Experience in Managing Severe Malnutrition in a Government Tertiary Treatment Facility in Bangladesh

Abstract

Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean±SD age 23.5±15.3 months) were admitted during June 2005–May 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US$ 40. The main reason for bringing children by their families to the hospital was associated major illnesses: bronchopneumonia (33%), oedema (24%), diarrhoea (11%), pulmonary tuberculosis (9%), or other conditions, such as meningitis, septicaemia, and infections of the skin, eye, or ear. The exit criteria from the Nutrition Unit were: (a) for children admitted without oedema, an absolute weight gain of ≥500 and ≥700 g for children aged less than two years and 2-5 years respectively; and for children admitted with oedema, complete loss of oedema and weight-for-height >70% of the reference median, and (b) the mother or caretaker has received specific training on appropriate feeding and was motivated to follow the advice given. Of all the admitted children, 7.6% of parents insisted for discharging their children early due to other urgent commitments while 11.7% simply left with their children against medical advice. Of the 138 remaining children, 88% successfully graduated from the Nutrition Unit with a mean weight gain of 10.6 g/kg per day (non-oedematous children) and loss of −1.9 g/kg per day (oedematous children), 86% graduated in less than three weeks, and the case-fatality rate was 10.8%. The Nutrition Unit of CMCH also functions as a training centre, and 197 health functionaries (82 medical students, 103 medical interns, and 12 nurses) received hands-on training on management of severe malnutrition. The average cost of overall treatment was US$ 14.6 per child or approximately US$ 1 per child-day (excluding staff-cost). Food and medicines accounted for 42% and 58% of the total cost respectively. This study demonstrated the potential of addressing severe acute malnutrition (with complications) effectively with minimum incremental expenditure in Bangladesh. This public-private approach should be used for treating severe acute malnutrition in all healthcare facilities and the treatment protocol included in the medical and nursing curricula.

Analysis of Hospital Records on Treatment Outcome of Severe Acute Malnutrition: The Case of Gondar University Tertiary Hospital

“…It is similar with studies done in Bangladesh tertiary Hospital [9] 10.8% and in Northcentral Nigeria 10.1% [13]. Though this outcome is below acceptable range, it is lower than another studies conducted in sub-Saharan Africa [11,14].…”

“…The immediate causes of malnutrition and child death are mutually reinforcing conditions of inadequate dietary intake and infectious disease [3,[7][8][9].…”

Routine Amoxicillin for Uncomplicated Severe Acute Malnutrition in Children

“…1 To reduce the risk of death from severe acute malnutrition, specialized nutritional and medical intervention is required. Bacterial infection can complicate advanced cases of severe acute malnutrition, [2][3][4][5][6][7][8][9] and the risk of nosocomial infection in inpatient settings can be high. Therefore, in 1999, when all children with severe acute malnutrition were treated as inpatients, the World Health Organization (WHO) recommended routine use of broad-spectrum antibiotics for the management of severe acute malnutrition, irrespective of clinical indications.…”

Treatment outcome in patients with severe acute malnutrition managed with protocolised care at malnutrition treatment corner in Rajasthan, India: a prospective observational study (quasi-experimental)

“…Likewise, in another studies by Savadogo et al, Patel et al and Iqbal et al, it was observed that mean weight gain was 10.18, 9.0 and 10.6 gm/kg/day respectively. [7][8][9] Iqbal et al also reported that during nutritional rehabilitation centre (NRC) stay 14.7% of the children demonstrated poor gain in weight (<5 gm/kg/day), 30.9% moderate (5-10 gm/kg/day), and the remaining 30.9% demonstrated good gain in weight (>10 gm/kg/day). 9 In our study, weight gain in 2nd week was more as compared to other weeks.…”

“…[7][8][9] Iqbal et al also reported that during nutritional rehabilitation centre (NRC) stay 14.7% of the children demonstrated poor gain in weight (<5 gm/kg/day), 30.9% moderate (5-10 gm/kg/day), and the remaining 30.9% demonstrated good gain in weight (>10 gm/kg/day). 9 In our study, weight gain in 2nd week was more as compared to other weeks. There was significant more weight gain in 2nd week as compared to 3rd week (p<0.01).…”