Predictors of mortality among children under five with severe acute malnutrition in intensive therapeutic nutrition units in Kasaï Central Province, 2024: a retrospective cohort study.

INTRODUCTION: severe acute malnutrition affects approximately 19 million children under 5 years of age worldwide. In the Democratic Republic of Congo, between July 2024 and June 2025, approximately 1.4 million children aged 6 to 59 months are estimated to suffer from severe acute malnutrition. It represents a major cause of mortality in low-income countries, particularly in this country. This study aims to identify predictors of mortality among children admitted to the intensive therapeutic nutrition units in Kasaï Central. METHODS: a retrospective cohort study was conducted among 432 children admitted for severe acute malnutrition (SAM) in six intensive therapeutic nutrition units in Kasaï Central, from January to November 2024. Data were collected via KoboCollect, cleaned in Excel, and analyzed with SPSS. Survival analyses (Kaplan-Meier) and a multivariate Cox model were used to identify predictors of mortality. RESULTS: mortality was 6.3%, and median survival time was 7 days. Weight gain ≥100 g was more common in survivors (51.9%) than in non-survivors (33.3%). Significant predictors included sepsis (HRa = 3.325), hypoglycemia (HRa = 4.324), anemia (HRb = 2.32), and dehydration (HRa = 1.726). CONCLUSION: early detection of comorbidities and their prompt management are essential to improve the survival of children with SAM. Specific strategies targeting the main complications must be strengthened in the Intensive Therapeutic Nutrition Units of Kasaï Central.