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Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa

Deen, Jacqueline L., Funk, Matthias, Guevara, Victor C., Saloojee, Haroon, Doe, James Y., Palmer, Ayo and Weber, Martin W. (2003). Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa. Bulletin of the World Health Organization,81(4):237-245.

Document type: Journal Article
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Title Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa
Author Deen, Jacqueline L.
Funk, Matthias
Guevara, Victor C.
Saloojee, Haroon
Doe, James Y.
Palmer, Ayo
Weber, Martin W.
Journal Name Bulletin of the World Health Organization
Publication Date 2003
Volume Number 81
Issue Number 4
ISSN 00429686   (check CDU catalogue open catalogue search in new window)
Start Page 237
End Page 245
Total Pages 9
Place of Publication Switzerland
Publisher World Health Organization
Abstract Objective: To investigate the problems, benefits, feasibility, and sustainability of implementation of WHO guidelines on management of severe malnutrition.

Methods: A postal survey invited staff from 12 African hospitals to participate in the study. Five hospitals were evaluated and two were selected to take part in the study: a district hospital in South Africa and a mission hospital in Ghana. At an initial visit, an experienced paediatrician reviewed the situation in the hospitals and introduced the principles of the guidelines through a participatory approach. During a second visit about six months later, the paediatrician reviewed the feasibility and sustainability of the introduced changes and helped find solutions to problems. At a final visit after one year, the paediatrician reassessed the overall situation.

Findings: Malnutrition management practices improved at both hospitals. Measures against hypoglycaemia, hypothermia, and infection were strengthened. Early, frequent feeding was established as a routine practice. Some micronutrients for inclusion in the diet were not locally available and needed to be imported. Problems were encountered with monitoring of weight gain and introducing a rehydration solution for malnutrition.

Conclusion: Implementation of the main principles of the WHO guidelines on severe malnutrition was feasible, affordable, and sustainable at two African hospitals. The guidelines could be improved by including suggestions on how to adapt specific
recommendations to local situations. The guidelines are well supported by experience and published reports, but more information is needed about some components and their impact on mortality.
Keywords Child nutrition disorders/therapy
Infant nutrition disorders/therapy
Fluid therapy
Diet therapy
World Health Organization
Practice guidelines
Guideline adherence
(source: MeSH, NLM )
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Created: Mon, 26 Nov 2012, 16:43:11 CST by Teresa Haendel