Evaluating the clinical management of severely malnourished children - A study of two rural district hospitals

Background. Severe malnutrition is an important cause of preventable mortal ity in most South African hospitals. Work recently done in two rural Easter n Cape hospitals supports the literature which shows that many deaths occur as a result of outdated clinical practices and that improving these practi ces reduces case fatality rates. Rapid assessment of clinical management in paediatric wards is necessary to highlight areas for improvement. Objective. To assess the management of severely malnourished children in tw o rural district hospitals and to recommend improvements for their care. Methods. Based on draft World Health Organisation (WHO) guidelines for inpa tient care of children with severe malnutrition, data collection instrument s were developed in conjunction with the district nutrition team to assess the quality of care given to malnourished children in two Mount Frere hospi tals, Eastern Cape. Data were collected through retrospective review of cas e records, with detailed studies of selected cases, structured observations of the paediatric wards, and interviews with ward sisters and doctors. Results. The combined case fatality rate for severe malnutrition was 32%. I nadequate feeding, poor management of rehydration and infection, lack of re sources, and a lack of knowledge and motivation among staff were identified as areas that need attention. Conclusion. The clinical management of severely malnourished children can b e rapidly assessed to highlight areas for improvement. Involving staff in t he assessment process has led to their active involvement in improving the management of malnourished children in their hospitals.