Treatment Outcomes and Predictors of Nutritional Recovery Among Children with Severe Acute Malnutrition Attending the Outpatient Therapeutic Clinic in Mulago Hospital: A prospective longitudinal study

<title>Abstract</title> <p>Background Severe Acute Malnutrition (SAM) remains a major contributor to child mortality in Uganda. Although Outpatient Therapeutic Care (OTC) has been implemented for the management of SAM at Mwanamugimu Nutrition Unit (MNU) for over a decade, evidence on treatment outcomes and predictors of nutritional recovery is lacking. This gap limits the ability to evaluate program effectiveness and optimize care. This study, therefore, aimed to assess treatment outcomes and identify predictors of nutritional recovery among children attending the OTC at MNU Methods A prospective longitudinal study followed up 198 children aged 6 to 59 months with uncomplicated SAM for a maximum of eight weeks. Quantitative data was collected using a pre-tested questionnaire at enrolment and clinic record books. Qualitative data was obtained from Focus Group Discussions with selected caregivers and key informant interviews with health workers at the clinic to obtain an in-depth understanding of factors influencing recovery in Mwanamugimu. Quantitative analysis included descriptive statistics and bivariate and multivariable Cox Proportional Hazard analysis while Content thematic analysis was used for the qualitative data. Results Among the 198 children, 98(49.5%) recovered by 8 weeks, 74(37.4%) defaulted, 18(9.1%) were non-responders, 4(2%) were transferred to inpatient care and 4(2%) of the children died. The predictors of recovery were age &gt; 12months (AHR 1.61, CI: 1.09–2.82, p = 0.04), SAM with edema (AHR 1.95, CI:1.22–3.12, p = 0.01), married (AHR 2.03, CI:1.07–3.82, p = 0.03), increased meal frequency (AHR 1.86, CI:1.06–3.25, p = 0.03) and breast feeding (AHR 0.49, CI:0.30–0.82, p = 0.01). Facilitators to recovery included family support, good attitudes of the health worker, availability of Ready-to-Use Therapeutic Food and availability of multidisciplinary services. Key barriers are high cost of local food preparations, co-morbidities, long distances, lack of home visits, staff shortage, negative culture beliefs, occupation of caregiver, changing of caregiver, discontinuation of care and stigma. Conclusions The nutritional recovery rate at the OTC is far below the accepted minimum international standards. Efforts are therefore needed to improve recovery through special attention to infants below one year and children with non-edematous malnutrition, providing household supplementary food, emphasizing quality young infant feeding practices, and establishing social support structures for unmarried caregivers.</p>