Treatment Outcome and Predictors of Severe Acute Malnutrition using the WHO Guideline at a Referral Hospital in Southern Ethiopia
Abstract
Background: Management of severe acute malnutrition (SAM) is a challenge in the developing world because it is a common problem which consumes the majority of the scarce resources. Despite the marked progress in improving mortality of SAM through implementation of the WHO protocol in well resourced settings, the reported mortality from institution based management ofSAM in the developing world remained high. This article reports on the outcome predictors of management of SAM at a developing country setting; Methods, From September 2006 to August 2009, a total of 151 cases who fulfilled the inclusion criteria were included for final analysis at the paediatric ward of Hawassa University Referral Hospital (HURH). Data were abstracted from the clinical records on structured data retrieval forms. The data were analyzed using SPSS for windows version 16.0. Bivariate and multivariable logistic regression wasused to identify predictor variables; Results: Of the reviewed 151cases, 84(55.6%) had oedematous malnutrition. In response to the treatment provided, 105(70%), 23(15.2%) and 23(15.2%) of the cases had improved/ been discharged, defaulted and died respectively. The non-oedematous cases of SAM were more likely to default from the course of treatment (COR: 2.8[95%CI: 1.0-7.68], P <0.05). Most deaths of children with SAM occurred in the early course of treatment:8(35%) of the deaths occurred in the first
48hours while 11(48%) occurred within the first week of admission (P<0.05).On multivariable logistic regression, fluid or blood transfusion (AOR: 8.73 [95%CI: 2, 06-37, 02]) and age of the child (AOR: 1.05 [95%CI: 1, 00-1.09]) were the independent predictors of death while on treatment. Presence of HIV infection and severe anaemia doubled the mortality rate; Conclusion, The treatment success of SAM against the WHO protocol at HURH is below the standard. Various predictors of death of children while of treatment based on the WHO protocol have been identified. Addressing these risk factors for death is vital to decreasing the child mortality due to malnutrition.
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References
http://www.who.int/nutrition/topics/Statement_community_based_man_sev_acute_mal_eng.pdf(Date accessed: December. 20, 2009)
Ciliberto MA, Sandige H , Ndekha MDJ, et al. Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial1–4. Am J ClinNutr 2005; 81:864 - 70
UNICEF. Progress for Children. A Report Card on Nutrition, no. 4. UNICEF, New York, 2006. Available from; www.unicef.org/progressforchildren/2006n4/12-15. (Date accessed; December 6,2009)
Caulfield LE, de Onis M, Blössner M, and Black RE. Under nutrition as an underlying cause of child deaths associated with diarrhoea, pneumonia, malaria, and measles. Am J Clin.Nutr. 2002; 80:193–198
Rice AL, Sacco L, Hyder A, Black RE. Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries, Bull World Health Organ. 2000; 78:1207–1221.
Pelletier DL, Frongillo EA. Changes in child survival are strongly associated with changes in malnutrition in developing countries, J Nutr. 2003; 133:107–119.
Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet 2003; 361:2226-34.
Müller Olaf, KrawinkelMichael. Malnutrition and health in developing countries. CMAJ.2005; 173: 279-86.
MSF, WHO, what are the consequences of malnutrition? 2008. Accessed from: http://china.org.cn/international/malnutrition/2008-12/03/content_16891515.htm (Date accessed: July 20, 2009)
Ashworth A, Sultana K, Alan J, Claire S. Guidelines for the inpatient treatment of severely malnourished children. New Delhi: World Health Organization Regional Office for South-East Asia.
WHO 2003. Accessed from; http://www.searo.who.int/LinkFiles/FCH_malnourished_children.pdf (Date accessed: December. 20, 2009)
Dubik M. Mortality of Children Worldwide, AAP Grand Rounds 2005; 14:22-23.
Maitland K, Berkley JA, Shebbe M, Peshu N, English M, Newton CR. Children with Severe Malnutrition: Can Those at Highest Risk of Death Be Identified with the WHO Protocol? PLoS Med 2006; 3:e500.
Yimer G. Malnutrition among children in Southern Ethiopia: levels and risk factors. Ethiop. J. Health Dev. 2007; 14(3):283-292.
Collins S, Dent N, Binns P, Bahwere P, Sadler K, Hallam A.Management of severe acute malnutrition in children. Lancet 2006; 368: 1992–2000.
IASC, UNICEF. Global Nutrition Cluster. New York, 2008. Accessed from: http://www.humanitarianreform.org/humanitarianreform/Default.aspx?tabid=74 (Date accessed;July 21, 2009)
16. Federal Ministry of Health of Ethiopia and UNICEF. Guidelines for the Management of Severe Acute Malnutrition.2 nd edition,FMOH,
2007:122.Accessed from; http://motherchildnutrition.org/resources/pdf/mcn-ethiopia-sam-guidelines.pdf (Date accessed: July 20,
2009.)
Berti A, Bregania ER, Manentia F, Pizzi. C. Outcome of severely malnourished children treated according to UNICEF 2004 guidelines: a one-year experience in a zone hospital in rural Ethiopia.Transactions of the Royal Society of Tropical Medicine and Hygiene 2008; 102: 939-944.
Collins S, Sadler K,Dent N, et al. Key issues in the success of community-based management of severe malnutrition. Food Nutr Bull 2006; 27:S49-82.
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