 43) 0.204
No 11 39.90 88 30.20 1
6 % %
Folic acid Yes 27 9.30% 21 7.20% 0.854(0.46,1. 0
59) 0.671
No 14 50.20 97 33.30 1
6 % %
Albendazole/ Yes 15 5.20% 6 2.10% 1.772(0.67,4. 0
Mebendazole 71) 0.366
No 15 54.30 11 38.50 1
8 % 2 %
Paracetamol tab/syrup Yes 29 9.90% 17 5.80% 1.196(0.62,2. 0
29) 0.377
No 14 49.50 10 34.70 1
4 % 1 %

Children who were breastfeeding at the time of admission were 2.6 times more likely to recover
than children who were not breastfeeding. However those who were readmissions were 0.278
times less likely to recover as well as children who had medical comorbidities such as
pneumonia, HIV,and TB were 0.36 times, 0.115 times, and 0.286 times higher probability of
poor recovery from SAM.

Treatment response
of the child COR
(95%CI) AOR (95%CI) P-
Cured/ Not value
recovered recovered
Breastfeeding Yes 85 29.20 41 14.10% 1.814(1.12,2.93) <0.001
on admission %
No 88 30.20 77 26.50% 1 2.665(1.49,4.74
% )

Admission type New 134 46.00 94 32.30% 0.877(0.49,1.55) 0.002

admission % 0.278(0.12,0.64
)

26
 Readmissio 39 13.40 24 8.20% 1
n %
Pneumonia Present 47 16.10 61 20.90% 0.349(0.21,0.57) 0.361(0.18,0.71 0.003
% )
Absent 126 43.20 57 19.60% 1
%
HIV status of Positive 9 3.10% 29 9.90% 0.878(0.76,0.37) 0.115(0.04,0.31 <0.001
the child Negative 164 56.40 89 30.60% 1 )
%
Is TB present Yes 15 5.20% 23 7.90% 0.392(0.19,0.79) 0.286(0.12,0.67 0.004
No 158 54.30 95 32.70% 1 )
%
Table(5) Multivariate logistic regression analysis for factors associated with treatment outcome
of children admitted with SAM to TFU at Bishoftu general hospital, Bishoftu town, Central
Ethiopia, 2023

6.Discussion

This study investigated the treatment outcome of severe acute malnutrition and the factors
associated with treatment outcome among under five children who were admitted at the
therapeutic feeding unit of Bishoftu General hospital. It also assessed other common clinical
conditions in order to come-up with co-existing problems probably predicting treatment
outcome.

The finding of the study showed that among children treated for severe acute malnutrition,
59.2%were recovered. The substandard recovery rate of the children that were admitted could be
because of the high rate of defaulters and because the children are often brought to the hospital
for other comorbidities.The socio-economic status of the parents also plays a significant role.The
proportion of recovery in this study was below the recommended sphere standard which should
be >75% (8). Similarly it was lower than the finding from Uganda(66.9%)Woldiya hospital
(85%),Debre markos, Finoteselam (77.9%) and Yirgalem(78%)(13,14,18,20). However this
study was in line with a study done in Felege Hiwot hospital(58.4%) and Sekota(59.7%)
(15,21).

27
This study found a high proportion of death (16.8%) than previous findings in Uganda(11.9%),
Gondar(11.7%), Woldia(6%) and Debremarkos Finoteselam hospital(5.5%).It was also higher
than the recommended minimum sphere standard which should be <10% but it was found to be
in line with a study done in Yirgalem(16.2%) (13,14,16,18,20).In this study the proportion of
death was higher this mainly could be because children reach hospitals late after developing
complications. The other reason may be inappropriate management of children such as, partial
prescription of routine medication and high prevalence of co-morbidities.

The proportion of defaulted children was 14.8% and the proportion of readmissions was 21.6%
associated to this children who were readmitted were 0.278 times less likely to recover. The
proportion of defaulters was similar with the finding Gondar (19.8%). This outcome was below
the acceptable range of sphere standard, but it was found to be higher than another study
conducted in Yirgalem hospital (16,20). The reason the result of this study was higher could be
because of the hospital’s lack of an effective system to monitor the patients and appropriate
education and information about the treatment of SAM. It could also be because of the socio-
economic status of the families.

