Severe acute malnutrition (SAM) is the most severe and visible form of undernutrition and remains a major cause of morbidity and mortality in developing countries, particularly in Sub-Saharan Africa. Despite its public health significance, limited studies especially multicenter studies have been conducted in Ethiopia, including the present study area. Therefore, this study aimed to assess the time to achieve target mid-upper arm circumference (MUAC) and its predictors among children with severe acute malnutrition treated in the outpatient therapeutic feeding program (OTP) in Hossana Town, Central Ethiopia. A retrospective follow-up study was conducted among 631 children with SAM enrolled in OTP using systematic random sampling. Kaplan–Meier survival analysis was used to estimate the time to achieve target MUAC, and Cox proportional hazards regression analysis was employed to identify independent predictors. Variables with a p-value <0.25 in the bivariable analysis were included in the multivariable Cox regression model, and statistical significance was declared at p-value <0.05. A total of 631 children were included in the study. The incidence rate of achieving target MUAC was 17.7 per 1000 child-days of observation. Overall, 94.9% of children achieved the target MUAC, while 5.31% were censored (2.16% lost to follow-up and 3.15% referred). The median time to achieve target MUAC was 60 days (IQR: 54–65). Factors significantly associated with time to achieve target MUAC included the presence of cough (AHR = 0.39; 95% CI: 0.30–0.51), inappropriate consumption of ready-to-use therapeutic food (RUTF) (AHR = 0.21; 95% CI: 0.17–0.26), and HIV/AIDS infection (AHR = 0.42; 95% CI: 0.22–0.77). In conclusion, the time to achieve target MUAC was significantly influenced by cough, HIV/AIDS infection, and inappropriate RUTF consumption. Therefore, providing special attention and appropriate management for children with these conditions is essential to improve recovery outcomes and reduce the duration of treatment in OTP programs.
| Published in | Science Discovery Medicine (Volume 1, Issue 1) |
| DOI | 10.11648/j.sdmed.20260101.15 |
| Page(s) | 24-37 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2026. Published by Science Publishing Group |
Central Ethiopia, Severe Acute Malnutrition, Target MUAC and Under-5 Children
| [1] |
Federal Ministry of Health (FMOH). Guidelines for the Management of Common Illnesses in Hospitals. 2nd edition. Adis-Ababa, Ethiopia: FMOH; 2016. Available from:
https://hakimethi.org/wp–content/uploads/2024/09/Pediatric-illness-Tx-guideline-2016.pdf |
| [2] | De Onis M, Blössner M. The World Health Organization global database on child growth and malnutrition: methodology and applications. International Journal of Epidemiology. 2003; 32(4): 518–526. |
| [3] | United Nations Children’s Fund (UNICEF). Nutrition in Emergencies: Saving Lives Today, Strengthening Systems for Tomorrow. 2018. Available from: |
| [4] | Ariza NR, Nadhiroh SR, Willmart AC. Mid Upper Arm Circumference (MUAC) Accuracy in Detecting Acute Malnutrition in Children under 5 Years: A Literature Review. Amerta Nutrition. 2023, 7(2SP), 328–335. |
| [5] | Kliegman RM, Stanton BM, Geme JS. Nelson textbook of pediatrics, 2-volume set, 20th edition. 2015. |
| [6] | World Health Organization, United Nations Children’s Fund (UNICEF), The World Bank Group. Levels and Trends in Child Malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates Key Findings of the 2021 Edition. World Health Organization. 2021. Available from: |
| [7] | Sphere Association. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. 4th ed. Practical Action Publishing; 2018. Available from: |
| [8] | Baye K, Hirvonen K. Accelerating progress in improving diets and nutrition in Ethiopia. ESSP Research Note 75, International Food Policy Research Institute; 2020. |
| [9] | National Guideline for the Management of Acute Malnutrition in Ethiopia. Federal Ministry of Health–Ethiopia; 2021. Available from: |
