Brief report. Reduction in in-hospital mortality of children with malnutrition

Abstract

In northern Natal/KwaZulu South Africa pediatricians at Hlabisa Hospital treated all patients with marasmus kwashiorkor and marasmic-kwashiorkor during January-June 1993 using a standard malnutrition protocol. Upon learning about the role of unrecognized (especially gram-negative) infection and of hypoglycemia in sudden and unexpected death in children with unrecognized infection the pediatricians treated all children admitted with severe malnutrition using a new malnutrition treatment regimen during July-December 1993. The new regimen consisted of the standard protocol plus administration of oral ampicillin for 7 days and intramuscular gentamicin for 5 days for all children irrespective of clinical condition on admission. Finger-prick glucose readings were done every 6 hours. Oral or intravenous 50% dextrose was given to treat hypoglycemia (blood sugar < 2.2 mmol/l). The case fatality rate for the first half of 1993 was significantly higher than that for the second half of the year (20% vs. 6%; p = 0.0007). These findings suggest that the two changes to the regimen (ampicillin/gentamicin and monitoring/treating for hypoglycemia) greatly reduced deaths in severely malnourished children. They motivated the pediatricians to improve community-based detection and management of less severe malnutrition (e.g. training of community health workers and construction of a nutrition rehabilitation unit).