Association between childhood morbidity and length of stay for transition from severe to moderate acute malnutrition in community-based management of acute malnutrition program: Evidence from Rohingya refugee camp

BackgroundSevere Acute Malnutrition (SAM) among children is often characterized by the presence of morbidities, impacting recovery pathways. Even so, the effect of morbidity at admission on Length of Stay (LoS) among children with SAM admitted in Outpatient Therapeutic Program (OTP) in Rohingya contexts remains unexamined.Aims/objectivesTo estimate the effects of morbidity at admission on LoS of children with SAM admitted in OTP in Rohingya refugee camps in Bangladesh.Methods/methodologyA longitudinal study design was employed and data was collected from children with SAM admitted in four OTP centers in Rohingya refugee camps at Cox's Bazar, Bangladesh. A Kaplan-Meier survival estimate and Cox proportional hazards model were used to estimate the relevant effect.Results/FindingsA total of 297 children with SAM were included. Among them, 190 (63.97%) had morbidity at admission. The mean LoS (days) among children with SAM with and without morbidity at admission was 68 ± 10 and 64 ± 9 (<i>p</i> = 0.002), respectively. Furthermore, at any given time during follow-up, children with SAM who had morbidity at admission had 25% lower hazard (rate) of being discharged as cured (adjusted HR: 0.75, 95% CI: 0.59, 0.96, p = 0.03) compared with those without morbidity at admission, indicating a longer LoS and slower rate of recovery.ConclusionEffective prevention of morbidity at admission can improve nutrition program efficacy by decreasing the LoS and increasing the likelihood of recovery. These findings can inform integrated health-nutrition interventions in refugee contexts.