title: Inpatient management of children with severe acute malnutrition: a review of WHO guidelines.
abstract: OBJECTIVE
  To understand how the World Health Organization's (WHO's) guidelines on the inpatient care of children with complicated severe acute malnutrition may be strengthened to improve outcomes.
  
  
  METHODS
  In December 2015, we searched Google scholar and WHO's website for WHO recommendations on severe acute malnutrition management and evaluated the history and cited evidence behind these recommendations. We systematically searched WHO International Clinical Trials Registry Platform, clinicaltrials.gov and the Controlled Trials metaRegister until 10 August 2015 for recently completed, ongoing, or pending trials.
  
  
  RESULTS
  WHO's guidelines provide 33 recommendations on the topic. However, 16 (48.5%) of these recommendations were based solely on expert opinion - unsupported by published evidence. Another 11 (33.3%) of the recommendations were supported by the results of directly relevant research - i.e. either randomized trials (8) or observational studies (3). The other six recommendations (18.2%) were based on studies that were not conducted among children with complicated severe malnutrition or studies of treatment that were not identical to the recommended intervention. Trials registries included 20 studies related to the topic, including nine trials of alternative feeding regimens. Acute medical management and follow-up care studies were minimally represented.
  
  
  CONCLUSIONS
  WHO's guidelines on the topic have a weak evidence base and have undergone limited substantive adjustments over the past decades. More trials are needed to make that evidence base more robust. If the mortality associated with severe malnutrition is to be reduced, inpatient and post-discharge management trials, supported by studies on the causes of mortality, are needed.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, United States of America (USA).
authors.forename: Kirkby D
authors.initials: KD
authors.lastname: Tickell
authors.affiliation: Departments of Pediatrics and Global Health, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA 98115, USA .
authors.forename: Donna M
authors.initials: DM
authors.lastname: Denno
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D019468:Disease Management; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D007297:Inpatients; D007552:Isotonic Solutions / Q000627:therapeutic use; D018977:Micronutrients / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D000077331:Ringer's Solution; D000067011:Severe Acute Malnutrition / Q000628:therapy*; D014944:World Health Organization
chemical_list: D044966:Anti-Retroviral Agents; D007552:Isotonic Solutions; D018977:Micronutrients; D000077331:Ringer's Solution