Incidence, associated factors, and short adverse outcomes of diarrhea among children aged 6–59 months admitted with Severe Acute Malnutrition at Mubende Regional Referral Hospital, Uganda

Diarrhea remains a major cause of morbidity and mortality among children under five years globally, with a disproportionately higher burden among those with Severe Acute Malnutrition (SAM). The coexistence of diarrhea and SAM worsens clinical outcomes, leading to dehydration, electrolyte imbalance, prolonged hospitalization, and increased mortality. However, there is limited prospective evidence on the incidence, associated factors, and clinical outcomes of diarrhea among hospitalized children with SAM in Uganda. To determine the incidence, associated factors, and short adverse outcomes of diarrhea among children aged 6–59 months admitted with Severe Acute Malnutrition at Mubende Regional Referral Hospital, Uganda. A hospital-based prospective cohort study was conducted among 372 children aged 6–59 months admitted with SAM. Participants were enrolled at admission and followed throughout hospitalization. Data were collected using structured questionnaires and clinical record review. Descriptive statistics summarized participant characteristics. Bivariate and multivariate logistic regression analyses were performed to identify factors independently associated with diarrhea. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was set at p < 0.05. Out of 372 children, 141 (38%) developed diarrhea, giving a cumulative incidence of 38% and an incidence rate of 11.2 per 100 person-days. Diarrhea was more common among children with Kwashiorkor (97/141, 69%) and those aged 12–24 months (66/141, 47%). In multivariate analysis, Kwashiorkor (AOR 2.6, 95% CI 1.3–5.4, p = 0.004), HIV-positive status (AOR 3.1, 95% CI 1.4–6.8, p = 0.002), and severe anemia (AOR 2.2, 95% CI 1.1–4.2, p = 0.01) were independently associated with diarrhea. Children with diarrhea had longer hospital stays (16.8 ± 5.6 vs. 11.3 ± 4.2 days, p < 0.001) and higher mortality (31/141, 22% vs. 18/231, 8%, p = 0.01). Diarrhea is a common and serious complication among children with SAM and is associated with poorer clinical outcomes, including prolonged hospitalization and increased mortality. Strengthening early identification and targeted management of high-risk children, alongside improved inpatient care and infection prevention strategies, is essential to improve survival and recovery.