Abstract

Evaluation of the In-patient Therapeutic Feeding Program Used for Children Admitted with Severe Protein Energy Malnutrition in El-Obied Specialized Pediatric Hospital

This hospital-based retrospective analytical study was done during the year 2018 in El-Obied specialized pediatric hospital in Sudan and included the 296 children under the age of 5 years who were admitted to the inpatient center for treating acute severe malnutrition. This center is the main center in the whole state of Kordofan in Sudan with under 5-year children in the whole state approaching about 700,000 children. The center is a very crowded center containing only 25 beds with sometimes more than one patient on the same bed. The objectives of the study were to evaluate the use of the standard protocol of inpatient management of severe malnutrition in this center which is under the supervision of the federal and state ministry of health and also to assess aspects of the duration of therapy and outcome of management. A prepared questionnaire was used to fill in all information about the patient’s nutritional and clinical condition on admission and with a concentration on the nutritional management and follow up during the hospital stay and the outcome of the hospital management. All the necessary information was obtained using the designed WHO register for inpatient treatment of severe malnutrition in children; the CCP (Critical Care Pathway register). Ethical approval and hospital and Ministry of health permissions were obtained. The results show that most of the patients (80%) were in the younger age group of 6-24 months and 72% have a z-score less than 3SD with 87.5 sufferings severe wasting and 75.7% having a MUAC indicating severe wasting. Nutritional edema was detected in 24.3% on admission diarrhea in 60.8% and signs of vitamin A deficiency in 68.2% F-75 were the starter feeding for all children in the group and appetite test performed in all. Most of the children did not take the proper prescribed amount of F-75 and 30.7% of those with diarrhea were not given re-so-mal. About 85% of patients took more than 3 days to transfer to F-100 milk. And about 55% stayed in the hospital for 8-14 days. The mortality rate was 5.4% and the escape from inpatient care was high at 12.5%. The rest of the patients were referred for outpatient care. Significant relationships were found with the presence of diarrhea and the duration of hospital stay.

The study recommended improvements in some of the parts of protocol implementation like giving re-so-mal to all patients with diarrhea and addressing the problem of escaping from hospital treatment. Also, to raise the number of acting nutritionists in the center and to improve both under and postgraduate training in nutritional therapy of SAM for all of the health personnely.

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