Missed diagnosis of malnutrition in children aged 6-59 months attending health care at the Mbagathi District Hospital

Abstract

ABSTRACT Background Malnutrition remains a challenge worldwide and more so in the developing countries. Malnutrition is associated with more than 60% of childhood mortality in these countries¹. Studies have shown that clinicians miss the diagnosis of malnutrition in children, more so mild and moderate forms of malnutrition in which the clinical presentation may not be obvious. Objectives Primary objective: To find out the prevalence of missed diagnosis of malnutrition in children aged 6-59 months attending health care at Mbagathi District Hospital. Secondary objective: To determine the reasons why health workers missed the diagnosis of malnutrition. Methodology It was a cross sectional study carried out at the pediatric emergency outpatient clinic. The children’s nutritional assessment was carried out consecutively after they concluded their consultation with the attending clinician. The records were then reviewed to find out if malnutrition, should it be present in the child was missed. For the secondary objective, different cadres of health workers attending to the paediatric patients were interviewed. Results A total of two hundred and fifty five children were recruited into the study. Malnutrition was missed in 88(38.3%) of these children. The investigators identified malnutrition in 230 (90.2%) of 255 children who were seen, severe malnutrition was detected in 111(43.5%), moderate malnutrition in 46(18%) and at risk of malnutrition in 73 (28.6%) of the children. The reasons health workers gave for lack the missed diagnosis of malnutrition included: lack of anthropometric measurements being taken, lack of knowledge on how to make a diagnosis, a focus on the presenting complaints, poor clinical assessment of patients, not recording the nutritional status of the patients, understaffing, lack of equipment for taking anthropometric measurements, and lack of knowledge of the mother on the nutritional status of their children.