WHO guidelines for severe malnutrition: are they feasible in rural African hospitals?

Abstract

Guidelines for severe malnutrition are largely feasible but training workshops are insufficient to achieve optimal management as staff turnover and an unsupportive health system erode the gains made and doctors treat cases without having being trained. Medical and nursing curricula in Africa must include treatment of severe malnutrition.

Symposium 5: Joint BAPEN and Nutrition Society Symposium on ‘Feeding size 0: the science of starvation’ Severe malnutrition: therapeutic challenges and treatment of hypovolaemic shock

“…High case-fatality rates are often attributed to insufficient staff training and poor compliance with the recommended protocols (6)(7)(8)(9)(10)(11)(12) . The WHO has developed consensus management guidelines (2) that include a stabilisation phase during which life-threatening problems are identified and treated, a staged introduction of milk-based nutritional rehabilitation, micronutrient and vitamin supplementation and empirical use of antimicrobial and antihelminth treatments.…”

The impact of a short-term intervention using the WHO guidelines for the management of severe malnutrition at a rural facility in Angola

“…According to the literature, implementation of WHO guidelines, even without the continued presence of qualified personnel, is possible, but short training workshops are insufficient 9. In addition, successful training programmes and interventions may not be sustainable without the effective support of senior managers committed to creating positive organisational structures and a motivational environment 16.…”

The Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: A Prospective Empirical Study (Preprint)

“…The WHO guidelines for the management of SAM have been shown to be demonstrably effective when implemented appropriately [2,[21][22][23] and well trained, motivated staff have been shown to reduce SAM mortality in practice [23][24][25]. These studies, which illustrate the efficacy of the WHO guidelines in reducing child mortality and improving recovery, also highlight the importance of 'motivated' and 'skilled' staff who follow the WHO Ten Steps with fidelity, and optimize the impact on clinical outcomes.…”