Assessing the role of stabilization centers in saving lives of children under five years of age with severe acute malnutrition in drought-affected Somalia
Authors: ALI MOHAMED M , Hassan Aweis O. , Musani Altaf , Mohamud Farhan M. , Mohamed Abdulmunim A. , Lasu Gladys K. , Mengistu Kumlachew , Farah Mohamed M. , Figuereo Salvador , Kaddu Ssentamu Simon , Adrianopoli Marina , Ma SK Md Mamunur Rahman 
Published: April 2024

Background: The cycles of drought in Somalia have exacerbated severe acute malnutrition (SAM) in children under five years of age. In response to this current drought, the World Health Organization (WHO) Somalia country office and partners have supported stabilization centers across the drought-affected regions in addition to other life-saving measures. These centers are a lifeline for children with severe acute malnutrition (SAM) with medical complications, offering a comprehensive array of medical and nutritional inpatient care services. However, their effectiveness and the ability of care givers to access these centers have not been systematically evaluated. The main aims of this study therefore are to estimate cure rate and time to recovery of severely malnourished children in stabilization centers, assess the effect of critical care on survival and identify barriers to access of timely treatment.
Methods:This study will use a prospective design to evaluate the effectiveness of stabilization centers in treating children under five years of age with SAM with medical complications. All eligible children admitted to 18 of 63 stabilization centers will be enrolled. These selected centers, which are supported by WHO Somalia, are in 12 regions of Somalia and they have been stratified based on their monthly case load observed between January and December 2022. The Open Data Kit (ODK) tool will be used to collect data on the children at admission, during their stay and at discharge or death. An exit interview with the children’s caregivers will be done to record their experiences during their child’s stay. Children will be followed up by telephone for up to 42 days after discharge. The availability of essential resources and supplies in the stabilization centers will also be assessed.
Analysis plan: Descriptive statistics will be used to summarize the admission characteristics, overall and by the center. A repeated measures approach will be used to analyze the treatment and nutrition interventions provided at admission and during the child’s stay to the time of discharge by different treatment outcomes. Kaplan-Meier survival curves will be used to estimate the cumulative risk of death up to discharge and in the subsequent follow up after discharge. Cox proportional hazards models will be used to estimate the hazard of death adjusting for both fixed and time-varying covariates and stratified by case load. All rates and measures of associations will be calculated with their 95% confidence intervals.
Discussion:The study design and extensive coverage will ensure reliable results supporting our findings. The study will cover a range of stabilization centers varying by caseloads across drought-affected regions thus ensuring a representative sample allowing generalization of our findings. Collecting information at the facility and individual levels will enable in-depth analysis to document the key factors that affect recovery, survival and death and highlight gaps in management of SAM and barriers to reaching the centers as well as the risk of relapses post discharge.