Treatment outcomes and determinants of mortality in children aged 0-59 months diagnosed with complicated severe acute malnutrition in two referral hospitals in Ghana

Background: Complicated severe acute malnutrition (SAM) poses an enormous threat to the survival of children. However, the relationship between admission characteristics and recovery, weight gain and the risk of mortality in children with complicated SAM is limited in Ghana, especially those <6 months old. This study aimed at investigating the treatment outcomes and determinants of mortality in children aged 0-59 months with complicated SAM. Methods: A review of records of children, 0-59 months treated for complicated SAM between January 2013 and June 2017 in two hospitals in Ghana was conducted. Results: Discharge, death and abscond rates were 77.7%, 17.7% and 3.8%, respectively. Median time to death was 5.0 days (IQR: 2.0; 9.0), with infants <6 months dying earlier (1.5 days; 95% CI: 0.7; 3.2, p = 0.001) compared to the 6-59 month group (5.9 days). Shock, convulsion, oedema and HIV-positive status were associated with 7.1 (95% CI: 2.7; 20.5, p < 0.001), 4.2 (95% CI: 1.6; 10.7, p < 0.001), 2.5 (95% CI: 1.2; 5.5, p = 0.02) and 3.1 (95% CI: 1.3; 7.2, p = 0.03) increased odds of death. Conclusion: The high death rate beyond the internationally accepted minimum observed in this study necessitates further research into effective care delivery, appropriate interventions and implementation to reduce SAM deaths in hospitals.