Recovery Rate of Under‐Five Children From Severe Acute Malnutrition and Its Predictors in Ethiopia: A Systematic Review and Meta‐Analysis

TL;DR

This study finds that 71% of children under five in Ethiopia recover from severe malnutrition, but factors like anemia and HIV lower recovery rates, while treatments like vitamin A and therapeutic food help.

Contribution

The study provides updated, regionally diverse data on malnutrition recovery in Ethiopia, including conflict-affected areas, and identifies new predictors of recovery.

Findings

The pooled recovery rate of under-five children from severe acute malnutrition in Ethiopia is 71.37%.

Anemia, shock, HIV/AIDS, and tuberculosis are associated with decreased recovery rates.

Amoxicillin, vitamin A, deworming, and ready-to-use therapeutic food improve recovery rates.

Abstract

Previous reviews on severe acute malnutrition recovery in Ethiopia were limited by outdated data and narrow scope. This study used recent and regionally diverse data, including from conflict‐affected areas, to inform current nutrition efforts.

To provide up‐to‐date information on the recovery rate of Children under five from severe acute malnutrition in Ethiopia.

A systematic review and meta‐analysis of observational studies published between January 2015 and July 2025 was conducted. PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online were searched. The pooled prevalence was estimated using random‐effects model with 95% confidence intervals. Publication bias was assessed using funnel plots and Egger's test.

The pooled recovery rate of under‐five children from severe acute malnutrition was 71.37% (95% CI: 67.57–75.16%). Anemia (AHR = 0.75, 95% CI: 0.63–0.87), shock (AHR = 0.52, 95% CI: 0.13–0.92), HIV/AIDS (AHR = 0.71, 95% CI: 0.44–0.97), use of a nasogastric tube (AHR = 0.62, 95% CI: 0.31–0.93), vomiting (AHR = 0.65, 95% CI: 0.43–0.86), diarrhea (AHR = 0.71, 95% CI: 0.56–0.86), tuberculosis (AHR = 0.47, 95% CI: 0.34–0.60), and pneumonia (AHR = 0.73, 95% CI: 0.61–0.84) were associated with decreased recovery rate. Conversely, the use of amoxicillin (AHR = 2.10, 95% CI: 1.54–2.70), vitamin A supplementation (AHR = 1.50, 95% CI: 1.21–1.79), absence of malaria (AHR = 1.51, 95% CI: 1.03–1.98), deworming (AHR = 1.45, 95% CI: 1.04–1.82), and provision of ready‐to‐use therapeutic food (AHR = 1.63, 95% CI: 1.07–2.20) were associated with improved recovery rate.

The recovery rate of under‐five children from severe acute malnutrition in Ethiopia remained below national and international targets. Strengthening early detection and management of symptoms and comorbidities, along with scaling up proven interventions, is essential to improving recovery rate.

What is Known
◦Previous reviews on severe acute malnutrition (SAM) recovery in Ethiopia relied on older data and lacked coverage of conflict‐affected regions, limiting their relevance to current national nutrition challenges.
What is New
◦This study synthesizes recent, regionally diverse evidence (2015–2025) and provides an updated pooled recovery rate of 71.37%, identifying clinical factors that significantly decrease or improve recovery among children under five.
Clinical Implications
◦Strengthening management of comorbid conditions (e.g., anemia, diarrhea, HIV, pneumonia) and ensuring access to amoxicillin, vitamin A, deworming, and ready‐to‐use therapeutic foods can improve SAM recovery outcomes in Ethiopian treatment programs.

What is Known
◦Previous reviews on severe acute malnutrition (SAM) recovery in Ethiopia relied on older data and lacked coverage of conflict‐affected regions, limiting their relevance to current national nutrition challenges.

Previous reviews on severe acute malnutrition (SAM) recovery in Ethiopia relied on older data and lacked coverage of conflict‐affected regions, limiting their relevance to current national nutrition challenges.

What is New
◦This study synthesizes recent, regionally diverse evidence (2015–2025) and provides an updated pooled recovery rate of 71.37%, identifying clinical factors that significantly decrease or improve recovery among children under five.

This study synthesizes recent, regionally diverse evidence (2015–2025) and provides an updated pooled recovery rate of 71.37%, identifying clinical factors that significantly decrease or improve recovery among children under five.

Clinical Implications
◦Strengthening management of comorbid conditions (e.g., anemia, diarrhea, HIV, pneumonia) and ensuring access to amoxicillin, vitamin A, deworming, and ready‐to‐use therapeutic foods can improve SAM recovery outcomes in Ethiopian treatment programs.

Strengthening management of comorbid conditions (e.g., anemia, diarrhea, HIV, pneumonia) and ensuring access to amoxicillin, vitamin A, deworming, and ready‐to‐use therapeutic foods can improve SAM recovery outcomes in Ethiopian treatment programs.

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