The effect of therapeutic feed in the management of severe acute malnutrition in children, South Africa.

Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.Globally, 14.3 million infants and young children (IYC) suffer from severe acute malnutrition (SAM), with 75% living in low and low-middle income countries like South Africa (SA). Inpatient management of SAM forms an essential component of SAM treatment among IYC. In SA, the SAM treatment protocol is based on the World Health Organization (WHO) Ten Steps to the Successful Management of SAM. As a result of SA efforts, the SAM mortality rate decreased from 12,7% in 2012 to 8% in 2017, being below the global and national target of 9%. The study aim was to determine if compliance with the national SAM treatment protocol improves SAM treatment outcomes. A multi-centre prospective, descriptive and comparative observational study was employed. IYC hospitalized for SAM treatment (N=245) were conveniently sampled. The study sample comprised of 150 males (61.2%) and 95 females (38.8%) with a mean age of 14.6 ± 8.2 months. Mean admission and discharge weight, heightfor- age and MUAC was 6.63 ± 1.89kg and 7.03 ± 2.02kg; 66.16 ±16.06 cm and 71.29 ± 11.47 cm, and 11.38 ±2.35cm and 11.51±2.35cm. There was a significant difference between mean admission and discharge weight (p= 0.0278) and height-for-age (p= 0.0005), with no significant difference between admission and discharge MUAC (p= 0.6533). Prevalence of mild, moderate and severe oedema was 21.7%, 11.1% and 8.2% respectively. The study sample had a mortality rate of 6.1%. SAM treatment was complicated by LARIs, sepsis, HIV, TB, anaemia, herbal intoxication, vomiting, hypoglyceamia and cerebral palsy. Using the designed scoring tool, overall compliance with the SAM treatment protocol was 63.1%, with 98.6% compliance with admission and 4.4% compliance with discharge standards. Nearly three out of ten (27.2% of households) were food insecure, of which 14.6% were moderately and 10.7% severely food insecure. Food insecurity was associated with delayed recovery from oedema (X2= -0.235; 0.035) and diarrhoea (X2= -0.199; 0.037), inadequate daily weight gain of less than 10g/kg/day (X2= -0.190; 0.003) and IYC mortality (X2= -0.131; 0.522). These associations define HHFIS as a predictable risk factor for poor SAM treatment outcomes, recovery and possible mortality. Compliance with the SAM treatment protocol was average (61.3%), with premature discharge, increasing the risk for relapse, readmission and mortality. A cyclic link between HHFIS and the outcome of inpatient management of SAM should be considered when revising and updating national SAM treatment protocols