Evaluating The Implementation Of Ministry Of Health Guidelines In The Management Of Severe Malnutrition At The Garissa Provincial General Hospital, Garissa, Kenya
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Date
2013-06Author
Warfa, O
Njai, D
Laving, A
Bashir, M
Mburugu, P
Type
PresentationLanguage
enMetadata
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Background: Every year 10.6 million children die worldwide [1], with
malnutrition accounting for about 2.2 million of these deaths. Half of Kenya’s
high infant and under five mortality rates is also due to malnutrition. Although
the national prevalence of acute malnutrition is 6%, the prevalence in North
Eastern Province ranges from 17 to 30% [1]. Malnutrition is thus an important
public health problem. Among other interventions in reducing child mortality,
the World Health Organization has developed an evidence based guidelines
(EBG) in the management of severe malnutrition. Proper implementation of this
protocol was shown to reduce mortality rates to less than 5%.
Objectives: The primary objective of the study was to establish the level of
adherence to Ministry of Health (MOH) guidelines in the management of severe
malnutrition at Provincial General Hospital Garissa (PGH). The secondary
objectives was to find out the proportion of children appropriately managed
for severe malnutrition (steps 1-8) as per the protocol, the availability and
accessibility of the guidelines, and to find out the barriers health workers face in
utilizing the guidelines at PGH Garissa.
Study design: This was a short longitudinal study of 96 children, aged 6-59 months
admitted to the Garissa Provincial General Hospital with diagnosis of severe
malnutrition over 4 months period (July to October 2012).
Methods: The primary targets were children admitted to the pediatric ward with
diagnosis of severe malnutrition and the staff working in paediatric ward, child
welfare clinic and general outpatient department. Data extracted from medical file
was recorded in an audit tool and a questionnaire administered to the health workers.
Data Management: Data was entered into the computer using MS access and
analyzed with Stata version 11.
Results: Marasmus was the commonest presentation (93.8%); A higher proportion
(63.5%) of patients were males. 85.4% of patients were younger than 2 years. Patients
with marasmus were younger [mean age for admissions with marasmus was 16 (±
10.6) months compared to a mean age of 25 (± 13.7) months for kwashiorkor]. The
commonest co- morbid conditions were diarrhea (52.1%), malaria (43.7%) and
pneumonia (31.3%).
The mean length of stay was 7.6 days (± 2.9). Overall, 13 children died giving
an inpatient case fatality rate of 13.5% with 53.8% deaths occurring after 48 hrs
of admission. 22% of HCWs were trained on Integrated Management of Acute
Malnutrition and availability of guidelines was reported by 37.5%. Health workers
constraints included lack of training (78%), lack of guidelines (63%) and language
barrier (68%).
Appropriate management was documented in only 14.6% for hypoglycemia, 5.2% for
hypothermia, 31.3% for dehydration, 85.4% for electrolyte imbalance, and 90% for
Infections.
Overall monitoring (Temp, pulse, RR, fluids) was done for 5.8% of patients.
Conclusion:
♦ MOH guidelines were followed in 5 out of the 8 steps
♦ Appropriate management of children with severe acute malnutrition was
inadequate at Garissa PGH particularly for the critical steps (1,2 and 3)
despite the availability of essential supplies
♦ Less than half(37.5%) of the HCWs were aware of MOH guidelines and
only 37.5% reported the availability of guidelines at GPGH
♦ Health care workers have challenges -lack of updates(31.3%), staff
shortage (40.6%) & language barrier(31.3) in the care of malnourished
child.
Recommendations: Training of HCWs on the implementation of WHO guideline
and improving staffing levels can improve quality of care for these children.
Citation
Warfa, O., Njai, D., Laving, A., Bashir, M.,Mburugu, P.;June,2013.Evaluating The Implementation Of Ministry Of Health Guidelines In The Management Of Severe Malnutrition At The Garissa Provincial General Hospital, Garissa, Kenya,presented At The 2nd International Scientific Conference, CHS And KNH, 19th - 21st June 2013.Publisher
University of Nairobi College of Health Sciences
Description
Evaluating The Implementation Of Ministry Of Health Guidelines In The Management Of Severe Malnutrition At The Garissa Provincial General Hospital, Garissa, Kenya,presented At The 2nd International Scientific Conference, CHS And KNH, 19th - 21st June 2013.