Factors associated with child survival in children admitted to outpatient therapeutic program at public health institutions in Afar Regional State, Ethiopia: a prospective cohort study.

INTRODUCTION: About 20 million children suffer from severe acute malnutrition each year. The World Health Organization recommends the outpatient therapeutic program as a standard treatment protocol for the management of uncomplicated severe acute malnutrition and for children who are transferred from inpatient cares after recovery. This study aimed to assess the treatment outcome of severe acute malnutrition and determinants of survival in children admitted to outpatient therapeutic program at public health institutions, Afar Regional State. METHODS: Institution-based prospective cohort study was conducted on 286 children aged 6-59 months admitted to the outpatient therapeutic program, from April to September 2017, at selected public health institutions in Afar Regional State. For the comparison of time to recovery among the different groups of children on the outpatient therapeutic program, Kaplan-Meir curve was used and significance test for these differences was assessed by the log-rank test. Then, a proportional hazard in the Cox model was used to identify independent predictors of survival. p value < 0.05 was considered significant. RESULTS: Of 286 children, 238 (83.2%; 95% CI (79, 88)), 18 (6.3%), 14 (4.9%), 8 (2.8%), and 8 (2.8%) cases were cured, defaulters, non-responder, died, and transfer to inpatient care, respectively. The overall mean rate of weight gain was 10.5(± 3.45) g/kg/day, and mean length of stay was 44.15(± 8.77) days. The recovery rate of children whose mothers travel less than 2 h to the health institution was about three times (AHR, 2.91; 95% CI (2.18, 3.88)) higher than children whose mothers travel 2 h and above. Compared with children who received vitamin A supplementation, children who lack supplementation were less likely (AHR, 0.39; 95% CI (0.25, 0.59)) to be cured. Moreover, the rate of recovery from outpatient therapeutic program among children who received antibiotics was about 1.4 times (AHR, 1.38; 95% CI (1.01, 1.89)) higher compared with children who did not receive of antibiotics. CONCLUSION: This study showed that nearly eight children in every ten had recovered from severe acute malnutrition. Therefore, considering the distance of health facility from children's residence, improving vitamin A supplementation and antibiotics are vital in improving the rate of recovery. Further research is also required to identify and address barriers to the provision of antibiotics and vitamin A supplementation.

Pregnant Women's Intentions to Deliver at a Health Facility in the Pastoralist Communities of Afar, Ethiopia: An Application of the Health Belief Model.

Despite the significant benefits of giving birth at a health facility to improve maternal and child health, the practice remains lower than expected in pastoralist communities of Ethiopia. Understanding the intentions of pregnant women to use health facilities for delivery predicts the adoption of the behavior, yet documented evidence of intention in the context of pastoralist populations remains scarce. The current study aimed to assess pregnant women's intentions to use a health facility for delivery in the Afar region of Ethiopia using the framework of the health belief model (HBM). A community-based, cross sectional survey was conducted from April 1 to April 30 2016 among 357 randomly sampled pregnant women using an interviewer-administered, semi-structured questionnaire. Data were entered into EpiData and exported to SPSS version 20.0 for analysis. Principal component factor analysis was done to extract relevant constructs of the model, and the reliability of items in each construct was assessed for acceptability. Multivariate logistic regressions were applied to identify predictors of pregnant women's intentions to give birth at a health facility. The odds ratio was reported, and statistical significance was declared at 95% CI and 0.05 p value. Three hundred fifty seven pregnant women participated in the study (104.6% response rate indicating above the minimum sample size required). Among the respondents, only 108 (30.3%) participants intended to use a health facility for the delivery for their current pregnancy. Higher household average monthly income [AOR = 1.23, 95% CI = (1.10 - 2.90), antenatal clinic (ANC) attendance for their current pregnancy [AOR = 1.41, 95% CI = (1.31 - 2.10), perceived susceptibility to delivery-related complications [AOR = 1.52, 95% CI = (1.30 - 2.70), and perceived severity of the delivery complications [AOR = 1.66, 95% CI = (1.12 - 2.31) were positively associated with pregnant women's intentions to deliver at a health facility. Intention was negatively associated with participants' perceived barriers to accessing a health facility [AOR = 0.62, 95% CI = (0.36 - 0.85). Conclusions: A low proportion of pregnant women in the sampled community intended to deliver at a health facility. Pastoralist communities may have special needs in this regard, with household income, antenatal care attendance, perceived risk of complications, and perceived barriers to accessing a health facility largely explaining the variance in intention. Community-based interventions providing counseling and messaging on danger signs in the perinatal period and emphasizing benefits of delivering at a facility are recommended, alongside improving access.