ASSOSA UNIVERSITY

COLLEGE OF HEALTH SCIENCE

DEPARTMENT OF PUBLIC HEALTH

Program-MPH

Subject:-Fundamental Of Epidemiology

Individuals Assignment:-Identify one epidemiological study and try to summarize the paper
based on the given points

Title selected: - Time to Discharge and its Predictors among Children Aged 1-60 Months with
Severe Acute Malnutrition Admitted to the Therapeutic Feeding Centre in a Tertiary Hospital,
North West Ethiopia

Mehretie Kokeb1, Abinet Mariyo1*

Name:-HABTAMU BIRHANU BEYENE

Submit To:-ALEMAYEHU A. (PhD)

January-29/2023

Assosa, Ethiopia

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 Table of Content
ACRONYMS ................................................................................................................................................ iii
Acknowledgement ......................................................................................................................................... iv
1. INTRODUCTION ...................................................................................................................................... 1
2. Methodology used to select the epidemiological study ........................................................................ 2
3. Title......................................................................................................................................................... 3
4. Core aims of the study ............................................................................................................................ 3
5. Type of epidemiological study design used and Explain where it is appropriate/not............................. 3
6. Sample size/number of participants included ......................................................................................... 3
7. Main findings of the study ...................................................................................................................... 3
a. Treatment outcome and time of discharge from inpatient care for children with Severe Acute
malnutrition: ............................................................................................................................................... 3
b. Predictors of time to Discharge from Inpatient treatment (stabilization Center): .............................. 4
8. How is the importance /locally applicability of the study ...................................................................... 4
9. SUMMARY .............................................................................................................................................. 5
References ...................................................................................................................................................... 6

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ACRONYMS
AHR- Adjusted Hazard Ratio

EDHS-Ethiopia Demographic Healthm Survey

HAI-Hospital Acquired Infection

IQR-Inter Quartile Range

SAM- Severe Acute Malnutrition

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Acknowledgement
I wanted to acknowledge and give strong appreciation to Alemayehu Asefa (PHD) and Mulatu
Agajie (Mph) Assosa University College of health science instructors for training fundamental of
epidemiology, gave me individual assignment to identify one epidemiological study and try to
summarize the paper that helped me and capacitate for future the research paper review.

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 1. INTRODUCTION
Acute malnutrition among children is a serious global health concern affecting an estimated 50
million children aged <5 years in low and middle income countries [1]. It is the leading cause of
mortality, accounting for 11.5% of total deaths and contributes significantly to the overall disease
burden [1]. Asia and Africa accounted for more than two thirds and a quarter of all wasted
children globally [2].

Ethiopia is prone to recurrent droughts that impact food security and water availability, and
contribute to high rates of malnutrition in the country [4].

The magnitude and factors associated with under-nutrition among children under the age of 5 in
Ethiopia based on national data. The prevalence of stunting was 37.71%, of which 12.40% were
severely stunted and 7.14% had wasting [5].

According to the Ethiopian demographic and health survey report, about 10% of Ethiopian
children were wasted. From these, 3% were severely wasted. In Benishangul Gumuz Region, the
region where the study was conducted, 11.5% under five children were acutely malnourished of
whom 3.1% were with severe acute malnutrition [6].

Acute malnutrition results from sudden reductions in food intake or diet quality and is often
combined with pathological causes [7]. Causes of acute malnutrition are numerous and
multifaceted. It depends on complex interactions of factors including socioeconomic,
environmental, reproductive, institutional, cultural, political and regional factors [7].

Therefore, based the above magnitude of SAM this epidemiological study paper Time to
Discharge and its Predictors among Children Aged 1-60 Months with Severe Acute Malnutrition
Admitted to the Therapeutic Feeding Center in a Tertiary Hospital, North West Ethiopia was
selected and summarized based on the given points.

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 2. Methodology used to select the epidemiological study
First, I decide to screech different research topics which was update published on Africa journals
online publication web site. Then I interested the topic research Time to Discharge and its
Predictors among Children Aged 1-60 Months with Severe Acute Malnutrition Admitted to the
Therapeutic Feeding Center in a Tertiary Hospital, North West Ethiopia from different published
research topics. After the selection of this research topic, I started to browse updates and deferent
related articles about acute malnutrition under 5 years’ children’s. Finally I was summarised the
paper based on the given points.

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 3. Title
Time to Discharge and its Predictors among Children Aged 1-60 Months with Severe Acute
Malnutrition Admitted to the Therapeutic Feeding Center in a Tertiary Hospital, North West
Ethiopia

Mehretie Kokeb1, Abinet Mariyo1*

4. Core aims of the study

The main objective of this study was to assess the time to discharge and its predictors among
children 1-60 months with Severe Acute Malnutrition admitted to University of Gondar Hospital

5. Type of epidemiological study design used and Explain where it is

appropriate/not
The type of epidemiological study design used in this article is Hospital Based retrospective
follow up study was conducted. In this research the study design used is appropriate because the
researchers were go back in time to define the exposures and risk group to look current outcome
by collecting data from medical records that is characteristics of retrospective study design.

6. Sample size/number of participants included

In this study the total sample size was 282 and the participants were recruited based on simple
random sampling technique.

