dc.contributor.author | Ann, Wangechi | |
dc.date.accessioned | 2014-01-13T06:44:01Z | |
dc.date.available | 2014-01-13T06:44:01Z | |
dc.date.issued | 2013 | |
dc.identifier.citation | MASTER OF MEDICINE IN PEDIATRICS AND CHILD HEALTH | en_US |
dc.identifier.uri | http://hdl.handle.net/11295/63248 | |
dc.description.abstract | BACKGROUND: Inappropriate case management of severe malnutrition is believed to be one
of the main reasons why high case fatality rates (20-30%) persist worldwide. In 1999, the WHO
developed guidelines for the management of severe malnutrition which have shown to reduce
mortality rate of children .These guidelines have been adopted by the ministry of health in Kenya
in the Basic Paediatric Protocols.
OBJECTIVE: The objective of this study was to evaluate the use of the World Health
Organization guidelines for the treatment of children with severe acute malnutrition at Mbagathi
District Hospital.
METHODOLOGY: A prospective audit of care given to 102 children aged 6-59 months
admitted to Mbagathi District Hospital with severe malnutrition was carried out over a period of
4 months between June 2012 and September 2012. Consecutive sampling of study subjects was
done until the desired sample size was achieved. Relevant information was extracted from
medical records and entered in a structured data collection tool which allowed assessment of
WHO steps 1-8 of management of severe acute malnutrition. Additional information was
collected through daily observations in the ward and interviews with care givers and health
workers.
RESULTS
A total of 102 children were recruited. The male: female ratio was 1:1 and the median age was
13 months. The majority (84.3%) of the children were aged below 24 months out of whom
47.5% were aged below 12 months. Overall, 77.5% of children had marasmus, 12.7% had
kwashiorkor and 9.8% had marasmic kwashiorkor. The initial steps (steps 1,2 and 3) of
stabilization, which were essential for the survival of these children, were poorly implemented
and inappropriately provided. The least implementation was in step I where none of the children
were fed within one hour and there was a delay in initiating feeds with a median time of 12.3
hours from the time of admission. Less than half of the children were appropriately managed as
per Step 3 (48.3%, 95%CI42.7-65.1) and step 8 (40.8%, 95%CI 33.7-47.8).There was modest
implementation of Step 2 (78.6%, 69.1-86.1) and Step 6 (68.8%, (95%CI 60.4-78.2). The highest
implementation was in Step 4 (96.1%, (95%C1 90.3-98.9), Step 5 (92.2%, 950/oC185.1-95.6) and
step 7 (92%, (95%C182.7-95.2).
Overall essential supplies were mostly available.
CONCLUSIONS
The management of children with severe malnutrition at Mbagathi District Hospital is inadequate
and WHO guidelines are not adequately followed. Essential supplies needed for the management
of these children are mostly available.
RECOMMENDATIONS
Continued training of health care workers in the use of the WHO guidelines and further studies
to assess barriers to utilization of the WHO protocol which will help identify gaps which can be
addressed. | en_US |
dc.language.iso | en | en_US |
dc.publisher | University of Nairobi | en_US |
dc.title | Audit of the current standard of care For children admitted to Mbagathi District hospital with severe Malnutrition | en_US |
dc.type | Thesis | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |