Audit of care for children Aged 6 to 59 months admitted with severe malnutrition at Kenyatta National Hospital

Abstract

Background: World Health Organization treatment guidelines for severe malnutrition aim to improve the quality of inpatient care and reduce mortality. This study audited quality of care for severely malnourished children admitted at Kenyatta National Hospital, a large tertiary level health facility. Patients and methods: This was a prospective study of 101 children, aged 6 to 59 months with severe malnutrition admitted between l " February and 28th April 2008. A data pro-forma sheet was prepared according to steps in the WHO guidelines and applied to each patient thus assessing care provided during hospitalization. The care of the children was provided by clinicians, nurses and nutritionists. Results: Overall, 58.5% of children had marasmus and 47.5% of children were younger than one year old. Common co-morbidities at admission were diarrhoea (70.3%) and pneumonia (51.4%). Of the eight steps of care evaluated, five steps were followed correctly in less than 55% of cases. The proportion of children appropriately managed was 7.9 % (95% CI 2.6-13.2) in step 1,46.5% (95% CI 36.8-56.2) in step 2,54.9 %( 95% CI 43.3-66.5) in step 3,55.4% (95% CI 45.7-65.1) in steps 4 and 6.90% (95% CI 85.1- 96.9) in step 5, 16.8% (95% CI 9.5-24.1) in step 7 and 23.8% (95% CI 13.6-34.0) in step 8. Conclusion: Quality of care for children admitted with severe malnutrition at KNH is inadequate and often does not follow the evidence based WHO guidelines