| [10] |
UNICEF W, World Bank Group. Levels and trends in child malnutrition. UNICEF, World Health Organization, World Bank Group; 2017:
https://www.who.int/publications/m/item/jme–estimates-2017-edition |
| [11] | Joosten KF, Hulst JM. Prevalence of malnutrition in pediatric hospital patients, 2018; 20(5): 590-6. |
| [12] | Bourke CD, Berkley JA, Prendergast AJ. Immune dysfunction as a cause and consequence of malnutrition. Trends in immunology. 2016; 37(6): 386-98. |
| [13] | Organization WH. Community-based management of severe acute malnutrition: a joint statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children's Fund: World Health Organization; 2017. |
| [14] | Attia S, Versloot CJ, Voskuijl W, van Vliet SJ, Di Giovanni V, Zhang L, et al. Mortality in children with complicated severe acute malnutrition is related to intestinal and systemic inflammation: an observational cohort study. The American journal of clinical nutrition. 2016; 104(5): 1441-9. |
| [15] | Nalwanga D, Musiime V, Kizito S, Kiggundu JB, Batte A, Musoke P, et al. Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective cohort study from Kampala, Uganda. BMC pediatrics. 2020; 20(1): 1-11. |
| [16] |
Chakraborty A, Mukhopadhyay S. Global Hunger Index: Misplaced Debate and Ignoring Priorities. URL:
https://www.theindiaforum.in/economy/global-hunger-index-misplaced-debate-and-ignoring-priorities |
| [17] | Ephi I. Ethiopian public health Institute (EPHI)[Ethiopia] and ICF. Ethiopia mini demographic and health survey. 2019. |
| [18] | Girum T, Kote M, Tariku B, Bekele H. Survival status and predictors of mortality among severely acute malnourished children< 5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study. Therapeutics and clinical risk management. 2017: 101-10. |
| [19] | Teferi E, Lera M, Sita S, Bogale Z, Datiko DG, Yassin MA. Treatment outcome of children with severe acute malnutrition admitted to therapeutic feeding centers in Southern Region of Ethiopia. Ethiopian Journal of Health Development. 2019; 24(3). |
| [20] | Organization WH. Levels and trends in child malnutrition child malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates: Key findings of the 2023 edition: World Health Organization; 2023. |
| [21] | Collins S, Sadler K. Outpatient care for severely malnourished children in emergency relief programmes: a retrospective cohort study. The Lancet. 2018; 360(9348): 1824-30. |
| [22] | Atnafe B, Roba KT, Dingeta T. Time of recovery and associated factors of children with severe acute malnutrition treated at outpatient therapeutic feeding program in Dire Dawa, Eastern Ethiopia. PloS one. 2019; 14(6): e0217344. |
| [23] | UNICEF WHO, World Bank Group Joint Child Malnutrition Estimates. GLOBAL ACTION PLAN ON CHILD WASTING A framework for action to accelerate progress in preventing and managing child wasting and. 2019. |
| [24] | Tadesse E, Ekström E-C, Berhane Y. Challenges in implementing the integrated community-based outpatient therapeutic program for severely malnourished children in rural southern Ethiopia. Nutrients. 2016; 8(5): 251. |
| [25] | Hailegebreal S, Gilano G, Simegn AE, Seboka BTJPo. Spatial variation and determinant of home delivery in Ethiopia: Spatial and mixed effect multilevel analysis based on the Ethiopian mini demographic and health survey 2019. 2022; 17(3): e0264824. |
| [26] | Sphere Association. Humanitarian Charter and Minimum Standards in Humanitarian Response. Sphere Handbook. 2018. Available from: URL: |
| [27] | Kabalo MY, Shanka MM. Seasonal variations of admission and survival status of children treated for severe acute malnutrition (SAM) at outpatient therapeutic program (OTP) in Wolaita Zone, Southern Ethiopia. International Journal of Collaborative Research on Internal Medicine & Public Health. 2016; 8(9): 512-26. |
| [28] | Yebyo HG, Kendall C, Nigusse D, Lemma W. Outpatient therapeutic feeding program outcomes and determinants in treatment of severe acute malnutrition in Tigray, northern Ethiopia: a retrospective cohort study. PloS one. 2013; 8(6): e65840. |
