Peer-reviewed article
Hospital-acquired infections (HAIs) and delayed recovery from severely malnourished children during stabilization: Evidence from retrospective cohort analysis
Teshome Bekele Elema, Solomon Gebretsadik, Ashenafi Habtamu, Tewodros Desalegn Nebi, Gemechu Edae et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study looked at hospital records of 493 children with severe acute malnutrition at Asella Referral and Teaching Hospital in Oromia, Ethiopia. It compared how quickly children recovered depending on whether they caught an infection in hospital. Children without hospital-acquired infections were more likely to recover sooner than those with them. Rural residence, incomplete immunisation and nasogastric tube feeding were linked to getting these infections. The authors call for stronger infection prevention and control, reliable water, sanitation and hygiene (WASH) facilities, and safer feeding practices in therapeutic feeding units.
Key points
- 493 children with comprehensive records were included, after 142 of 635 records were excluded.
- Children without hospital-acquired infections had a higher probability of recovery over time than those with them (log-rank test, p < 0.001).
- Rural residence, incomplete immunisation and nasogastric tube feeding were significantly associated with hospital-acquired infections.
- Hospital-acquired infections are described as common among children admitted with severe acute malnutrition and linked to slower recovery and longer hospital stay.
- The authors recommend integrated infection prevention and control, reliable WASH infrastructure, and safe feeding and hygiene practices.
Limitations
This is a single-hospital retrospective record review, so it shows association rather than cause, and infection was based on clinician documentation in records. The abstract gives no effect sizes, infection rates or recovery times, and it does not test any intervention.
Abstract
Background: Several studies have highlighted the high impact of HAIs and their effects on pediatric recovery in Ethiopia. Objectives: This study examined the effect of hospital-acquired infections (HAIs) on the recovery of children with severe acute malnutrition (SAM). Design: A retrospective cohort study was conducted at Asella Referral and Teaching Hospital in Oromia, Ethiopia. Materials and methods: Hospital acquired infections (HAIs) defined as infections occurred within 48 hours or more after admission to the Hospital and documented by treating clinicians in medical records. Diagnosis was made using routine clinical assessment, and available laboratory findings according to the standard hospital practice. Of 635 children admitted during the study period, 142 records were excluded (not meeting SAM criteria, unacceptable age range, or incomplete data). Consequently, 493 eligible children with comprehensive documentation were included in the final study. Kaplan–Meier survival analysis was used to compare recovery times between children with and without HAIs. Time to nutritional recovery (in days), defined as the length of hospital stay until recovery, and compared between children with and without hospital-acquired infections. Results: Children without hospital-acquired infections had a higher probability of recovery over time compared to those with HAIs (log-rank test, p < 0.001). Factors significantly associated with HAIs included rural residence, incomplete immunization, and nasogastric tube feeding. Conclusions: Hospital-acquired infections are a common complication among children admitted with severe acute malnutrition and are associated with slower recovery and prolonged hospital stay. Improving child survival requires an integrated approach that strengthens infection prevention and control (IPC), ensures reliable WASH infrastructure, and promotes safe feeding and hygiene practices in therapeutic feeding units. Addressing these structural and procedural gaps is essential to achieving sustainable improvements in nutrition recovery and infection control in Ethiopian hospitals.