Abstract
BackgroundDespite the widespread implementation of the World Health Organization (WHO) guidelines for the management of severe malnutrition in South Africa, poor treatment outcomes for children under 5 years are still observed in some hospitals, particularly in rural areas.ObjectiveTo explore health care workers’ perceptions about upstream and proximal factors contributing to poor treatment outcomes for severe acute malnutrition in two district hospitals in South Africa.MethodsAn explorative descriptive qualitative study was conducted. Four focus group discussions were held with 33 hospital staff (senior clinical and management staff, and junior clinical staff) using interview guide questions developed based on the findings from an epidemiological study that was conducted in the same hospitals. Qualitative data were analysed using the framework analysis.FindingsMost respondents believed that critical illness, which was related to early and high case fatality rates on admission, was linked to a web of factors including preference for traditional medicine over conventional care, gross negligence of the child at household level, misdiagnosis of severe malnutrition at the first point of care, lack of specialised skills to deal with complex presentations, shortage of patient beds in the hospital and policies to discharge patients before optimal recovery. The majority believed that the WHO guidelines were effective and relatively simple to implement, but that they do not make much difference among severe acute malnutrition cases that are admitted in a critical condition. Poor management of cases was linked to the lack of continuity in training of rotating clinicians, sporadic shortages of therapeutic resources, inadequate staffing levels after normal working hours and some organisational and system-wide challenges beyond the immediate control of clinicians.ConclusionFindings from this study suggest that effective management of paediatric severe acute malnutrition in the study setting is affected by a multiplicity of factors that manifest at different levels of the health system and the community. A verificatory study is encouraged to collaborate these findings.
Highlights
Despite the widespread implementation of the World Health Organization (WHO) guidelines for the management of severe malnutrition in South Africa, poor treatment outcomes for children under 5 years are still observed in some hospitals, in rural areas
Compelling evidence exists on the link between HIV infection and Severe acute malnutrition (SAM), and some studies have reported high HIV prevalence among children treated for SAM.[7,8,9]
Studies conducted in Africa have shown that children with SAM who are co-infected with HIV are at increased mortality risk compared to their HIV uninfected counterparts.[12,13,14,15,16]
Summary
Despite the widespread implementation of the World Health Organization (WHO) guidelines for the management of severe malnutrition in South Africa, poor treatment outcomes for children under 5 years are still observed in some hospitals, in rural areas. The prevalence of undernutrition in children under 5 years of age remains high in Africa and South East Asia.[1] Close to 35% of the 7.6 million deaths that occur each year among children who are under 5 years of age are because of nutrition-related factors,[2] and about 5% of such deaths are attributable to severe wasting.[3] Severe acute malnutrition (SAM) – which results from a relatively short duration of nutritional deficits4 – can be complicated by concurrent infective illnesses, acute respiratory infection, diarrhoea and gramnegative septicaemia,[5] as well as chronic infections such as HIV.[6] Compelling evidence exists on the link between HIV infection and SAM, and some studies have reported high HIV prevalence among children treated for SAM.[7,8,9] A recent study conducted in two rural South African hospitals recorded an HIV prevalence of 43.2% in a sample of 454 children under 5 years of age who were admitted and treated for SAM.[10]. Studies conducted in Africa have shown that children with SAM who are co-infected with HIV are at increased mortality risk compared to their HIV uninfected counterparts.[12,13,14,15,16] In a bid to improve mortality outcomes for children with SAM, the World http://www.phcfm.org
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