Evaluating the level of adherence to Ministry of Health guidelines in the management of Severe Acute Malnutrition at Garissa Provincial General Hospital, Garissa, Kenya

Abstract

IntroductionHalf of Kenya's high infant and under five mortality rates is due to malnutrition. Proper implementation of World Health Organization's (WHO) Evidence Based Guidelines (EBG) in management of severe acute malnutrition can reduce mortality rates to less than 5%. The objectives were to establish the level of adherence to WHO guideline and the proportion of children appropriately managed for severe acute malnutrition (steps 1-8) as per the WHO protocol in the management of severe acute malnutrition. This was a short longitudinal study of 96 children, aged 6-59 months admitted to the pediatric ward with diagnosis of severe acute malnutrition.MethodsData was extracted from patients’ medical files and recorded into an audit tool to compare care provided in this hospital with WHO guidelines.ResultsNon-edematous malnutrition was the commonest presentation (93.8%). A higher proportion (63.5%) of patients was male. Most (85.4%) of patients were younger than 2 years. Patients with non-edematous malnutrition were younger (mean age for non-edematous malnutrition was 16 (± 10.6) months versus 25 (± 13.7) months in edematous malnutrition). The commonest co- morbid condition was diarrhea (52.1%). Overall, 13 children died giving an inpatient case fatality rate of 13.5%. Appropriate management was documented in only 14.6% for hypoglycemia (step1), 5.2% for hypothermia (step 2) and 31.3% for dehydration (step 3).ConclusionThe level of adherence to MOH guidelines was documented in 5 out of the 8 steps. Appropriate management of children with severe acute malnutrition was inadequate at Garissa hospital.

Poor adherence to the World Health Organisation guidelines of management of severe acute malnutrition in children 6 to 59 months of age at Kalakla Turkish Hospital in Khartoum, Sudan

“…Studies have demonstrated the possibility to attain low CFR using the WHO protocol for inpatient management of SAM [15]. Unlike the practice in this cohort, studies from Africa and Asia have https://www/sudanjp.com demonstrated that classification of SAM was in accordance with the guidelines as moderate/ severe and oedematous/non-oedematous SAM [4,16]. This can be attributed to documented training in these settings in comparison to this study setting where training coverage is unknown despite a well-constructed module of training [14].…”

“…Worldwide, 19 million children under 5 years of age are suffering from SAM [3]. The WHO protocol of management of severe malnutrition for hospital setting has been so far partially assessed by studies in African and Asian settings [4][5][6][7]. Partial adherence to the guidelines was documented, however, adherence to the classification of SAM was acceptable in these settings [4,5].…”

“…The WHO protocol of management of severe malnutrition for hospital setting has been so far partially assessed by studies in African and Asian settings [4][5][6][7]. Partial adherence to the guidelines was documented, however, adherence to the classification of SAM was acceptable in these settings [4,5]. Malnutrition constitutes more than 20% of the causes of admission of under 5-yearold children to a referral hospital in the capital city of Sudan, Khartoum [6].…”

Nutritional status and association of demographic characteristics with malnutrition among children less than 24 months in Kwale County, Kenya

“…Severe acute malnutrition often comes with complications although can be managed using WHO guidelines. These guidelines have been shown to reduce mortality associated with SAM by less than 5% [ 26 , 27 ]. Mothers' literacy level is a predictor of children nutrition status [ 28 ].…”

Gaps in the Process of Case Detection, Reporting and Feedback of Severe Acute Malnutrition Program in Three Governorates in Yemen: A Quantitative Study

“…In this study; only about half of participants have previous training regarding SAM management guideline (51%) and this was reflected on the knowledge and practice f participants where 66% of them answer correctly about management of SAM children and 51% of participants have SAM management guideline but only 43% of participants practice SAM management according to the guideline; emphasizing on training about guideline to improve practice toward SAM management was reported elsewhere [15,16]. Wuehler SE et al [17] reported in their study in Mauritania the need for support activities to adapt training materials and programme protocols to fit local needs [17]. This poor knowledge and practice reflected on the ability of the system to detect and manage SAM children: only 49% of participants did not detect any SAM child during two weeks preceding the data collection and 69% did not treat any case of SAM while 59% of participants did not refer any SAM case to the TFC.…”