Improving the management of severe acute malnutrition in an area of high HIV prevalence.
OBJECTIVE
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.
Sadler
Kate
K
Valid International Ltd., Unit 9, Standingford House, 26 Cave Street, Oxford OX4 1BA, UK. kate.sadler@tufts.edu
Kerac
Marko
M
Collins
Steve
S
Khengere
Hilda
H
Nesbitt
Anne
A
D046688:Child Mortality; D002675:Child, Preschool; D015331:Cohort Studies; D003153:Community Health Services; D005260:Female; D005527:Food, Fortified; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology*; D015528:HIV Seroprevalence; D006801:Humans; D007297:Inpatients; D007732:Kwashiorkor / Q000150:complications / Q000178:diet therapy* / Q000401:mortality / Q000628:therapy; D008295:Malawi / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000178:diet therapy* / Q000401:mortality; D010045:Outpatients; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome