Outcome of severely malnourished children treated according to UNICEF 2004 guidelines: a one-year experience in a zone hospital in rural Ethiopia

Abstract

Malnutrition still has a dramatic impact on childhood mortality in sub-Saharan African countries. Very few studies have tried to evaluate the outcome of severely malnourished children treated according to the UNICEF 2004 guidelines and reported fatality rates are still very high. During 2006, 1635 children were admitted to the paediatric ward of St. Luke Catholic Hospital in Wolisso, South West Shewa, Ethiopia. Four hundred and ninety-three (30.15%) were severely malnourished and were enrolled in the study. We reviewed the registration books and inpatient charts to analyze their outcome. A mortality rate of 7.1% was found, which is significantly lower than reported in the literature. 28.6% of deaths occurred within 48 h of admission; the recovery rate was 88.4%; the drop-out rate was 4.5%. Early deaths were due to the poor condition of the children on admission, leading to failure of treatment. Late mortality was considered to be related to electrolyte imbalances, which we were unable to measure. The clinical skills of nursing and medical staff were considered an important factor in improving the outcome of malnourished patients. We found that proper implementation of WHO guidelines for the hospital treatment of severely malnourished children can lead to a relatively low mortality rate, especially when good clinical monitoring is assured.

Treatment outcome and associated factors of severe acute malnutrition among 6–59 months old children in Debre Markos and Finote Selam hospitals, Northwest Ethiopia: a retrospective cohort study

“…The recovery rate in our study is higher than previous findings from Tigray [10], Kamba District [11], Uganda [12], Sudan [13], Tamale Teaching Hospital [14] and India [15]. But it is lower than findings from Jimma University Specialized Hospital [16], Woldiya General Hospital [17], Southern region of Ethiopia [18] and Rural Ethiopia [19]. This difference could be due to differences in socio-economic status, quality of care provided for children, health seeking behavior, availability as well as accessibility of therapeutic foods and medications.…”

“…However, it is lower than reports from Uganda [12], Sudan [13], Jimma University Specialized Hospital [16], Woldiya General Hospital [17] and Rural Ethiopia [19]. The possible explanation for this variation might be differences in quality of services provided for children admitted with SAM and management of medical complications associated with SAM.…”

Treatment of severe and moderate acute malnutrition in low- and middle-income settings: a systematic review, meta-analysis and Delphi process

“…In terms of recent studies, we found one before/after study [25], two retrospective chart reviews [26,27], one quasi-experimental study [28] and four prospective cohorts [29-33] that examined the case fatality rates and recovery rates of children with SAM treated according to the WHO protocol or an adapted WHO protocol. There was also one cluster RCT that compared inpatient treatment to home-care and day-care treatment [34,35]; this study contained methodological issues and did not adequately describe the intervention (see additional file 3 for study assessment).…”

Desnutrição energético-proteica grave durante a hospitalização: aspectos fisiopatológicos e terapêuticos

“…Alguns autores (1,4,13,15,20,21,24,25) apontam que as falhas na implementação desse protocolo estão relacionadas ao cuidado e à monitoração dos pacientes. Tal aspecto deve ser considerado principalmente em instituições localizadas em regiões com alta prevalência de DEP e que não dispõem de recursos humanos capacitados para a instituição do tratamento adequado.…”