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Time to Recovery From Severe Acute Malnutrition and Its Predictors Among Children Aged 6-59 Months in Ethiopia: A

Dejen Kahsay Asgedom¹, Maru Feleke², Abraham Walelegn Zelalem³

¹Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia.

Maternal & Child Nutrition

|July 28, 2026

Insights

In Ethiopia, children with severe acute malnutrition (SAM) recovered in a median of 10 days. Weight gain and F-100 formula significantly improved recovery, while HIV and anemia were associated with longer recovery times.

Area of Science:

Pediatrics
Public Health
Nutrition Science

Background:

Severe acute malnutrition (SAM) is a critical health issue in low-resource settings like Ethiopia.
Predictors of time to recovery (TTR) from SAM and longitudinal weight patterns are understudied, hindering effective clinical interventions.
Identifying these factors is crucial for improving treatment outcomes in SAM children.

Purpose of the Study:

To determine the incidence and predictors of recovery from SAM in Ethiopian children aged 6-59 months.
To investigate the association between longitudinal weight changes and time to recovery from SAM.
To provide evidence for optimizing clinical management of SAM in resource-limited contexts.

Main Methods:

An institution-based retrospective follow-up study was conducted in Northwest Ethiopia.
Cox proportional hazards and linear mixed-effects models were used with a Bayesian approach to analyze time-dependent weight trajectories and recovery.
Data from 480 SAM children were analyzed using R software.

Main Results:

The recovery incidence density was 6.69 per 100 person-days of observation, with a median recovery time of 10 days.
Positive weight change was significantly associated with faster recovery (AHR=1.15).
Predictors of delayed recovery included HIV seropositivity, edematous malnutrition, vomiting, and anemia at admission. F-100 formula and IV antibiotic use were associated with faster recovery.

Conclusions:

The study found a recovery proportion lower than SPHERE standards, highlighting the need for improved interventions.
Positive weight trajectory is a key factor in SAM recovery.
F-100 formula and IV antibiotics show promise for enhancing SAM recovery rates in Ethiopian children.

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Abstract:

In low-resource settings such as Ethiopia, where predictors of time to recovery from SAM remain understudied, identifying predictors and longitudinal weight patterns associated with time to recovery (TTR) from SAM is crucial for early and appropriate clinical interventions. Therefore, this study aimed to determine the incidence and predictors of recovery from SAM, as well as its association with longitudinal weight changes, among children aged 6-59 months in Ethiopia. An institution-based retrospective follow-up study was conducted among SAM children aged 6-59 months at Amhara Region Comprehensive Specialized Referral Hospitals (CSEHs), Northwest Ethiopia. Cox PH and linear mixed effect models were jointly used to evaluate the effects of time-dependent weight trajectories on the time to recovery from the SAM via the Bayesian approach. An adjusted hazard ratio (AHR) with a 95% credible interval (CrI) was used to determine statistically significant predictors. The data were entered into the Kobo toolbox and analyzed with R software version 4.5.1. A total of 480 children aged 6-59 months were followed for 4356 person-days of observation (PDO). At the end of the follow-up, 291 patients (291/480, 60.6%) had recovered, with an incidence density of 6.69 cases per 100 PDOs (95% CI: 5.93-7.47). The median recovery time from severe acute malnutrition was 10 days (IQR: 7-16). The time-dependent current value of weight was significantly positively associated with the time to recovery (AHR = 1.15 95% CrI: [1.04, 1.26]). Additionally, being HIV seropositive (AHR = 0.46, 95% CrI: [0.22, 0.90]), having edematous malnutrition (AHR = 0.48, 95% CrI: [0.32, 0.70]), vomiting at admission (AHR = 0.62, 95% CrI: [0.44, 0.87]), anemia at admission (AHR = 0.45, 95% CrI: [0.31, 0.64]), folic acid supplementation (AHR = 0.70, 95% CrI: [0.53, 0.94]), F-100 formula milk (AHR = 1.40, 95% CrI: [1.08, 1.80]), and antibiotic use (AHR = 1.58, 95% CrI: [1.04, 2.46]) were significant predictors of the time to recovery from severe acute malnutrition. The proportion of recovery reported in this study was lower than the minimum 75% threshold set by the national and international SPHERE standards. The median recovery time of 10 days was optimal. The unobserved true current value of weight change was significantly associated with the time to recovery from severe acute malnutrition. Additionally, HIV status, anemia, edema, vomiting at admission, folic acid supplementation, F-100 formula milk, and IV antibiotic use were significant predictors of the time to recovery from SAM. F-100 supplements and IV antibiotics should be used to improve and increase the recovery rate.

Keywords:

Bayesian joint model Ethiopia children aged 6–59 months severe acute malnutrition time to recovery (TTR)weight changes

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