title: Improving the hospital management of malnourished children by participatory research.
abstract: OBJECTIVE
  To improve the clinical management of severely malnourished children in rural hospitals in South Africa.
  
  
  METHODS
  A pre- and post-intervention descriptive study in three stages: assessment of the clinical management of severely malnourished children, planning and implementing an action plan to improve quality of care, and monitoring and evaluating targeted activities. A participatory approach was used to involve district and hospital nutrition teams in all stages of the research.
  
  
  METHODS
  Two rural first-referral level hospitals (Mary Theresa and Sipetu) in Mount Frere District, Eastern Cape Province.
  
  
  METHODS
  A retrospective record review of all admissions for severe malnutrition to obtain patient characteristics and case fatality rates, a detailed review of randomly selected cases to illustrate general case management, structured observations in the paediatric wards to assess adequacy of resources for care of malnourished children, and in-depth interviews and focus group discussions with nursing and medical staff to identify barriers to improved quality of care.
  
  
  RESULTS
  Before the study, case fatality rates were 50% and 28% in Mary Theresa and Sipetu hospitals, respectively. Information from case studies, observations, interviews, and focus group discussions revealed many inadequacies in knowledge, resources, and practices. The hospital nutrition team developed and implemented an action plan to improve the quality of care and developed tools for monitoring its implementation and evaluating its impact. In the 12-month period immediately after implementation, case fatality rates fell by approximately 25% in both hospitals.
  
  
  CONCLUSIONS
  Participatory research led to the formation of a hospital nutrition team, which identified shortcomings in the clinical management of severely malnourished children and took action to improve quality of care. These actions were associated with a reduction in case fatality rates.
authors.affiliation: School of Public Health, University of the Western Cape, Private Bag X17, Bellville 7535, South Africa. tpuoane@uwc.ac.za
authors.forename: Thandi
authors.initials: T
authors.lastname: Puoane
authors.forename: David
authors.initials: D
authors.lastname: Sanders
authors.forename: Ann
authors.initials: A
authors.lastname: Ashworth
authors.forename: Mickey
authors.initials: M
authors.lastname: Chopra
authors.forename: Susan
authors.initials: S
authors.lastname: Strasser
authors.forename: David
authors.initials: D
authors.lastname: McCoy
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D017144:Focus Groups; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009748:Nutrition Disorders / Q000453:epidemiology / Q000628:therapy*; D018529:Nutritional Support; D010348:Patient Care Team / Q000458:organization & administration*; D016730:Program Development; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology