Adherence to outpatient therapeutic care and its associated factors among children 6-59 months with severe acute malnutrition at Jinja Regional Referral Hospital

Abstract

Background: Malnutrition remains a major public health challenge, particularly among children under five, with severe acute malnutrition (SAM) contributing significantly to child morbidity and mortality. Aims: This study investigated adherence to Outpatient Therapeutic Care (OTC) and its associated factors among children aged 6-59 months at Jinja Regional Referral Hospital (JRRH). The specific objectives were to assess socio-demographic, client-related, and service-related factors influencing adherence. Methodology: An analytical cross-sectional design was employed, with data collected from 138 caregivers of children receiving OTC at JRRH. Structured questionnaires, key informant interviews, and hospital records provided both quantitative and qualitative data. Adherence was assessed using the Medication Adherence Report Scale (MARS-5), and data were analyzed through descriptive statistics, chi-square tests, and logistic regression. Results: Findings revealed that 60.1% of caregivers demonstrated optimal adherence to OTC. Socio-demographic factors, including caregiver age, marital status, and education level, were not significantly associated with adherence (p > 0.05). However, maternal occupation emerged as a significant predictor, with informally employed mothers more likely to exhibit sub-optimal adherence (aOR = 0.516, p = 0.030). Client-related factors, including caregiver awareness and perceptions of malnutrition, had no significant impact. Among the service-related factors, supplement sharing negatively impacted adherence (aOR = 0.437, p = 0.048), while satisfaction with treatment and accessibility of refills did not significantly influence adherence. Conclusion: The study concluded that financial constraints and supplement sharing were key barriers to OTC adherence. Strengthening community outreach, improving stock management of therapeutic foods, and implementing financial support programs for caregivers were recommended to enhance adherence and improve child health outcomes.