Rural children remain more at risk of acute malnutrition following exit from community based management of acute malnutrition program in South Gondar Zone, Amhara Region, Ethiopia: a comparative cross-sectional study

BACKGROUND: Community-based management of acute malnutrition has been reported effective in terms of recovery rate, but recovered children may be at increased risk of developing acute malnutrition after returning to the same household (HH) environment. OBJECTIVE: Compare the magnitude and factors associated with acute malnutrition among recovered and never treated children in South Gondar Zone, Amhara Region, Ethiopia. METHOD: A comparative cross-sectional study was conducted in three districts of South Gondar Zone by tracing 720 recovered and an equal number of age matched children who were never treated for acute malnutrition. Parents were asked to bring children to health post for survey data collection, anthropometric measurements, and edema assessment. Data were collected using a survey questionnaire, entered in to EpiData and analyzed using SPSS v20. Anthropometric indices were generated according to the WHO’s 2006 Child Growth Standards using WHO Anthro software version 3.2.2. Bivariate and multivariable logistic regression was utilized. Values with P < 0.05 were considered statistically significant and Odds Ratio with 95% CI was used to measure strength of association. RESULT: A total of 1,440 parents were invited, of which 1,414 participated (98.2% response rate). Mean age in months of children (±SD) was 23.7 (±10.4) for recovered and 23.3 (±10.8) for comparison group. About 49% of recovered and 46% of comparison children were females. A significant difference was observed on magnitude of acute malnutrition between recovered (34.2% (95% CI [30.9–38.0]) and comparison groups (26.7% (95% CI [23.5–30.2]), P = 0.002. Factors associated with acute malnutrition among recovered were district of Ebnat (AOR = 3.7; 95% CI [1.9–7.2]), Tach-Gayint (AOR = 2.4; 95% CI [1.2–4.7]); male child (AOR = 1.4; 95% CI [1.0–2.0]); prelactal feeding (AOR = 2.6; 95% CI [1.3 –5.1]); not feeding colostrum (AOR = 1.5; 95% CI [1.1–2.3]); not consuming additional food during pregnancy/lactation (AOR = 1.6; 95% CI [1.1–2.3]); not given Vitamin A supplement (AOR = 2.1; 95% CI [1.4–3.2]); and safe child feces disposal practice (AOR = 1.7; 95% CI [1.2–2.5]) while district of Tach-Gayint (AOR = 2.5; 95% CI [1.3–4.8]); male child (AOR = 1.5; 95% CI [1.1–2.1]), not feeding colostrum (AOR = 1.7; 95% CI [1.2–2.5]), poor hand washing practice (AOR = 1.6; 95% CI [1.1–2.2]); food insecure HH (AOR = 1.6; 95% CI [1.1–2.4]), birth interval <24 months (AOR = 1.9; 95% CI [1.2–3.2]), and poor access to health facility (AOR = 1.7; 95% CI [1.2–2.4]) were factors associated with acute malnutrition among comparison group. CONCLUSION: Recovered children were more at risk of acute malnutrition than the comparison group. Nutrition programs should invest in improving nutrition counseling and education; as well as the hygienic practices to protect children against post-discharge relapse of acute malnutrition.