Long-term survival after therapeutic failure during hospitalization for severe acute malnutrition: Lwiro cohort follow-up in the Eastern Democratic Republic of the Congo

Purpose: The aim of this study was to assess the association between therapeutic failure during hospitalization for severe acute malnutrition (SAM) and long-term survival of children, 11 to 30 years after nutritional rehabilitation. Methodology: Referring to the data collected from December 2017 to November 2018 from the Lwiro cohort; we updated this database with additional data. Records of subjects admitted for SAM between 1988 and 2007 were extracted from the archives of the pediatric hospital in Lwiro, South Kivu, Democratic Republic of Congo (DRC). Therapeutic failure was defined as a hospitalization duration > 45 days and/or edema resolution time > 30 days. A multivariate Cox proportional hazards regression was used to evaluate the impact of therapeutic failure on long-term mortality. Results: A total of 812 subjects were found to be alive and 118 died. The mean age at admission to nutritional rehabilitation was 46 months. Around two third of the subjects had edema, and in 5,6% of these subjects, edema resolutions took more than thirty days in hospital. Almost one in ten (9.4%) cases of SAM resulted in therapeutic failure. The risk of death was significantly higher in subjects with a hospital stay ≥ 45 days (HR = 1.98 and 95%CI: 1.07; 3.67). In the subgroup of subjects with edema, in those whose edema had was resolved late (≥ 30 days) during their hospitalization had a poorer prognosis compared to those whose edema resolved during the first 30 days, with a risks of HR = 2.81 (1.14; 6.95). Conclusion: Improving the initial treatment of SAM is essential to reduce therapeutic failure rates. However, good follow-up after hospital discharge is also imperative to ensure the success of SAM management in the medium and long term.