Factors Associated with Treatment Adherence in Children with Malnutrition in Turkey

Aims: Malnutrition (MN) is associated with an increased mortality rate in infants and children and is an important comorbidity. Adherence to MN treatment is critical for a successful outcome, as are early diagnosis and administration of an appropriate treatment regimen. This study aimed to identify the factors pediatricians perceive to be associated with adherence to MN treatment in children. Materials and Methods: This mixed-methods study employed both qualitative and quantitative methods. The study included 136 pediatricians from various geographical regions of Turkey. Data were obtained via face-to-face interview, questionnaire, and group discussion. Results: Physicians perceived that among the patients that were diagnosed with MN, 66% underwent enteral nutrition therapy and that the treatment adherence rate was 59%. Patient-related factors associated with adherence to MN treatment were treatment tolerability, the severity of MN, and comorbidities. Nutritional product-related factors associated with treatment adherence were cost and flavor. Family-related factors associated with treatment adherence were parental level of education, economic status, and the level of confidence in the treatment modality. Use of an unflavored pediatric oral nutritional product increased the treatment adherence in patients aged 18-24 months (60% vs. 40%), whereas flavored varieties increased the treatment adherence rate after 2 years of age. Conclusion: The prevalence of MN is high in Turkey and non-adherence to MN treatment is common. Increasing awareness of the factors that contribute to adherence to MN treatment among physicians, the general public, and government are important for improving the rate of adherence to MN treatment.