OBJECTIVE: To evaluate implementation and sustainability of the WHO-IMCI protocol for management of severe malnutrition in rural hospitals in South Africa. METHODS: The study hospitals received training in the WHO-IMCI protocol for management of severe malnutrition from March 1998 to August 1999. The study sample is children 5 years or younger admitted to the malnutrition wards of these two small district hospitals post-implementation, from April 2000 to April 2001. Data collection includes record reviews; semi-structured observations of care practices; interviews of mothers, doctors, hospital managers and nurses; periodic inventory of essential supplies; a time series analysis of case fatality rates and weight gain; and post-discharge home visits. RESULTS: Preliminary results show a mean age of 17 months, with a mean weight for age Z-score of –2.7, and mean weight for height Z-score of –1.6. Case fatality rates have decreased by almost 50% and the average weight gains were 5.7g/kg/day. Success areas include preventing hypoglycaemia, hypothermia and dehydration. Moderate success has been seen with catch-up growth, and treating electrolyte imbalances, micronutrient deficiencies, and infections. Areas with limited improvement were stimulation/play, and discharge planning and follow-up. CONCLUSION: Implementation of the WHO-IMCI inpatient protocol for management of severe malnutrition has shown mixed results in these rural hospitals, with some aspects of the protocol implemented successfully and others still in need of improvement. Supervision and care not specifically related to the malnutrition protocol appear to be contributing factors for the lack of success in some areas. Improvements were noted in mortality and weight gain.
Learning Objectives: The participant will be able to describe the WHO-IMCI inpatient guidelines for the management of severe malnutrition and discuss issues related to implementation of these guidelines in rural hospitals in South Africa.
Keywords: Food and Nutrition, International MCH
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.