Facteurs associés à la non-réponse au traitement nutritionnel chez les enfants de 6 à 59 mois malnutris sévères admis dans les STA du district sanitaire de Kibumbu

Abstract

Introduction : Non-response to nutritional treatment among children remains a public health concern despite the use of ready-to-use therapeutic foods (RUTF). This study aimed to identify factors associated with non-response to treatment among children aged 6–59 months in outpatient therapeutic services in Kibumbu Health District. Methods : A retrospective case-control study was conducted among children aged 6–59 months with severe acute malnutrition admitted to outpatient therapeutic programs in Kibumbu from January 1 to December 31, 2025. Mothers and health workers were included as complementary information sources. Seven health facilities were randomly selected from 12, followed by a random selection of 198 children (99 non-responders and 99 responders) from admission registers. Data were collected using KoboCollect after informed consent. Sample size was calculated using the Schwartz formula with a non-response prevalence of 6.5%, a 95% confidence level, and a 5% margin of error. Data analysis was performed using STATA 15.1 with a significance threshold of 5%. Model performance was assessed using ROC curve analysis. Results : Multivariate analysis identified five factors independently associated with non-response in children. These were: poor home follow-up (adjusted OR = 14.99; 95% CI : 5.14–43.71 ; p < 0.001), sharing of ready-to-use therapeutic foods (adjusted OR = 9.67; 95% CI : 3.34–28.00 ; p < 0.001), poor appetite (adjusted OR = 11.72; 95% CI : 3.99–34.47 ; p < 0.001), poor household hygiene (adjusted OR = 8.42; 95% CI : 2.81–29.27 ; p < 0.001), and having a large number of children (≥4) in the household (adjusted OR = 5.77; 95% CI : 2.06–16.19 ; p = 0.001). The final logistic regression model showed excellent goodness of fit and very high discriminative power (AUC = 0.9672). Conclusion : Strengthening home follow-up, improving adherence to RUTF use, and promoting appropriate household hygiene practices could improve treatment outcomes.