Rate and time of recovery and its predictors among children aged 6–59 months admitted to inpatient therapeutic feeding centers for the treatment of severe acute malnutrition in Sana’a, Yemen: a prospective cohort study

Severe acute malnutrition (SAM) is responsible for 1 in 5 deaths of children under five years of age worldwide. In war and conflict countries such as Yemen, the burden of SAM is exacerbated by nutrition emergencies. As a response, inpatient therapeutic feeding centers (TFCs) have been expanded. The aims of this study are to assess the time to recovery, identify its predictors, and examine the anthropometric status, specifically the weight-for-height z-score (WHZ) of children at the time of discharge from Therapeutic Feeding Centers (TFCs) in Sana’a City. An institution-based prospective study was carried out. All admitted children from September to December 2021 were included. Data were collected using a structured questionnaire and abstraction form. Epi Info 7 and STATA 14 were used for data analysis. The Kaplan–Meier curve and the log-rank test were used to assess significant differences in recovery time between groups. The multivariable Cox regression with proportional hazard assumption for the fitness, and adjusted hazard ratio (AHR) at 95% Confidence interval (CI) and P-value < 0.05 were used to determine predictors. A total of 291 children aged 6–59 months with complicated severe acute malnutrition (SAM) were admitted, including 257 with marasmus and 34 with nutritional edema. The incidence rate of recovery was 8.2 per 100 child-days, with a cumulative recovery rate of 82% (238/291) and a median recovery time of 9 days (IQR: 7–14), Among those who recovered, none met the SPHERE minimum standard of ≥ 8 g/kg/day weight gain, and only 9.2% (22/238) achieved anthropometric recovery, defined as a weight-for-height z-score ≥ − 2. The average weight gain among recovered children with marasmus at admission was 2.2 g/kg/day (95% CI: 1.9–2.5). Breastfeeding (AHR = 1.49, 95% CI: 1.10–2.02) and Ready-to-Use Therapeutic Food (RUTF) (AHR = 3.28, 95% CI: 2.26–4.77) were predictors of faster recovery. Edematous malnutrition (AHR = 0.54, 95% CI: 0.33–0.87), comorbidities with pneumonia (AHR = 0.63, 95% CI: 0.44–0.89) and diarrhea (AHR = 0.51, 95% CI: 0.36–0.74), IV fluids (AHR = 0.53, 95% CI: 0.39–0.72), and blood transfusion (AHR = 0.32, 95% CI: 0.12–0.84) were associated with prolonged recovery. Although the cumulative recovery rate met SPHERE standards and the median recovery time of 9 days aligns with WHO stabilization guidelines, absence of sufficient weight gain and anthropometric recovery highlights a critical gap. These findings highlight the urgent need to strengthen follow-up mechanisms and improve the transition between TFCs and OTPs. Incorporating anthropometric cut-off points into discharge criteria in Yemen may help reduce the risks of post-discharge relapse. Further research is recommended to assess long-term outcomes and explore additional factors influencing recovery.