Marasmus was found the to be the predominant (52.6%) form of malnutrition in this study.
Which is lower than the study done in Felegehiwot hospital (63.1%)but higher than the study
conducted in Uganda (41.8%) (13). The reason for the high number of such patients could be
because of discontinuation of breastfeeding and inadequate complementary feeding practices as
the child’s age increases.
The finding of this study also showed that more than two third of the study subjects have at least
one form of medical comorbidities at admission from this diarrhea was the most prevalent
(54.6%) co-morbidity found in this study and the other comorbidities vomiting(44.0%),
pneumonia(37.1%),and anemia(21.3%). Other studies done in different areas had also indicated
these comorbidities are common in children with severe acute malnutrition (18,20).

The study finding showed that a majority (58.8%) of the children who were admitted to the
therapeutic feeding unit were from rural areas which is consistent with the study done in Debre
markos, Finote Selam hospital,and Yirgalem hospital Ethiopia(18,20). This could be because the

28
parents of the patients were seeking better care for their children and came to the urban area as a
result.

Children who had pneumonia and TB at admission were 0.36 times and 0.29 times higher
probability of poor recovery from SAM compared to children who didn’t have pneumonia and
TB. Similarly children who tested positive for HIV were 0.115 times higher probability of poor
recovery from SAM compared to HIV-negative children. At admission, children who were
presented with co-morbidity were 84% times less likely to be recovered than children without
comorbidities at admission. Severely malnourished children co-morbid with HIV/AIDS and
tuberculosis were more likely to have poor recovery(15).In this study children who did not have
medical comorbidities such as TB and pneumonia were more likely to recover this could be
because they are less likely to have developed complications.
.

This study showed that children who were breastfeeding when they were admitted were 3.01
times more likely to recover than those who were not breastfeeding. This could be because
children who were breastfeeding are more likely to have better feeding habits. However a study
conducted at Yirgalem hospital showed that among admitted children 79.1%were on breast
feeding, out of this 78.8% were recovered and among children not breast feeding on admission
75% were recovered and that breastfeeding had no significant effect on recovery (20).

Strength
The strength of this study was that it utilized data organized from real life scenarios. Hence, it
provided the insight of what was really going on in the pediatrics ward of BGH.

Limitation
This study has its own limitations. The study used the recorded data of discharged children to
assess treatment outcomes and associated factors. Therefore, this study was limited in measuring
treatment outcome only using medical records due to that could not include other factors such

29
as, distance from the hospitals, educational and economic status of the parents, completing breast
feeding history and factors related to health care providers. It also does not provides information
about the availability and use of guidelines or about the availability of essential supplies and
equipment. Due to financial and time constraints this study could not assess the potential impact
of all these factors on outcomes.

7. Conclusion and recommendation

7.1. Conclusion
Proper management of severe acute malnutrition and high proportion of recovery has huge
contribution to save the lives of many children. This study tried to assess treatment outcome of
severe acute malnutrition among children under the age of five years. The major finding of the
study showed that among children treated for severe acute malnutrition, 59.2%were recovered.
The recovery rate of the children that were admitted could be because of the high rate of
defaulters and because the children are often brought to the hospital after having developed
complications or for other comorbidities.

This study also found high proportion of death; it could mainly be because children reach
hospitals late after developing complications.The other reason may be inappropriate management
of children such as, partial prescription of routine medication and high prevalence of
comorbidities. Marasmus was found to be the predominant form of malnutrition in this study.
The reason for the high number of such patients could be because of discontinuation of
breastfeeding and inadequate complementary feeding practices as the child’s age increases.
Children who were breastfeeding at admission were more likely to recover; however children
who were readmitted and those with medical comorbidities such as TB, pneumonia, and HIV
were more likely to recover poorly as they may have developed complications.

7.2. Recommendations
Based on the findings of this study the following recommendations are forwarded.

30
For the hospitals
The hospitals should design appropriate and ongoing supervision mechanism for defaulter
tracing
The hospital staff should educate the patients about the benefits of breastfeeding and how to
properly breastfeed their children.
The hospital should also focus on treating and testing for medical comorbdities such as
pneumonia, TB, and HIV when a child is admitted to the TFU.
For zonal health office
The zonal health office should work with all concerned bodies to create awareness in the
community for early treatment seeking. In addition data from hospitals regarding severe acute
malnutrition management treatment outcome should be analyzed for local decision making.
Capacity building training for therapeutic feeding program staffs on proper management of
severe acute malnutrition to achieve the desired treatment outcome.
For researchers
Researchers should conduct further prospective studies using both qualitative and quantitative
techniques that better investigate the determinants of severe acute malnutrition treatment
outcome.

