Adherence to who guidelines on management of severe acute malnutrition among children admitted at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: World Health Organization (WHO) defines Severe Acute Malnutrition (SAM) in children as those requiring hospital management with weight for height ≤ -3 Z scores or presence of bilateral edema or left mid upper arm circumference of < 11.5cm. WHO guidelines entailing 10 steps of management were developed in an effort to reduce case fatality rates. These have been adopted globally and where these have been implemented, case fatality rates of SAM have reduced drastically. The Ministry of Health in Kenya has incorporated these into the Basic Pediatric Protocols but their implementation and impact on case fatality locally remain unknown. This study therefore aimed at evaluating the level of adherence to WHO treatment guidelines in management of children aged ≤ 60 months with SAM at Moi Teaching and Referral Hospital (MTRH). Objective: To evaluate the adherence to WHO guidelines on management of SAM among children admitted at MTRH, Eldoret, Kenya. Methods: This was a prospective hospital based study conducted between March and August 2016 at the MTRH pediatric wards located in the Shoe for Africa Children’s Hospital. Children aged ≤ 60 months admitted to pediatric wards with SAM were recruited into the study. Consecutive sampling was used till the estimated sample size of 89 was attained. Participants were then managed as per the Hospital protocols then the medical records were reviewed at the end of the treatment period. Data was collected using a structured questionnaire. Analysis was done using the statistical package for social sciences (SPSS) version 14 at 95% level of confidence. Frequency tables were used to summarize data. Descriptive statistics including median was used in continuous variables while percentages and frequency listings were used in description of discrete variables. Mann - Whitney U test was used to test for associations between the adherence to the steps of management and the median length of hospital stay. P values < 0.05 were considered statistically significant at 95% confidence interval. Results: Of the 89 children, 56 (63%) were males, 37(41.7%) were aged between 7-12 months with a median age of 13months (IQR 10.5, 23.0). Random blood sugar was documented for 35(39.3%), presumptive 10% dextrose prescribed in 6(6.7%) and median feeding time from admission was 6 hours. Hypothermia was noted in 3 (3.4%) and warmth was provided in 32 (69.5%).ReSoMal was prescribed in 41 (46%). All children received antibiotics. Initial feed types were appropriate for both < 6months and ≥ 6 months. Catch up growth feeding was also appropriate for those < 6 months and F100 was prescribed in 61(72.6%) of those aged ≥ 6 months, however, feed increment was documented in 24(28.6%). Overall adherence level was 4.5%, median length of hospital day was 10 days and the case fatality rate was 3.4%. Bivariate analysis showed no statistical significance between adherence and the median length of hospital stay. Conclusions: Adherence to WHO guidelines on management of SAM at MTRH was low at 4.5%. Case fatality was high at 3.4% and the median length of hospital stay was long at 10 days. Recommendations: MTRH to ensure adequate supply of the essential commodities required in the management of SAM. Further studies need to be carried out to determine factors affecting this adherence and length of hospital stay and adoption of the WHO structured protocol for documentation of care given to children with SAM at MTRH.