7. Main findings of the study

In this study the main findings based on the objective of the study are

a. Treatment outcome and time of discharge from inpatient care for children
with Severe Acute malnutrition:
 Majority admitted with SAM; 242 (85.8%) were improved discharged
 The median time to Discharge was 13 days (IQR: 9-18)
 Incidence of discharge was 6.4 (95% CI: 5.6-7.2) per 100 person- day observations.
 Majority (45.9%) of children were discharged in the 2nd week of admission followed by 1st
week (21.5%)
 Children with SAM who had anemia, kwash dermatosis and hospital acquired infection
were having longer Hospital stay compared with their counter parts.
 The median survival time for children with HAI, Kwash-dermatosis and Anemia was
21days (IQR: 16-35, 16 days (IQR: 13-21) and 15 days (IQR: 11-21), respectively
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 b. Predictors of time to Discharge from Inpatient treatment (stabilization
Center):
 Acute Gastroenteritis, Dermatosis, anemia, pneumonia, persistent diarrhea; rickets and
Hospital acquired infection were found to be significant independent variables.
 Kwash-dermatosis, anemia, pneumonia and Hospital acquired infection were predictors of
time to discharge.
 Children without kwash-dermatosis atadmission were 2.4(95% CI: 1.17-4.8) times to be
discharged earlier compared with those who had kwash-dermatosis.
 Not having anemia at admission had 1.7(95% CI: 1.1-2.6) times higher probability of earlier
discharge than those children who had anemia at admission.
 Children without pneumonia at admission had 1.6(95% CI: 1.01-2.63) times chance of being
discharged than those who had pneumonia at admission.
 Those children who had no Hospital acquired infection were 4.4(95% CI: 2.4-8.2) times to
be discharged earlier than those who didn’t have hospital acquired infection.

8. How is the importance /locally applicability of the study

The hospital based retrospective follow up study design used in this study is important and
applicable in our context because it is less expensive to perform and is quick than other
prospective cohort study design. The study conducted on SAM is important and locally
applicable.

Despite efforts made by the Ethiopian government and improvements in reducing malnutrition, at
the current rate of progress it will be difficult to reach the global target for reducing malnutrition by
2025. There are few comprehensive studies in Ethiopia based on nationally representative data to
identify determinants of malnutrition among children under age 5 [8].
Because of this the study was address many determinant variables at the same time, which will help
to generalize the study findings. This study was determined time to discharge and its predictors
among children 1-60 months with Severe Acute Malnutrition admitted to enable a multi-sectoral
response to malnutrition by identifying its determinants among children under age 5 and that is why
the this study was important and applicable locally in our context.
This is important to achieving the Sustainable Development Goals and to meeting the global target
by 2025. Understanding the extent and the causes of the problem will allow for appropriate
planning and interventions [8].

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 9. SUMMARY
Acute malnutrition among children is a serious global health concern affecting an estimated 50
million children aged <5 years in low and middle income countries [1].

The magnitude and factors associated with under-nutrition among children under the age of 5 in
Ethiopia based on national data. The prevalence of stunting was 37.71%, of which 12.40% were
severely stunted and 7.14% had wasting [5].

The main objective of this study was to assess the time to discharge and its predictors among
children 1-60 months with Severe Acute Malnutrition admitted to University of Gondar Hospital

The type of epidemiological study design used is Hospital Based retrospective follow up study
and total sample size was 282 and the participants were recruited based on simple random
sampling technique

Total research participants; 242 (85.8%) were discharged improved and 40 (14.2%) were
censored. The median time to Discharge was 13 days (IQR: 9-18) and the Incidence of discharge
was found to be 6.4 (95% CI: 5.6-7.2) per 100 person- day observations. Kwash-dermatosis
(AHR=2.4, 95% CI: 1.17-4.8), Anemia (AHR=1.7, 95% CI: 1.1-2.6), pneumonia at admission
(AHR=1.6, 95% CI: 1.01-2.63) and Hospital acquired infection (AHR=4.4, 95% CI: 2.4-8.2) were
predictors of time to discharge.

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References

1. Jelle M, Grijalva-Eternod CS, Haghparast-Bidgoli H, King S, Cox CL, Skordis-Worrall J, et

al. The REFANI-S study protocol: A non-randomised cluster controlled trial to assess the role
of an unconditional cash transfer, a non-food item kit, and free piped water in reducing the
risk of acute malnutrition among children aged 6–59 months living in camps for internally
displaced persons in the Afgooye corridor, Somalia. BMC public health. 2017; 17(1):632.
2. Unicef. Levels and trends in child malnutrition. eSocialSciences, 2018.
3. National Guideline for the Management of Acute Malnutrition in Ethiopia,2019
4. Temam Beshir Raru1, Galana Mamo Ayana1, Bedasa Taye Merga1*, Belay Negash1*,
Alemayehu Deressa1, Abdi Birhanu2, Fila Ahmed Hassen1 and Kedir Teji Roba3. Magnitude
of under-nutrition among under five children in Ethiopia based on 2019 Mini- Ethiopia
Demographic and Health Survey: Generalized Linear Mixed Model (GLMM). BMC public
health. (2022) 8:113.
5. Asfaw M, Wondaferash M, Taha M, Dube L. Prevalence of undernutrition and associated
factors among children aged between six to fifty nine months in Bule Hora district, South
Ethiopia. BMC Public health. 2015; 15(1):41.
6. EDHS E. demographic and health survey 2016: key indicators report. The DHS Program ICF.
2016.
7. Tariku A, Bikis GA, Woldie H, Wassie MM, Worku AG. Child wasting is a severe public
health problem in the predominantly rural population of Ethiopia: A community based cross–
sectional study. Archives of Public Health. 2017; 75(1):26.
8. EDHS-2016.

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