31
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Annex I
Consent form
Participant code number __________

I the undersigned study participant with SAM have been well informed about the objective of the
study entitled “Treatment outcomes and its Associated Factors among Under-Five Children with
Severe Acute Malnutrition at Therapeutic Feeding Units in Bishoftu General Hospital, Bishoftu,
Oromia, Ethiopia, 2023.". I have been informed that other people will not know my results as it
coded with number rather than writing my name if I am in this study. Moreover I have also been

35
well informed of my right to keep hold of, decline to cooperate and drop out of the study if I
want and none of my actions will have any bearing on hospital access. I agreed to cooperate.

Patient Name __________________________ Signature __________ Date __________

Investigator Name ______________________ Signature __________ Date __________

36
Annex consent form (የአማርኛ ግልባጭ)
የተሳታፊው ልዩ መለያ ቁጥር ____________________________

እኔከዚህበታችስሜየተጠቀሰዉናየፈረምኩትየጥናቱተሳታፊበቴራፒዩቲካልየምግብክፍሎችውስጥከባድአጣዳፊየተ

መጣጠነምግብእጥረትባለባቸውህጻናትመካከልያለውየሕክምናውጤትእናተያያዥምክንያቶችለመመርመር

የተዘጋጀ መጠይቅ ለማዎቅ የሚደረገዉን ጥናት አላማና ጥቅም በሚባተረድቻለሁ፡፡በጥናቱ ወቅት የእኔ መረጀዎች

በሚስጥር ስለሚያዝ በሌላሰዉ ዘንድእንደማይታወቅ ተረድቻለሁ፡፡ ጥናቱ

ላይመሳተፍምሆነአለመሳተፍበራሴፍቃድየሚወሰን

መሆኑምተገልጾልኛል፡፡በተጨማሪምከጥናቱባልሳተፍምሆነአቋርጨብወጣጤናተቋሙበማገኘዉ

የህክምናአገልግሎትምንምአይነትችግርእንደማይደርስብኝተነግሮኛል፡፡በመሆኑም አስፈላጊ መሆኑን

ስለተስማማሁበትለመስጠትሙሉፈቃደኛመሆኔንበፊርማዬእገልጻለሁ፡፡

የታካሚው ስም ___________________________ ፊርማ __________ ቀን _______________

የተማራማሪው ስም _______________________ ፊርማ __________ ቀን ________________

37
Waliigaltii gaafattamaa (Hiirmattaa) fii qoorattaa wajjiin godhammee
(Consent).
Codii Hiirmattaa (gaafattamaa):__________

Anii hiirmatta qorannoo maqqan koo fii mallattoon koo asii gaddii kan argammu kayyoo fii
fayyidda Qorannoo matta duree “Bu’aa Wal’aansaa fi wantoota kanaan walqabatan Daa’imman
Hanqina Nyaataa Cimaa Qaban Kutaa Nyaata Wal’aansaa keessatti
irratii barattoonnii koollejjii Fayyaa Assalla kaan geessan fageenaan hubadhee’rra. Qorannoo
kan irratti oddefannon koo dhokessa aka qabamuufii maqa’a koottiin akka hinibsamnee
beekee’rra. Qorannoo kan irratti hiirmaachuu fii hiirmaachuu miirgaa akka ta’uu akkasumaas
miidhan yookkin rakkoon na quunammu akka hiinjjiiruu naa ibasammeerra.

Maqaa Dhukkubsataa:___________________ Malattoo:___________ Guyyaa:_______

Maqaa Qorattaa:_______________________ Malatto:_____________ Guyyaaa:______

38
Annex- II
Questionnaire
This Data Collection Format is prepared for collecting information on Treatment Outcome and
associated factors among Children with Severe Acute Malnutrition at the Therapeutic Feeding
Units in BGH, Ethiopia

Part 1: Social-demographic characteristics of children with SAM treated at selected

Hospitals.

