title: Evaluating the level of adherence to Ministry of Health guidelines in the management of severe acute malnutrition at Garissa Provincial General Hospital, Garissa, Kenya.
abstract: BACKGROUND
  Half of Kenya's high infant and under five mortality rates is due to malnutrition. Proper implementation of World Health Organization's (WHO) Evidence Based Guidelines (EBG) in management of severe acute malnutrition can reduce mortality rates to less than 5%. The objectives were to establish the level of adherence to WHO guideline and the proportion of children appropriately managed for severe acute malnutrition (steps 1-8) as per the WHO protocol in the management of severe acute malnutrition. This was a short longitudinal study of 96 children, aged 6-59 months admitted to the pediatric ward with diagnosis of severe acute malnutrition.
  
  
  METHODS
  Data was extracted from patients' medical files and recorded into an audit tool to compare care provided in this hospital with WHO guidelines.
  
  
  RESULTS
  Non-edematous malnutrition was the commonest presentation (93.8%). A higher proportion (63.5%) of patients was male. Most (85.4%) of patients were younger than 2 years. Patients with non-edematous malnutrition were younger (mean age for non-edematous malnutrition was 16 (± 10.6) months versus 25 (± 13.7) months in edematous malnutrition). The commonest co- morbid condition was diarrhea (52.1%). Overall, 13 children died giving an inpatient case fatality rate of 13.5%. Appropriate management was documented in only 14.6% for hypoglycemia (step1), 5.2% for hypothermia (step 2) and 31.3% for dehydration (step 3).
  
  
  CONCLUSIONS
  The level of adherence to MOH guidelines was documented in 5 out of the 8 steps. Appropriate management of children with severe acute malnutrition was inadequate at Garissa hospital.
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.
authors.forename: Osman
authors.initials: O
authors.lastname: Warfa
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.
authors.forename: Daniel
authors.initials: D
authors.lastname: Njai
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.
authors.forename: Laving
authors.initials: L
authors.lastname: Ahmed
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.
authors.forename: Bashir
authors.initials: B
authors.lastname: Admani
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.
authors.forename: Fred
authors.initials: F
authors.lastname: Were
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.
authors.forename: Dalton
authors.initials: D
authors.lastname: Wamalwa
authors.affiliation: Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.
authors.forename: Boniface
authors.initials: B
authors.lastname: Osano
authors.affiliation: Garissa Provincial General Hospital, Garissa, Kenya.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mburugu
authors.affiliation: Garissa Provincial General Hospital, Garissa, Kenya.
authors.forename: Musa
authors.initials: M
authors.lastname: Mohamed
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence; D006769:Hospitals, General; D006801:Humans; D007223:Infant; D007630:Kenya; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition / Q000503:physiopathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index
keywords: Severe malnutrition; WHO guidelines; adherence; audit