Factors associated with default from the management of severe acute malnutrition among caregivers of children 6-59 months at Fort Portal Regional Referral Hospital, Uganda

Abstract

Background: The successful management of Severe Acute Malnutrition (SAM) lowers under-five morbidity and mortality. Despite this, a significant proportion of children receiving Outpatient Therapeutic Care (OTC) continue to default from management in the Tooro sub-region in Southwestern Uganda. Moreover, little is known about the factors associated with default from the management of SAM. Objective: To assess the factors associated with default from the management of SAM among caregivers of children 6-59 months at the Fort Portal Regional Referral hospital OTC clinic and explore their experiences and perceptions towards SAM and its management. Methods: A mixed methods, unmatched case-control study was conducted among caregivers of 88 cases and 111 controls aged 6-59 months who received SAM management from January 2018 to August 2022. Association between default from the management of SAM and other independent factors was tested both at bivariate and multivariate levels using STATA 14. 14 caregivers and 5 health workers were also interviewed, with informed consent. Interviews were recorded, transcribed verbatim and analyzed using Atlas.Ti 9 software. Results: The study found that compared to being Catholic, being Protestant (aOR=2.6; 95% CI: 1.12-5.9), or Orthodox/ Seventh day Adventist (aOR=3.65; 95% CI: 1.47-9.1) was associated with default from the management of SAM. Additionally, transport costs (aOR=3.3; 95% CI: 1.59-6.8), perceived insusceptibility to other illnesses (aOR=3.9; 95% CI: 1.84-8.3), lack of health education (aOR=3.97; 95% CI: 1.1-14.3) and lack of confidence to comply with health workers’ instructions about SAM management (aOR=0.33; 95% CI: 0.16-0.66) were also associated with default from the management of SAM. Caregivers had a positive experience with SAM management. Majority perceived that SAM was a threat to children’s health and SAM management was beneficial. Conclusion and recommendations: Religion, transport costs and perceptions about SAM and its management were associated with default from the management of SAM. Strengthening the VHT system could bring outpatient management services closer to the community and potentially lower default rate.