title: Efficacy of World Health Organization guideline in facility-based reduction of mortality in severely malnourished children from low and middle income countries: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Globally more than 19 million under-five children suffer from severe acute malnutrition (SAM). Data on efficacy of World Health Organization's (WHO's) guideline in reducing SAM mortality are limited. We aimed to assess the efficacy of WHO's facility-based guideline for the reduction of under-five SAM children mortality from low and middle income countries (LMICs).
  
  
  METHODS
  A systematic search of literature published in 1980-2015 was conducted using electronic databases. Additional articles were identified from the reference lists and grey literature. Studies from LMICs where SAM children (0-59 months) were managed in facilities according to WHO's guideline were included. Outcome was reduction in SAM mortality measured by case fatality rate (CFR). The review was reported following the Grading of Recommendations Assessment Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and meta-analyses done using RevMan 5.3®.
  
  
  RESULTS
  This review identified nine studies, which demonstrated reductions in SAM mortality. CFR ranged from 8 to 16% where WHO guideline applied. High rates of poverty, malnutrition, severe co-morbid condition, lack of resources and differences in treatment practices played a key role in large CFR variation. Most death occurred within 48 h of admission in Asia, between 4 days and 4 weeks in Africa and in Latin America. CFR was reduced by 41% (odds ratio: 0.59; 95% confidence interval: 0.46-0.76) when WHO guideline were applied. A 45% reduction in CFR was achieved after excluding human immunodeficiency virus positive cases. Dietary management also differed among WHO and conventional management.
  
  
  CONCLUSIONS
  Children receiving SAM inpatient care as per WHO guideline have reduced CFR compared to conventional treatment.
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Muttaquina
authors.identifier: http://orcid.org/0000-0001-6441-5641
authors.initials: M
authors.lastname: Hossain
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Mohammod J
authors.initials: MJ
authors.lastname: Chisti
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Mohammod Iqbal
authors.initials: MI
authors.lastname: Hossain
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Mahfuz
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Mohammad Munirul
authors.initials: MM
authors.lastname: Islam
authors.affiliation: Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
mesh_terms: D000208:Acute Disease; D000349:Africa / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007843:Latin America / Q000453:epidemiology; D044342:Malnutrition / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome; D014944:World Health Organization
keywords: World Health Organization; children; facility; mortality; severe acute malnutrition