Outcomes in malnourished children at a tertiary hospital in Swaziland after implementation of the World Health Organization treatment guidelines

Abstract

Background. Swaziland adopted the World Health Organization (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007, with the aim of reducing high case fatality rates for childhood malnutrition. However, no follow-up studies have been conducted to determine the reduction in these rates after implementation of the guidelines. Objectives. To determine the case fatality rate for childhood malnutrition after implementation of the WHO treatment guidelines. Methods. A retrospective observational study was undertaken. Demographic, anthropometric and clinical characteristics and outcomes for all children aged under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 were recorded and analysed. Results. Of the 227 children who met the study inclusion criteria, 179 (64.6%) were severely malnourished and 98 (35.4%) had moderate malnutrition; 111 children died during admission, giving an overall case fatality rate of 40.1%. Mortality was significantly higher among severely malnourished children than among those with moderate malnutrition (46.9% v. 27.6%) (odds ratio (OR) 3.0, 95% confidence interval (CI) 1.7 - 5.3). Co-morbid pneumonia and gastroenteritis were significant predictors of mortality (OR 2.0, 95% CI 1.2 - 3.4 and OR 1.9, 95% CI 1.1 - 3.2, respectively). Conclusion. Case fatality rates for childhood malnutrition remain high despite adoption of the WHO treatment guidelines. There is a need for periodic clinical audits and mortality review meetings to reduce deaths from childhood malnutrition so as to meet the WHO mortality target of less than 5% and improve child survival.