Incidence and predictors of treatment default among children aged 6-59 months with severe acute malnutrition in stabilisation centres in western Ethiopia: a prospective follow-up study.

Authors

Diriba Bekele Geleta, Lencho Kajela Solbana, Lalesa Tadese Chuko, Ibse Jirata Biri, Gutu Endalew Teina, Yonas Abebe Tarefa

Published in

BMJ public health. Volume 4. Issue 3. Pages e004688. Epub Jul 14, 2026.

Abstract

Treatment default from inpatient care for severe acute malnutrition (SAM) leaves children at high risk of mortality, relapse and incomplete recovery. Identifying factors associated with treatment default is essential to improve programme performance and reduce preventable deaths.
We conducted a hospital-based prospective follow-up study among children aged 6-59 months admitted with SAM to inpatient stabilisation centres of tertiary hospitals in western Ethiopia between 10 January and 15 August 2025. Eligible children were consecutively enrolled at admission and followed until treatment default, recovery, death, transfer or end of follow-up. Time-to-event data were analysed using Kaplan-Meier methods and Gompertz regression to estimate adjusted HRs (AHRs) with 95% CIs.
Three hundred children contributed 3182 child-days of observation. The cumulative incidence of treatment default was 17.7% (95% CI 13.0 to 22.2), with a median time to default of 18 days. Independent predictors of higher hazard of treatment default included rural residence (AHR 4.25; 95% CI 1.49 to 6.57), previous SAM treatment (AHR 2.47; 95% CI 1.06 to 5.76), female-headed household (AHR 3.14; 95% CI 2.32 to 7.45), greater distance to a health facility (AHR 3.58; 95% CI 1.98 to 5.12) and caregiver illiteracy (AHR 6.17; 95% CI 4.12 to 8.34).
The default rate exceeded Sphere standards for inpatient SAM care. Socioeconomic and geographic barriers were key predictors of treatment default, indicating the need for targeted multisectoral interventions to improve retention in inpatient treatment for complicated SAM.

PMID:
42466451
Bibliographic data and abstract were imported from PubMed on 17 Jul 2026.

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