Time to recovery from severe acute malnutrition and associated factors among children aged 6–59 months treated in an outpatient therapeutic program at Galguduud General Hospital, Dhuusamareb, Somalia: a retrospective cohort study

Introduction Severe acute malnutrition remains one of the main contributors to morbidity and mortality among children aged 6–59 months globally, particularly in sub-Saharan Africa. Somalia is one of the most affected countries by severe acute malnutrion, ​reflecting the country’s humanitarian and food insecurity challenges. Despite ​​​the ​being region being settings prone to conflict and drought, the evidence of the time to recovery from severe acute malnutrition and its predictors remains limited in the Dhuusamareb district, Galmudug, Somalia. Therefore, this study aimed to estimate time to recovery and associated factors among severe acute malnourished children aged 6–59 months admitted to the Outpatient Therapeutic Program at Galguduud General Hospital, Dhuusamareb, Somalia. Methods Retrospective cohort study was conducted among children aged 6-59 months who had been treated in the OTP site in the Galguduud General Hospital in Dhuusamareb between January 1, 2022, and December 31, 2025. The Kaplan-Meier curve and log-rank test were used to estimate median time to recovery and compare the time to recovery among different groups. The lognormal AFT model was used to identify significant predictors of time to recovery. In addition to being the best -fitting model based on th​e Akaike information criterion(AIC), the lognormal-AFT model allows us to report our results in terms of how much risk factors accelerate or decelerate patient recovery time, which is much easier to understand than interpreting hazard ratios. Associations were expressed using adjusted time ratio (ATRs), and statistical significance was determined at the 5% significance level, P < 0.05, with 95% confidence intervals. Result A total of 278 records of children aged 6–59 months were analyzed, of which 157 (56.5%) of the children were older than 24 months. More than half, 155 (55.7%), of the children were male​. Among the children aged 6–59 months, 209 (75.2%) recovered from SAM in the OTP program, whereas 60 (21.6%) and 9 (3.2%) were classified as defaulters and non-responders, respectively. The incidence rate of recovery was 1.85 per 100 child days (95% CI: 1.58–2.08). The median time to recovery was 43 days (IQR: 34–55). Children with cough had a 28% longer time to recovery compared to those without cough (ATR = 1.28, 95% CI = 1.13–1.46; p = 0.001). Moreover, children who tested posative for malariahad 16% longer time to recovery compared to those without malaria (ATR = 1.16, 95% CI = 1.03–1.29; p = 0.015). Likewise, recovery time was 3% shorter for every unit increase in consumption of RUTF (ATR = 0.97, 95% CI = 0.96–0.99; p = 0.001). Moderate appetite was associated with a 12% longer time to recovery (ATR = 1.12, 95% CI = 1.02–1.23; p = 0.015). Conclusion This study showed that the presence of cough, appetite, consumption of RUTF at admission, and malaria were significant factors independently associated with time to recovery. Policy makers, including governmental and non-governmental organizations should put more effort into children with complications and also strengthen defaulter tracing systems to further increase the recovery rate.