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

摘要

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 Z-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 and Z-score 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.