Hospital based Management of Severe Acute Malnutrition Children at a Tertiary Hospital

INTRODUCTION: Severe acute malnutrition affects approximately 13 million children below 5 years of age and it causes death of 1- 2 million children every year due to various preventable causes. According to the National survey (NFHS-3, 2005-06), 43% of the children below 5 years of age are underweight, 48% of the children under five are stunted, 20% of the children below five years are wasted and about 6% of the children among them have severe wasting (<-3SD). These children who are severely wasted are termed as having Severe Acute Malnutrition. In most developing countries, mortality rate in hospitals treating SAM remain at 20–30% and few of those requiring care actually have access to treatment. Malnourished children do not respond to treatment in the same way as the children who are nourished well. They are more likely to die, with or without complications, than the well-nourished children. Hence special guidelines are needed for the treatment of these children. AIMS AND OBJECTIVES: 1. To assess the efficacy of the feeding guidelines given by WHO and also to find out the feasibility of implementation of these guidelines in our hospital setting. 2. To measure the weight gain in severely malnourished children receiving feeds as per WHO guidelines at a tertiary hospital. DISCUSSION: Severe acute malnutrition increases the risk of death in children under the age of 5 years. Therefore its identification and management plays a vital role in the reduction in the under-five mortality rates. Management of SAM children consists of an initial stabilization phase followed by a rehabilitation phase during which rapid catch up growth in weight (>10g/kg/day) needs to be achieved as it facilitates early discharge and prevents secondary infections. The present study was done to assess the efficacy of the feeding guidelines given by WHO and also to find out the feasibility of implementation of these guidelines in our hospital setting. It also studies the weight gain achieved in severely malnourished children receiving feeds as per WHO guidelines at a tertiary hospital. Out of the 100 SAM children participated in our study 18% were found to have a poor outcome (10gm/kg/day) that was similar to the results obtained in a study conducted by Md Iqbal Hossain et al. CONCLUSION: This study was conducted in the department of Pediatrics, Madras Medical College from November 2010 to October 2012. A total of 100 SAM children were included in the study and were given feeds as per the WHO guidelines and the outcome were assessed in terms of weight gain achieved at the time of discharge. Majority of the children achieved good weight gain and the mean weight gain was found to be 8.5gm/kg/day which was comparable to those achieved in other studies. The reason for not achieving a weight gain of > 10 gm/kg/day as given by WHO in most of the children were due to the short duration of stay in the hospital and absence of uniformity in the preparation of feeds for the children as it was done by their mothers. During a 1 month follow up, it was found that weight gain achieved by the SAM children was moderate (mean weight gain was 4.5gm/kg/day). This could be due to the absence of availability of a RUTF to the SAM children during the home based rehabilitation. Thus from the present study it could be concluded that feeding guidelines given by WHO are effective and can be successfully implemented in our hospital setting with slight modifications. And also even though the weight gain achieved in our study was moderate, it was significant and could be improved if various limitations could be overcome