Implementation of WHO Guidelines on Management of Severe Malnutrition in Hospitals in Africa. (Research)

By Deen, Jacqueline L.; Funk, Matthias et al. | Bulletin of the World Health Organization, April 2003 | Go to article overview

Implementation of WHO Guidelines on Management of Severe Malnutrition in Hospitals in Africa. (Research)


Deen, Jacqueline L., Funk, Matthias, Guevara, Victor C., Saloojee, Haroon, Doe, James Y., Palmer, Ayo, Weber, Martin W., Bulletin of the World Health Organization


Introduction

Children with severe malnutrition present as complicated, and often frustrating, cases to health workers in developing countries. Much has been learned about the pathophysiology of malnutrition and the requirements for successful rehabilitation, but case-fatality rates remain high. A survey of treatment centres worldwide showed outmoded and conflicting teaching manuals, potentially fatal practices, and inappropriate diets (1).

Reductions in mortality and improvements in weight gain have been achieved on implementation of a standardized treatment protocol (2-5). Avoidance of intravenous rehydration, routine use of broad-spectrum antibiotics, cautious refeeding with low-sodium diets, and other changes in case management are credited with improved outcomes. It has been suggested that the mere presence of a standardized protocol increases discipline and attention to detail and results in fewer errors by health workers (6). As long as severe malnutrition is prevalent, efforts to improve its treatment and outcome remain a priority. Implementation of a standard in-hospital treatment protocol is an essential first step (6-7).

WHO published guidelines for the inpatient management of severe malnutrition in children (8, 9). The difficulties that arise from implementation, as well as the potential benefits, needed to be documented through formal evaluation. A randomized trial of the guidelines was not appropriate, because withholding the potential benefits from the control group would be difficult to justify and because blinding was not possible. A qualitative study in African hospitals was conducted to document the process of implementation and the feasibility and sustainability of each component of the guidelines.

Methods

Selection of hospitals

We searched the literature for articles on severe malnutrition in developing countries published during the past five years. The authors of identified articles and other recommended experts in malnutrition management were asked to suggest hospitals, including those they were affiliated with, in which this study could take place.

Health workers of the suggested hospitals were invited to participate in the study and to submit background information about admission patterns, the frequency of malnutrition, and current practice. Hospitals were chosen for a preliminary visit on the basis of this information. The basic requirements for selection included: a system of recording admissions of and outcomes for children; documentation of a case-fatality rate >20% for severely malnourished children <5 years of age over a period of at least one year; administrative support for food supply, essential drugs, and staff allocation; and interest and commitment of the health care staff to improve the management and outcome of severe malnutrition.

Paediatricians with experience in improving care practices for severe malnutrition in African hospitals (J.L.D., A.P.) carried out a preliminary visit to hospitals in which implementation of the guidelines was considered feasible. The local situation was assessed on the basis of the above criteria, and a final selection of hospitals was made.

Implementation of the guidelines

The guidelines were implemented by a paediatrician (J.L.D.) who visited the selected hospitals three times during a one-year period. A participatory approach was taken to give the hospitals' staff a feeling of ownership and responsibility in the process and outcome (10).

During the initial visit, which lasted two weeks, admission and death records were reviewed and current practices in the management of severe malnutrition were evaluated. Possible reasons for the high case-fatality rate for severely malnourished children, the guidelines, and how the guidelines could be adapted to the local setting were discussed with individuals or small groups. The visiting paediatrician showed how height and weight-for-height should be measured, weights charted, dally weight gain computed, and drinking cups standardized. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Implementation of WHO Guidelines on Management of Severe Malnutrition in Hospitals in Africa. (Research)
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.