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

Abstract

Severe acute malnutrition (SAM) constitutes about a third of the estimated 8 million deaths in under 5-year-old children, and the World Health Organisation (WHO) protocol of management is used in hospital management. The present study aims to assess adherence to the WHO guidelines of management of SAM in children aged 6-59 months at Kalakla Turkish Hospital in Khartoum, Sudan. Medical records/files of 169 children, mean (standard deviation) age was 18.5 (10.4) months with a range of 6-54 months, admitted to the hospital were reviewed. The male/female ratio was 1.5:1. No records of history and the proportion of missing examination information were >5%. Weight-for-height score was not calculated for 61% of children and other anthropometric measurements were inadequately recorded. Seven classifications of acute malnutrition were recorded instead of two. Oedema, mid-upper arm circumference andscore were neglected as tools of classification. Blood sugar, haemoglobin concentration and malaria film/rapid diagnostic tests were the only requested tests in 122 (72.2%), 14 (8.3%) and 49 (29%), respectively. Appropriate treatment was documented in 68 (40.2%) children for intravenous (IV) dextrose for hypoglycaemia, 25 (14.8%) for kangaroo technique, 32 (18.9%) covering with blanket for hypothermia, 106 (62.7%) for F75 milk formula and 115 (68%) for F100 milk formula feeding; and there were no records of receiving oral/IV rehydration. The case fatality rate was 5.9%. Quality of care can be improved by training. Improvement of hospital infrastructure with attention to specifying rooms for management of acute malnutrition will be of benefit to the application of the guidelines.

Risk and Adverse Outcome Factors of Severe Acute Malnutrition in Children: A Hospital-Based Study in Odisha

“…Introduction of prelacteals, not on exclusive breastfeeding for six months, and introduction of complementary food before six months had a significant association with SAM as was found in this study. Previous studies had similar reports [ 10 , 17 ]. Association of infections like ARI (pneumonia), sepsis, and UTI reduces the physiological reserve of SAM children and increases metabolic demand to contain fever, work of breathing, and cardiac output.…”

Determinants of mortality among under-five children admitted with severe acute malnutrition in Addis Ababa, Ethiopia

“…However, this finding is slightly higher than the studies conducted in several parts of Ethiopia such as in Hadya Zone (7%) [ 28 ], Dilchora Hospital (7.6%) [ 17 ], Debremarkose (5.9%) [ 26 ], Jima Zone (9.3%) [ 24 ], Tigray (3.8%) [ 14 ], Gedeo Zone (9.3% [ 16 ], Southern Ethiopia (9.3%) [ 23 ], Felegehiwot Referal Hospital (8.47%) [ 34 ], Nekemte Referral Hospital (4.4%) [ 27 ], North Shoa Zone Hospitals (5.8%) [ 35 ], South Wollo Zone (3.4%) [ 36 ] and Hiwot Fana Specialized University Hospital (2.1%) [ 29 ]. This finding is also higher than the study results from Sudan, Malawi and India [ 12 , 37 , 38 ]. The difference could be resulted from differences in the demography of study subjects and it might be also associated with delayed referral process of SAM children to the current study area.…”

“…A cohort study in Kenya substantiates that the coincidence of comorbidities like diarrheal diseases, HIV and pneumonia increases the inpatient and post discharge mortality of children with SAM [ 11 ]. The inappropriate implementation SAM management protocols may also have an effect [ 12 ]. Ethiopia is placed at the second place in high burden of malnutrition among sub-Saharan countries [ 13 ].…”

Micronutrient supplementation practices in relation to the World Health Organisation 2013 guidelines on management of severe acute malnutrition

“…The motivation for the additional supplementation of micronutrients, as observed in this study, could probably be due to health care professionals exercising their professional discretion and judgement in the treatment of each patient and other reasons not documented in the patient's medical record. Another possible reason that forces health workers to use other treatment means which may not be in line with the well‐documented WHO recommendations is interrupted supply of the WHO‐recommended feeds and other supplies (Mumbere et al, 2018 ; Otiti & Allen, 2021 ; Salih, 2018 ). The other feeds that were administered to children with unknown contents of micronutrients (vitamin A, iron and folic acid) might have influenced medical practitioners in the studied hospitals to administer supplements regardless.…”