Factors associated with hospital-acquired diarrhea among children (0-59 months) with severe acute malnutrition at Mwanamugimu Nutrition Unit, Mulago National Referral Hospital, Kampala District

Abstract

Introduction: Hospital-acquired diarrhea remains a major global public health concern and is one of the leading causes of morbidity and mortality among children with severe acute malnutrition. In Uganda, Hospital acquired diarrhea is among the top causes of morbidity and mortality in children severe acute malnutrition under five years, leading to a significant health and economic burden on the country. Objective: To assess the risk factors of Hospital- Acquired Diarrhea among children with severe acute malnutrition (0-59 months) at Mwanamugimu nutrition unit Mulago, Uganda. Methods: This was an unmatched case-control study. Both qualitative and quantitative techniques of data collection were used. An unmatched case-control study conducted among children with Severe Acute Malnutrition (SAM) at Mwanamugimu Nutrition Unit. A total of 17 cases (those with diarrhea) and 34 controls were selected. The qualitative study involved 10 Key Informant Interviews with the Health Workers and 12 In-Depth Interviews with the care takers who were purposively selected to provide their experiences about managing HAD in the same setting. Quantitative data was analyzed using Stata 17.0. Qualitative data was analyzed using thematic analysis in ATLAS. ti 6 software. Results: From the quantitative, a total of 51 children were recruited in the study; the mean age was 15 (±1) months, majorities 62.8% (32/51) of the children were female. The odds of hospital-acquired diarrhea (HAD) among children with SAM was 5.15 (OR=5.15; 95%CI: 1.35 – 10.84). Factors associated with Hospital-Acquired Diarrhea were care takers who faced challenges in managing HAD (AOR=3.9; 95%CI: 1.98-7.67), and sharing rooms with children having diarrhea (AOR=2.65; 95%CI: 1.11-6.32). From the qualitative, the health workers challenge of managing HAD included; delayed detection, inadequate hygiene practices, limited isolation facilities, staff shortages, caregiver exhaustion, infection control issues, patient malnutrition, financial strain, and lack of proper sanitation supplies, all complicating effective care and management. Conclusions and Recommendations: The risk of HAD at Mwanamugimu is high. Risk of developing hospital-acquired diarrhea (HAD) included; facing problems regarding management of HAD, and sharing rooms with children having diarrhea. There is need to educate care takers of children admitted with malnutrition on personal hygiene measures in the nutrition unit and isolation of children having diarrhea from those without diarrhea.