Determinants of Relapse of Severe Acute Malnutrition Among Children Under Five in Mbujimayi Town, Democratic Republic of Congo

Background: Relapse after treatment for severe acute malnutrition (SAM) undermines child survival and the effectiveness of integrated management of acute malnutrition programs. Evidence on relapse in urban settings of the Democratic Republic of Congo (DRC) remains limited. Methods: We conduct an analytical cross-sectional study among children aged 6– 59 months admitted to outpatient therapeutic nutrition units in the Muya Health Zone, Mbujimayi, from May 2023 to April 2024. Two groups were considered at the time of data collection: children readmitted with SAM following discharge (relapse group) and children newly admitted with SAM during the same study period without documented relapse (new admission group). Data were collected from structured questionnaires and medical records. Descriptive statistics were used to summarize the sociodemographic and clinical characteristics. Bivariate associations were tested using the chi-square test or Fisher’s exact test, and odds ratios (OR) were calculated. Variables with p < 0.20 were entered into multivariate logistic regression. Results: The median age was 24 months (IQR:15– 40) and 56.6% were aged 24– 59 months. Boys accounted for 52.8%. Relapse was independently associated with history of SAM (aOR: 9.847; 95% CI: 3.619– 26.792), lack of measles vaccination (aOR: 3.120; 95% CI: 1.657– 5.873), malaria (aOR: 1.910; 95% CI: 1.012– 3.605), diarrhea at admission (aOR, 3.690; 95% CI, 1.143– 11.921), and clinical outcomes (aOR: 3.660; 95% CI:1.215– 13.026). These findings indicate that relapse in Mbujimayi is driven by the combined effect of prior nutritional vulnerability, incomplete preventive care, and intercurrent infection. Conclusion: SAM relapse was frequent in this urban Congolese setting. Strengthening immunization, infection control, discharge quality, and structured post discharge follow-up may reduce repeated admissions and improve child survival. Keywords: determinants, relapse, severe acute malnutrition, children, Mbujimayi