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Background <p>Uganda’s Outpatient Therapeutic Care (OTC) programs have scaled up community-based Severe Acute Malnutrition (SAM) management, yet treatment default rates remain higher than acceptable thresholds. Evidence on the drivers of default, particularly in referral settings in northern Uganda, is limited. The aim of this study was to assess the prevalence and determinants of treatment default among children aged 6–59 months enrolled in OTC at Gulu Regional Referral Hospital (GRRH) in Northern Uganda.</p> Methods <p>A cross-sectional analysis was conducted using retrospective chart review data of 411 children enrolled in the OTC program at GRRH between July 2022 and June 2024. Data on sociodemographic (age, sex, residence), anthropometric (weight, height, Mid Upper Arm Circumference (MUAC), and clinical characteristics (HIV status, admission type, nutritional status, and infant feeding practice) were extracted from the integrated nutrition register and analyzed using STATA version 17. Descriptive statistics summarized demographic and clinical characteristics. Bivariate analysis assessed associations with treatment default. Variables with <i>p</i> &lt; 0.20 or theoretical relevance were included in multivariable logistic regression. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (CIs) were reported, with <i>p</i> &lt; 0.05 considered statistically significant.</p> Results <p>Of the 411 children included, the median age was 18 months (IQR: 12–25); 57.2% were male, 66.2% were under 24 months, over half weighed &lt; 7&#xa0;kg, and 67.6% had SAM without edema at admission The treatment default rate was 24.8%. Bivariate analysis showed significant associations between default and HIV status (<i>p</i> = 0.01), lower median admission weight (median = 6.4&#xa0;kg; IQR 5.5–8.1 vs. 7.0&#xa0;kg; IQR 6.0–8.2; <i>p</i> = 0.02), and weight &lt; 7&#xa0;kg (<i>p</i> = 0.03). In multivariable analysis, none of the variables remained statistically significant; however, admission weight &lt; 7&#xa0;kg showed a positive, non-significant association with default (AOR = 1.52; <i>p</i> = 0.12).</p> Conclusions <p>Default from OTC remains high at GRRH, particularly among younger and underweight children. Targeted interventions should include strengthened follow-up systems to enhance treatment completion in OTC programs.</p>

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Prevalence and exploratory analysis of factors associated with treatment default in outpatient therapeutic care for severe acute malnutrition among children aged 6–59 months in northern Uganda: a cross-sectional study

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  • 发表日期：

    2026年1月5日

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  • Peterson David Kamulegeya,
  • Ronald Wanyama,
  • Peter Akera

摘要

Background

Uganda’s Outpatient Therapeutic Care (OTC) programs have scaled up community-based Severe Acute Malnutrition (SAM) management, yet treatment default rates remain higher than acceptable thresholds. Evidence on the drivers of default, particularly in referral settings in northern Uganda, is limited. The aim of this study was to assess the prevalence and determinants of treatment default among children aged 6–59 months enrolled in OTC at Gulu Regional Referral Hospital (GRRH) in Northern Uganda.

Methods

A cross-sectional analysis was conducted using retrospective chart review data of 411 children enrolled in the OTC program at GRRH between July 2022 and June 2024. Data on sociodemographic (age, sex, residence), anthropometric (weight, height, Mid Upper Arm Circumference (MUAC), and clinical characteristics (HIV status, admission type, nutritional status, and infant feeding practice) were extracted from the integrated nutrition register and analyzed using STATA version 17. Descriptive statistics summarized demographic and clinical characteristics. Bivariate analysis assessed associations with treatment default. Variables with p < 0.20 or theoretical relevance were included in multivariable logistic regression. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (CIs) were reported, with p < 0.05 considered statistically significant.

Results

Of the 411 children included, the median age was 18 months (IQR: 12–25); 57.2% were male, 66.2% were under 24 months, over half weighed < 7 kg, and 67.6% had SAM without edema at admission The treatment default rate was 24.8%. Bivariate analysis showed significant associations between default and HIV status (p = 0.01), lower median admission weight (median = 6.4 kg; IQR 5.5–8.1 vs. 7.0 kg; IQR 6.0–8.2; p = 0.02), and weight < 7 kg (p = 0.03). In multivariable analysis, none of the variables remained statistically significant; however, admission weight < 7 kg showed a positive, non-significant association with default (AOR = 1.52; p = 0.12).

Conclusions

Default from OTC remains high at GRRH, particularly among younger and underweight children. Targeted interventions should include strengthened follow-up systems to enhance treatment completion in OTC programs.