Evaluating the clinical management of severely malnourished children--a study of two rural district hospitals

S Afr Med J. 2001 Feb;91(2):137-41.


Background: Severe malnutrition is an important cause of preventable mortality in most South African hospitals. Work recently done in two rural Eastern Cape hospitals supports the literature which shows that many deaths occur as a result of outdated clinical practices and that improving these practices reduces case fatality rates. Rapid assessment of clinical management in paediatric wards is necessary to highlight areas for improvement.

Objective: To assess the management of severely malnourished children in two rural district hospitals and to recommend improvements for their care.

Methods: Based on draft World Health Organisation (WHO) guidelines for inpatient care of children with severe malnutrition, data collection instruments were developed in conjunction with the district nutrition team to assess the quality of care given to malnourished children in two Mount Frere hospitals, Eastern Cape. Data were collected through retrospective review of case records, with detailed studies of selected cases, structured observations of the paediatric wards, and interviews with ward sisters and doctors.

Results: The combined case fatality rate for severe malnutrition was 32%. Inadequate feeding, poor management of rehydration and infection, lack of resources, and a lack of knowledge and motivation among staff were identified as areas that need attention.

Conclusion: The clinical management of severely malnourished children can be rapidly assessed to highlight areas for improvement. Involving staff in the assessment process has led to their active involvement in improving the management of malnourished children in their hospitals.

Publication types

  • Case Reports
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Female
  • Fluid Therapy / methods*
  • Hospital Mortality
  • Hospitals, Rural / standards*
  • Humans
  • Infant
  • Male
  • Nutrition Disorders / diagnosis
  • Nutrition Disorders / mortality*
  • Nutrition Disorders / therapy*
  • Nutritional Support*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Quality Assurance, Health Care*
  • Retrospective Studies
  • Severity of Illness Index
  • South Africa / epidemiology
  • Survival Rate
  • World Health Organization