Malnutrition is the fourth commonest reason for hospital admission to the paediatric department of the Central Hospital, Maputo and has the second highest death rate (20 per cent). A study from 1995 into mortality at this paediatric department, suggested an increase in severe malnutrition. Recent studies have shown that the global burden of undernutrition in the world is declining; however, data for Eastern Africa shows a deterioration. The current study was aimed at describing and comparing the patients on the malnutrition ward, in 2001 and 1983. The study gathered indices of nutritional status and secondary diagnoses from the notes of all children (aged between 6 months and 5 years) discharged from the malnutrition ward for a period of l year (January-December 2001), and from data (collected in January-December 1983) for the malnutrition ward. Data was entered and analysed using Epi-Info 6 and SPSS statistics package. The ethics committee of the hospital approved the study. Data was collected for 558 children in 2001 and 833 in 1983. There was no gender difference, average age was 21.7 months in 2001 and 23.8 months in 1983 and the average hospital stay was 13.1 and 14.3 days, respectively. In 2001, 33 per cent had kwashiorkor, 26 per cent marasmus, and 28 per cent marasmic kwashiorkor. Three hundred and twenty children (82 per cent) were <2 Z-scores below the median weight-for-age and 252 children (65 per cent) were <3 Z-scores. Forty per cent had malaria, 65 per cent anaemia, 53 per cent bronchopneumonia, 14 per cent TB, 36 per cent diarrhoea, and 12 per cent HIV/AIDS. In 1983, 49 per cent had kwashiorkor, 17 per cent marasmus, and 11 per cent had marasmic kwashiorkor. A total of 494 children (81 per cent) were <2 Z-scores below the median weight-for-age and 335 children (55 per cent) were <3 Z-scores. Eighteen per cent had malaria, 37 per cent anaemia, 28 per cent bronchopneumonia, 6 per cent TB, 8 per cent diarrhoea, and 4.4 per cent measles/post-measles. A comparison between the clinical status of 1983 with that of 2001 shows little difference in age, gender or length of stay. There were fewer admissions in 2001, although a higher percentage of severely underweight children and the 2001 group had more secondary infections, especially malaria, bronchopneumonia and anaemia. Clinical malnutrition at a referral hospital level, in spite of the remarkable Mozambican economic growth, shows signs of following the depressing pattern for much of Eastern Africa. A prospective study including HIV tests and anthropometric data for this and the city's other hospitals is warranted. Discussion needs to be prompted on a local level about malnutrition and the use of guidelines.

Aims Globally, an estimated 0.8 million children under five die of diarrhoea annually. Clear, evidence-based clinical management protocols exist, but their successful implementation in resource-limited clinical settings remains challenging. This clinical audit aimed to evaluate the impact of a simple, novel integrated care pathway (ICP) on standards of assessment and management of children with acute diarrhoea in a rural hospial in Bangladesh, and to assess any cost implication for the family. The ICP includes a simple checklist of clinical symptoms and signs which allow the severity of dehydration to be accurately assessed, and integrates this with the relevant treatment algorithm.The impact of the new ICP was measured against the 4 endpoints listed in the results section. Methods Retrospective case notes study of admitted children (1 month to 12 years) with acute diarrhoea in 2012. Patient management was evaluated against hospital guidelines. As the ICP was implemented at the end of May 2012, the patients were split into two cohorts: A (pre-ICP) and B (post-ICP). 183 patients were included in total. Conclusion The implementation of the ICP in this clinical setting improved the quality of acute diarrhoea management.Rates of incorrect dehydration assessment fell by 25%, rates of evidence-based rehydration increased by 48% and rates of unnecessary IV fluid administration decreased by 33%. In addition, there was a 72% reduction in cost of fluids for the family. Aims Severe Acute Malnutrition (SAM) underlies some 500,000 young child deaths per year. For the first time, new (December 2013) World Health Organisation Guidelines recognise SAM in infants <6 months (u6m). Research in this group is however lacking: WHO assessed the quality of current evidence as 'VERY LOW' according to the GRADE framework (Grading of Recommendations Assessment, Development and Evaluation).In this study we aimed to address a key question highlighted by WHO: how best to identify high risk infants u6m. We did this by:-Comparing prevalence of infant SAM as defined by current weight-for-length (WFL)-based definitions with proposed new definitions based on mid-upper-arm circumference (MUAC).-Identifying risk factors for use in future clinical assessment tools. Methods A cross sectional prevalence survey conducted in two referral hospitals and three community health centres in Malawi. All infants u6m excluding twins attending for either medical attention or routine immunizations were measured and asked about potential malnutrition risk factors.Results From October 2013-January 2014 we measured 6,787 infants u6m. After data cleaning, we analysed a total of 5,717 infants u6m: 582 from hospitals; 5,135 from health centres.Defined by WFL <À3 z-scores, 1.6% (90) infants had SAM. Defined by MUAC <110mm, 3.9% (214) had SAM. By MUAC <115mm, an additional 3.5% (188) had SAM. However defined, prevalence was higher in the hospitals than in health centres (3.5% vs 1.4% by WFL; 4.5% vs 3.4% by MUAC).There were no male/female sex differences. Infants with low...

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