| [29] | Lambebo A, DTaTB. Utilization of Mid-Upper Arm Circumference as a Discharge Tool for Children in Outpatient Therapeutic Program, Ethiopia. 2022. Available from: [Journal of Nutritional Science. 2022; 11: e101.] |
| [30] | Baraki AG, TYA, Haileab Fekadu Wolde WWT, WNM, Behailu Derseh HDD, Abel Fekadu Dadi. Time to recovery from severe acute malnutrition and its predictors: a multicentre retrospective follow-up study in Amhara region, north-west Ethiopia. 2019. |
| [31] | Gebremicael Guesh GD, Mebrahtu Abay, Berhe Beyene, Ermyas Brhane and Kalayu Brhane. Survival status and predictors of mortality among children with severe acute malnutrition admitted to general hospitals of Tigray, North Ethiopia: a retrospective cohort study. 2018. |
| [32] | Dagim Biratu SZ, Ebissa Negera, Alemu aS. Achievement of adequate weight gain among infants and children with complicated severe acute malnutrition receiving treatment in therapeutic feeding centers of South Sudanese refugee camps in Ethiopia. 2023. |
| [33] | WHO. POCKET BOOK OF Hospital care for children. 2013 2nd EDITION; 2nd; URL: |
| [34] | Akinwande MO, Dikko HG, Samson A. Variance inflation factor: as a condition for the inclusion of suppressor variable (s) in regression analysis. Open journal of statistics. 2015; 5(07): 754. |
| [35] |
UNICEF. The state of the world’s children 2019: children, food and nutrition: growing well in a changing world: Unicef; 2019.
https://www.unicef.org/reports/state-of-worlds-children-2019 |
| [36] | Gebremichael DY. Predictors of nutritional recovery time and survival status among children with severe acute malnutrition who have been managed in therapeutic feeding centers, Southern Ethiopia: retrospective cohort study. BMC public health. 2015; 15: 1-11. |
APA Style
Geneti, E., Laemebo, W., Zewdu, T., Shewasinad, S., Ketema, H. (2026). Time to Achieve Target MUAC and Its Predictors Among Children with Severe Acute Malnutrition Under Outpatient Therapeutic Programs, Hossana, Ethiopia. Science Discovery Medicine, 1(1), 24-37. https://doi.org/10.11648/j.sdmed.20260101.15
ACS Style
Geneti, E.; Laemebo, W.; Zewdu, T.; Shewasinad, S.; Ketema, H. Time to Achieve Target MUAC and Its Predictors Among Children with Severe Acute Malnutrition Under Outpatient Therapeutic Programs, Hossana, Ethiopia. Sci. Discov. Med. 2026, 1(1), 24-37. doi: 10.11648/j.sdmed.20260101.15
AMA Style
Geneti E, Laemebo W, Zewdu T, Shewasinad S, Ketema H. Time to Achieve Target MUAC and Its Predictors Among Children with Severe Acute Malnutrition Under Outpatient Therapeutic Programs, Hossana, Ethiopia. Sci Discov Med. 2026;1(1):24-37. doi: 10.11648/j.sdmed.20260101.15
@article{10.11648/j.sdmed.20260101.15,
author = {Elias Geneti and Wondimu Laemebo and Tesfu Zewdu and Sisay Shewasinad and Hilina Ketema},
title = {Time to Achieve Target MUAC and Its Predictors Among Children with Severe Acute Malnutrition Under Outpatient Therapeutic Programs, Hossana, Ethiopia},
journal = {Science Discovery Medicine},
volume = {1},
number = {1},
pages = {24-37},
doi = {10.11648/j.sdmed.20260101.15},
url = {https://doi.org/10.11648/j.sdmed.20260101.15},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sdmed.20260101.15},
abstract = {Severe acute malnutrition (SAM) is the most severe and visible form of undernutrition and remains a major cause of morbidity and mortality in developing countries, particularly in Sub-Saharan Africa. Despite its public health significance, limited studies especially multicenter studies have been conducted in Ethiopia, including the present study area. Therefore, this study aimed to assess the time to achieve target mid-upper arm circumference (MUAC) and its predictors among children with severe acute malnutrition treated in the outpatient therapeutic feeding program (OTP) in Hossana Town, Central Ethiopia. A retrospective follow-up study was conducted among 631 children with SAM enrolled in