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Journal of Tropical Pediatrics Advance Access originally published online on May 1, 2008
Journal of Tropical Pediatrics 2008 54(6):364-369; doi:10.1093/tropej/fmn029
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© The Author [2008]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Improving the Management of Severe Acute Malnutrition in an Area of High HIV Prevalence

Kate Sadlera,b, Marko Keracc, Steve Collinsa,d, Hilda Khengeree and Anne Nesbittc

aValid International Ltd., Unit 9, Standingford House, 26 Cave Street, Oxford OX4 1BA, UK
bFeinstein International Center, Friedman School of Nutrition Science and Policy Tufts University, 200 Boston Avenue, Suite 4800 Medford, MA 02155, USA
cCollege of Medicine, University of Malawi, Blantyre, Malawi
dCentre for International Child Health, Institute of Child Health, London WC1N 1EH, UK
eMoyo House NRU, Queen Elizabeth Central Hospital, Blantyre, Malawi

Correspondence: Kate Sadler, Feinstein International Center, Friedman School of Nutrition Science and Policy, Tufts University, 200 Boston Ave, Medford, MA 02155, USA. Tel: +1 617 627 4163; Fax: +1 617 627 3428. E-mail <kate.sadler{at}tufts.edu>.


  Abstract

Aim: To assess the clinical outcomes of a combined approach to the treatment of severe acute malnutrition in an area of high HIV prevalence using: (i) an initial inpatient phase, based on WHO guidelines and (ii) an outpatient recovery phase using ready-to-use therapeutic food.

Methods: An operational prospective cohort study implemented in a referral hospital in Southern Malawi between May 2003 and 2004. Patient outcomes were compared with international standards and with audits carried out during the year preceding the study.

Results: Inpatient mortality was 18% compared to 29% the previous year. Programme recovery rate was 58.1% compared to 45% the previous year. The overall programme mortality rate was 25.7%. Of the total known HIV seropositive children, 49.5% died.

Conclusions: Inpatient mortality and cure rates improved compared to pre-study data but the overall mortality rate did not meet international standards. Additional interventions will be needed if these standards are to be achieved.

Key Words: severe malnutrition • treatment • HIV • Malawi • community-based


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