Health facility name ____________

Address of child ____________

Woreda_______________________

kebele ____________

Data recorder name/_________ signature___________/

Date _________________

Child’s Medical record number (MRN) ____________

NO Particulars Categories of response Skip

01 Child’s age _____ Months

02 Child’s sex A. Male

B. B. Female

03 Breast feeding on admission 1. Yes

2. No

39
04 Place of residence 1. Urban
2. Rural

Part :-2 Type of malnutrition at admission

05 Admission type 1. new admission

2. readmission

06 Admission criteria 1. only edema (kwashiokor)

2. Only wasting
3. Both edema and wasting
4. MUAC

07 If edema present what type 1. grade 1

2. Grade 2
3. Grade 3

08 Lowest weight during stay

Part:- 3 Medical Co-morbidity at admission

09 Co morbidity 1. Present
2. Absent

10 Fever (>37.5) 1. Present

2. Absent
3. Not checked

11 Hypothermia(<35) 1. Present
2. Absent
3. Not checked

12 Appetite at admission 1. Good

40
 2. Poor

13 Pneumonia 1. Present
2. Absent

14 Vomiting 1. Present
2. Absent

15 Diarrhea 1. Present If skip no

2. Absent to 17

16 If diarrhea which type 1. Watery diarrhea

2. Dysentery
3. Other specify

17 HIV status of child 1. Positive

2. Negative
3. Unknown

18 Does the child have TB? 1. Yes

2. No
3. Unknown

19 Presence of malaria? 1. Yes

2. No
3. Unknown

20 Anemia (pale conjunctiva and palmer 1. Present

pallor and/or a hemoglobin count 2. Absent
of <11g/dl
21 Severe superficial infection (ear 1. Present
discharge or skin that is 2. Absent
ulcerating)
Part:- 4 Treatment given at admission
41
22 IV fluids given 1. yes 2. No
23 IV antibiotics given 1. yes 2. No
24 Amoxicillin 1. yes 2. No
25 Vitamin A 1. yes 2. No
26 Measles vaccine 1. yes 2. No 3. Not
applicable
27 Fully immunized 1. yes 2. No 3. Not
applicable
28 Folic acid 1. yes 2. no
29 Albendazol / mebendazole 1. yes 2. No 3. Not
applicable
30 Paracetamol tab /syrup 1. yes 2. no
Part :-5 Treatment outcome
31 Treatment response of the child 1.cure/ recovered

Treatment response for those who 2. Defaulter

had been cured
3. Non responder

4. Died

42
Information sheet English version
Title: Treatment Outcome and associated factors among Children with Severe Acute
Malnutrition at the Therapeutic Feeding Units in BGH, Ethiopia
Name of the organization: Arsi University collage of health science, Public Health department.
Name of investigators: Hermella Lealem,Kalkidan Solomon,Liyat Kebede,Sara Solomon and
Tewodros Tadele.

Introduction: you are welcomed to participate in this research to be conducted by BSC Public
Health students from Arsi University, College of Health Science.

Risk associated with the study: you will not face any physical or psychological risk related
with the research study.
Confidentiality: all data you give was only used for study and was kept confidential.
Benefits of the study: you will not receive any payment for this research.
Result dissemination: The result of this study was presented to the department of Public Health.
Copies of the original finding were disseminated to Zonal health department, Bishoftu General
Hospital and other stake holders.
Person to contact: if you got any question or problem related with the research study. You can
contact the investigators at any time.

43
Assurance of principal investigators
The undersigned agrees to accept responsibility for the scientific ethical and technical conduct of
the research project and for provision of required progress report as per terms and condition of
the facility of public health in effect at the time of grant is forwarded as the result of this
application.
Name of the student: ____________
1.Hermella Lealem………………………………….............. 12558/11
2.Kalkidan Solomon……………………………………....... 1107225
3.Liyat Kebede……………………………………………… 12548/11
4.Sara Solomon……………………………………………… 1107235
5.Tewodros Tadele……………………………………….….. 1107213

Approval of advisors
Name of the advisor: ____________
Date: _________ Signature: ____________

Name of the advisor: ____________

Date: _________ Signature: ____________

Approval of the Department

Name of the Department head: ____________

Date: _________ Signature: ____________

44