SYSTEMATIC ANALYSIS OF IN-PATIENTS’ CARE OFSEVERELY MALNOURISHED CHILDREN AT HAYATABAD MEDICAL COMPLEX PESHAWAR: A TOOL TO IMPROVE QUALITY OF CARE

Background: Severe malnutrition has a high mortality rate among hospitalized children in developing countries. Much of this has been attributed to provision of inappropriate and poor quality clinical care. The aim of this study was to assess the implementation in our unit. Methods: Hospital-based prospective audit, to assess implementation of WHO guidelines for the treatment of severe malnutrition steps 1-8. Data was collected at admission and on daily basis, and case records were reviewed on day seven and/or on death or discharge. Participants were consecutive children aged 6 to 59 months admitted to Nutritional Rehabilitation Unit, Hayatabad Medical Complex, Peshawar, with severe malnutrition from 1st January to 31stAugust 2011. The care to these children was provided by a team trained under WHO guidelines. Results: Among 147 children, male: female ratio was 1.26:1 and median age was 11.7 months; majority (59.2%) was below 24 months. Children with marasmus were significantly younger than those with kwashiorkor and marasmickwashiorkor. The highest degree of implementation was observed for Steps 5, 6 and 8 but initial steps (steps 1, 2 and 3) of stabilization, which were essential for the survival of these children, were poorly implemented and inappropriately provided. Conclusion: Present study demonstrated the gaps in care of severely malnourished children in this unit. Improving care will require a holistic and not simply medical approach