Determinants of default from outpatient management of severe acute malnutrition among caregivers of children aged 6–59 months at Fortportal regional referral hospital, Southwestern Uganda: a mixed methods study

Abstract Background Successful outpatient management of severe acute malnutrition (SAM) significantly lowers the morbidity and mortality of patients. However, 29.5% of children under five years of age default from outpatient management of SAM in the Tooro subregion in southwestern Uganda, and little is known about the associated factors. This study assessed the determinants of default from the outpatient management of SAM among caregivers of children aged 6–59 months. It explored their experiences and perceptions of SAM and its management at Fort Portal Regional Referral Hospital in the Tooro subregion, Uganda. Methods A mixed methods study was conducted among caregivers of children who received outpatient management between January 2018 and August 2022. Cases were selected purposively, whereas controls were randomly selected. Data was collected using a structured questionnaire and exported to STATA 14 for analysis. Logistic regression was used to identify the determinants of default from the outpatient management of SAM. Fourteen caregivers and five health workers were purposively selected and interviewed, with informed consent. The interviews were audio recorded, transcribed verbatim, and analysed using Atlas. Ti 9 software. Ethical approval was sought from the Makerere School of Public Health Research & Ethics Committee (Protocol ID: 087). Results A total of 88 cases and 111 controls were recruited. Several factors, including being Protestant (AOR = 2.60; 95% CI: 1.12–5.90), being Orthodox/Seventh-day Adventist (AOR = 3.65; 95% CI: 1.47–9.10), high transport costs (AOR = 3.30; 95% CI: 1.59–6.80), lacking perceived susceptibility to other illnesses (AOR = 3.90; 95% CI: 1.84–8.30), lacking health education (AOR = 3.97; 95% CI: 1.1–14.30) and lacking self-efficacy (AOR = 0.33; 95% CI: 0.16–0.66), were significantly associated with default from the outpatient management of SAM. Most caregivers reported being afraid of the possible consequences of default and agreed that SAM management was beneficial. However, their confidence in adhering to management was undermined by several factors, including transport costs, distance to the health facility, and discrimination. Conclusion Being Protestant, Orthodox/Seventh-day Adventist, high transport costs, lack of perceived susceptibility to other illnesses, lack of health education, and lack of self-efficacy were essential determinants of default from outpatient management of SAM. To reduce the default rate, stakeholders must strengthen peripheral sites and community health workers to bring SAM management services closer to the community. Additionally, a closer examination of the role of religious beliefs in default from the outpatient management of SAM is needed.