Beyond the guidelines for the treatment of severely malnourished children with complications - Assessment from Cambodia

Abstract

Background: From 2005 to 2010, the percentage of children dangerously thin (also called wasted) crossed the International Phase Classification Emergency Threshold, increasing from 8.4 to 10.9 %. As a result, Cambodia is now among the 20 worst countries globally for child wasting - with malnutrition implicated in more than 6400 child deaths annually. This study, therefore, sought to provide information on the actual treatment of severely acute malnourished children with complication in Cambodian hospitals. Methods: Data was collected from March to June 2014, from hospital records of 1450 children admitted for treatment of severe acute malnutrition with complications as in-patient in 19 hospitals from 2011 to 2013. Recovery rates were determined using weight-for-height z-scores and the percentage of weight gain for children without oedema. Additional data on duration of stay in hospital, prevalence of follow-up visits, and rates of weight gain were also analyzed. Results: According to weight for height z-score (WHZ), 58.6 % of the children without oedema (n = 1100) were defined as cured of severe acute malnutrition at discharge. On average, during their stay in hospital, children were gaining approximately 7 % of their bodyweight. In regards to follow-up visits, 86.7 % of children without oedema were defined as cured after three follow-up visits, with an improved WHZ of +2.28 z-score since admission. When looking at the progress and achievements in regards to follow-up visits, the rate of children participating in three follow-up visits increased from 25.7 to 42.8 % between 2011 and 2013. Conclusions: A major finding from this research was that the children who completed three follow-up visits were not only cured (>-3 standard deviation (SD)) but were no longer moderately malnourished, as most of them ended up with a z-score >-2SD.