WHO guidelines for management of severe malnutrition in rural South African hospitals: effect on case fatality and the influence of operational factors

Ashworth, Ann; Chopra, Mickey; McCoy, David; Sanders, David; Jackson, Debra; Karaolis, Nadina; Sogaula, Nonzwakazi; Schofield, Claire

doi:10.1016/s0140-6736(04)15894-7

Cited by 187 publications

(181 citation statements)

References 13 publications

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“…A functioning supervisory and management system have been common factors in local interventions that have improved the performance of health-care workers, as shown in assessments of IMCI 54 and the WHO severe malnutrition protocols. 55 Quality services are dependent on health-system components relating to the administration of sites such as adequate infrastructure and equipment, and supplies such as drugs and disposables. Administrators need to have a quality-improvement mindset and process (with appropriate norms and standards), preservice and in-service training, and supervision.…”

Section: Accountability For Actionmentioning

confidence: 99%

Every death counts: use of mortality audit data for decision making to save the lives of mothers, babies, and children in South Africa

Bradshaw¹,

Chopra²,

Kerber³

et al. 2008

The Lancet

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Section: Accountability For Actionmentioning

confidence: 99%

Every death counts: use of mortality audit data for decision making to save the lives of mothers, babies, and children in South Africa

Bradshaw¹,

Chopra²,

Kerber³

et al. 2008

The Lancet

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“…On the other hand, SFC activities, which are mainly home-based, suffered because of the high level of vulnerability of the households. Good performance is documented for the classical protocol for treatment of malnutrition, when implemented in a specialised unit, with trained staff and appropriate bed capacity; while the low performance of NC in the absence of these characteristics is also reported (19,20) . Burundi did not differ from this scenario.…”

Section: Discussionmentioning

confidence: 99%

The humanitarian emergency in Burundi: evaluation of the operational strategy for management of nutritional crisis

Rossi

Verna

Villeneuve

2008

Public Health Nutr.

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Objective: To evaluate the impact and appropriateness of programmes for the management and treatment of severe malnutrition in emergency situations. Design: A central unified database was set up with all data and statistics provided by nutritional centres (NC) active in Burundi. Setting: The paper describes the case of Burundi as an example of the response of the humanitarian community to nutritional crisis. Subjects: Since 1999, more than one million (1 054 210) severely malnourished patients were treated in NC established in Burundi. Results: Peaks of beneficiaries were registered in 2000 and 2001; the admission rate started to decrease in 2002. In 2004, twenty therapeutic feeding centres (TFC) and 224 supplementary feeding centres (SFC) were active for the treatment of 127 420 beneficiaries. Nutritional programmes were present in every province with a coverage rate of 55 %. The most convincing impact of the nutritional programme in Burundi was the reduction of mortality rate in children under 5 years of age; an impact on the prevalence of acute malnutrition could not be demonstrated. Children under 5 years old accounted for 62 % of beneficiaries in TFC and 76 % in SFC. TFC performance indicators fulfilled the minimum standards in disaster response; the performance of SFC was not so optimal with a low recovery rate (69 % v. .80 %) and a high non-respondent rate (16 % v. ,5 %). With the combination of coverage and cure rate, the programme met 44 % of the assessed needs in 2004. Conclusions: In Burundi the stabilisation of security conditions permitted a combination of humanitarian responses ranging from emergency activities to strengthening of community-based initiatives that could correct the coverage and impact limitations.

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“…Key reasons include insufficiently trained staff, poor teamwork and inadequate compliance to WHO treatment recommendations proven to reduce mortality [6–10]. WHO Checklists have been developed in surgery [11] and obstetrics [12] to ameliorate similarly complicated, yet repetitive work processes.…”

Section: Introductionmentioning

confidence: 99%

Experience: developing an inpatient malnutrition checklist for children 6 to 59 months to improve WHO protocol adherence and facilitate quality improvement in a low-resource setting

Beck¹,

Mukantaganda

Bayitondere

et al. 2018

Global Health Action

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In low-resource settings, inpatient case fatality for severe acute malnutrition (SAM) remains high despite evidenced-based protocols and resources to treat SAM. Key reasons include a combination of insufficiently trained staff, poor teamwork and inadequate compliance to WHO treatment guidelines which are proven to reduce mortality. Checklists have been used in surgery and obstetrics to ameliorate similarly complicated yet repetitive work processes and may be a key strategy to improving inpatient SAM protocol adherence and reducing unnecessary death. Here, we share our experience developing and piloting an inpatient malnutrition checklist (MLNC) for children 6 to 59 months and associated scoring system to coordinate care delivery, improve team documentation, strengthen WHO malnutrition protocol adherence and facilitate quality improvement in a district hospital in rural Rwanda. MLNC was developed after careful review of the 2009 Rwandan National Nutrition Protocol and 2013 WHO malnutrition guidelines. Critical steps were harmonized, extracted and designed into an initial MLNC with input from pediatric ward nurses, doctors, a locally based pediatrician and a registered dietitian. A scoring system was developed to facilitate quality improvement. Using the standard Plan-Do-Study-Act cycle, MLNC was modified and progress assessed on a monthly to bimonthly basis. Significant modifications occurred in the first 6 months of piloting including incorporation of treatment reminders and formatting improvements, as well as initiation of the MLNC from the emergency department. The MLNC is the first checklist to be developed that unifies WHO 10 steps of treatment of inpatient SAM with local standards. Anecdotally, MLNC was observed to identify gaps in key malnutrition care, promote protocol adherence and facilitate quality improvement. Data gathering on the MLNC local facility impact is underway. Collaborative international efforts are needed to create an inpatient malnutrition checklist for wider use to improve quality and reduce unnecessary, facility-based child mortality.

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WHO guidelines for management of severe malnutrition in rural South African hospitals: effect on case fatality and the influence of operational factors

Cited by 187 publications

References 13 publications

Every death counts: use of mortality audit data for decision making to save the lives of mothers, babies, and children in South Africa

Every death counts: use of mortality audit data for decision making to save the lives of mothers, babies, and children in South Africa

The humanitarian emergency in Burundi: evaluation of the operational strategy for management of nutritional crisis

Experience: developing an inpatient malnutrition checklist for children 6 to 59 months to improve WHO protocol adherence and facilitate quality improvement in a low-resource setting

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