Risk factors for mortality in under-five children with complicated severe acute malnutrition at Woldia Comprehensive Specialized Hospital: an unmatched case-control study.

OBJECTIVE: To identify risk factors associated with inpatient mortality among under-five children admitted with complicated severe acute malnutrition (cSAM) at Woldia Comprehensive Specialized Hospital, Ethiopia. DESIGN: Hospital-based unmatched case-control study conducted from 1 January 2016 to 30 December 2022. Data were extracted from 588 medical records (147 cases and 441 controls). Bivariable and multivariable logistic regression analyses were performed to identify predictors of mortality. Adjusted ORs (AORs) with 95% CIs were used to measure associations and statistical significance was set at p<0.05. SETTING: Stabilisation centre of Woldia Comprehensive Specialized Hospital, Northeastern Ethiopia. PARTICIPANTS: Under-five children admitted with cSAM. OUTCOME MEASURES: Inpatient mortality among under-five children with cSAM. RESULTS: A total of 588 records were included in the analysis. In multivariable logistic regression, grade I nutritional oedema (AOR 13.70; 95% CI 1.09 to 172.76), history of bottle feeding (AOR 5.43; 95% CI 1.09 to 26.98), vomiting (AOR 7.96; 95% CI 1.97 to 32.17), pale conjunctiva (AOR 8.68; 95% CI 2.47 to 30.53), shock (AOR 6.11; 95% CI 1.44 to 25.88), no vaccination history (AOR 11.83; 95% CI 3.09 to 45.29) and intravenous fluid administration (AOR 5.55; 95% CI 1.33 to 23.10) were independent predictors of mortality. Children in the first treatment phase had lower odds of death compared with those in later phases (AOR 0.017; 95% CI 0.003 to 0.098). CONCLUSION: Bottle feeding history, grade I nutritional oedema, shock, intravenous fluid administration, pale conjunctiva, lack of vaccination and treatment phase were independent predictors of mortality among under-five children with cSAM. Strengthening adherence to cSAM management protocols and improving routine immunisation coverage may reduce inpatient mortality.