OTP using systematic random sampling. Kaplan–Meier survival analysis was used to estimate the time to achieve target MUAC, and Cox proportional hazards regression analysis was employed to identify independent predictors. Variables with a p-value <0.25 in the bivariable analysis were included in the multivariable Cox regression model, and statistical significance was declared at p-value <0.05. A total of 631 children were included in the study. The incidence rate of achieving target MUAC was 17.7 per 1000 child-days of observation. Overall, 94.9% of children achieved the target MUAC, while 5.31% were censored (2.16% lost to follow-up and 3.15% referred). The median time to achieve target MUAC was 60 days (IQR: 54–65). Factors significantly associated with time to achieve target MUAC included the presence of cough (AHR = 0.39; 95% CI: 0.30–0.51), inappropriate consumption of ready-to-use therapeutic food (RUTF) (AHR = 0.21; 95% CI: 0.17–0.26), and HIV/AIDS infection (AHR = 0.42; 95% CI: 0.22–0.77). In conclusion, the time to achieve target MUAC was significantly influenced by cough, HIV/AIDS infection, and inappropriate RUTF consumption. Therefore, providing special attention and appropriate management for children with these conditions is essential to improve recovery outcomes and reduce the duration of treatment in OTP programs.},
year = {2026}
}
TY - JOUR T1 - Time to Achieve Target MUAC and Its Predictors Among Children with Severe Acute Malnutrition Under Outpatient Therapeutic Programs, Hossana, Ethiopia AU - Elias Geneti AU - Wondimu Laemebo AU - Tesfu Zewdu AU - Sisay Shewasinad AU - Hilina Ketema Y1 - 2026/03/19 PY - 2026 N1 - https://doi.org/10.11648/j.sdmed.20260101.15 DO - 10.11648/j.sdmed.20260101.15 T2 - Science Discovery Medicine JF - Science Discovery Medicine JO - Science Discovery Medicine SP - 24 EP - 37 PB - Science Publishing Group UR - https://doi.org/10.11648/j.sdmed.20260101.15 AB - Severe acute malnutrition (SAM) is the most severe and visible form of undernutrition and remains a major cause of morbidity and mortality in developing countries, particularly in Sub-Saharan Africa. Despite its public health significance, limited studies especially multicenter studies have been conducted in Ethiopia, including the present study area. Therefore, this study aimed to assess the time to achieve target mid-upper arm circumference (MUAC) and its predictors among children with severe acute malnutrition treated in the outpatient therapeutic feeding program (OTP) in Hossana Town, Central Ethiopia. A retrospective follow-up study was conducted among 631 children with SAM enrolled in OTP using systematic random sampling. Kaplan–Meier survival analysis was used to estimate the time to achieve target MUAC, and Cox proportional hazards regression analysis was employed to identify independent predictors. Variables with a p-value <0.25 in the bivariable analysis were included in the multivariable Cox regression model, and statistical significance was declared at p-value <0.05. A total of 631 children were included in the study. The incidence rate of achieving target MUAC was 17.7 per 1000 child-days of observation. Overall, 94.9% of children achieved the target MUAC, while 5.31% were censored (2.16% lost to follow-up and 3.15% referred). The median time to achieve target MUAC was 60 days (IQR: 54–65). Factors significantly associated with time to achieve target MUAC included the presence of cough (AHR = 0.39; 95% CI: 0.30–0.51), inappropriate consumption of ready-to-use therapeutic food (RUTF) (AHR = 0.21; 95% CI: 0.17–0.26), and HIV/AIDS infection (AHR = 0.42; 95% CI: 0.22–0.77). In conclusion, the time to achieve target MUAC was significantly influenced by cough, HIV/AIDS infection, and inappropriate RUTF consumption. Therefore, providing special attention and appropriate management for children with these conditions is essential to improve recovery outcomes and reduce the duration of treatment in OTP programs. VL - 1 IS - 1 ER -