title: Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa.
abstract: OBJECTIVE
  To investigate the problems, benefits, feasibility, and sustainability of implementation of WHO guidelines on management of severe malnutrition.
  
  
  METHODS
  A postal survey invited staff from 12 African hospitals to participate in the study. Five hospitals were evaluated and two were selected to take part in the study: a district hospital in South Africa and a mission hospital in Ghana. At an initial visit, an experienced paediatrician reviewed the situation in the hospitals and introduced the principles of the guidelines through a participatory approach. During a second visit about six months later, the paediatrician reviewed the feasibility and sustainability of the introduced changes and helped find solutions to problems. At a final visit after one year, the paediatrician reassessed the overall situation.
  
  
  RESULTS
  Malnutrition management practices improved at both hospitals. Measures against hypoglycaemia, hypothermia, and infection were strengthened. Early, frequent feeding was established as a routine practice. Some micronutrients for inclusion in the diet were not locally available and needed to be imported. Problems were encountered with monitoring of weight gain and introducing a rehydration solution for malnutrition.
  
  
  CONCLUSIONS
  Implementation of the main principles of the WHO guidelines on severe malnutrition was feasible, affordable, and sustainable at two African hospitals. The guidelines could be improved by including suggestions on how to adapt specific recommendations to local situations. The guidelines are well supported by experience and published reports, but more information is needed about some components and their impact on mortality.
authors.affiliation: Southern Islands Medical Center, Cebu, Philippines. jdeen@ivi.int
authors.forename: Jacqueline L
authors.initials: JL
authors.lastname: Deen
authors.forename: Matthias
authors.initials: M
authors.lastname: Funk
authors.forename: Victor C
authors.initials: VC
authors.lastname: Guevara
authors.forename: Haroon
authors.initials: H
authors.lastname: Saloojee
authors.forename: James Y
authors.initials: JY
authors.lastname: Doe
authors.forename: Ayo
authors.initials: A
authors.lastname: Palmer
authors.forename: Martin W
authors.initials: MW
authors.lastname: Weber
mesh_terms: D000349:Africa; D002648:Child; D015362:Child Nutrition Disorders / Q000517:prevention & control / Q000628:therapy*; D002675:Child, Preschool; D004035:Diet Therapy / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy / Q000592:standards; D019983:Guideline Adherence; D006302:Health Services Research; D006767:Hospitals, District / Q000592:standards*; D016519:Hospitals, Religious / Q000592:standards*; D006801:Humans; D007035:Hypothermia / Q000628:therapy; D008297:Male; D009748:Nutrition Disorders / Q000628:therapy*; D010372:Pediatrics / Q000592:standards; D017410:Practice Guidelines as Topic; D008921:Religious Missions / Q000592:standards; D014944:World Health Organization