Evaluating the growth, associated co-morbidities and mortality in children under the age of five years, six months after treatment for Severe Acute Malnutrition (SAM) in the Oudtshoorn sub-district.
Thesis (MFamMed)--Stellenbosch University, 2017.
ENGLISH SUMMARY : Background: Malnutrition is an important cause of childhood mortality in South Africa. Severe acute malnutrition (SAM) is a major public health problem. The focus of treatment is awareness, early identification and nutritional intervention. With implementation of the revised World Health Organization’s (WHO) guideline to diagnose SAM in the Oudtshoorn sub-district in the Western Cape more children are being identified and admitted for treatment. Very little data exists about the outcome of children after being discharged back into the community following treatment for SAM. The aim of the study was to assess the success of the current rehabilitative and nutritional management programme for SAM by looking at weight gain, associated co-morbidities and mortality of children under five years of age six-months after discharge from Oudtshoorn District Hospital. Methods: A descriptive survey was conducted by extracting data from the medical records. All children aged 6-59 months who were admitted for SAM from 2014 to 2016 were included. Weight-for-height, mid-upper-arm circumference (MUAC) and the presence of peripheral oedema were recorded on hospital admission. Co-morbidities, specifically HIV and TB, were also recorded. Mortality and repeated anthropometric measurements were captured at the six-month follow-up at the respective primary care clinics from the medical record or the nutritional treatment programme register. Results: Sixty-three children were included with a median age 52 weeks (IQR 28-92). Six died (9.5%), ten failed to gain weight satisfactorily (15.8%) and overall children showed a median monthly weight increase of 325 grams per child (IQR 192-475). Co-morbidities were seen in 53 (84.1%) of children. The main associated co-morbidities were gastroenteritis, TB, anaemia, and respiratory tract infections. All participants were HIV negative. Only 73% of children had a MUAC measured at admission and 27% at follow up in primary care. Conclusion: Overall 25% of children had an adverse outcome, although weight gain and mortality was within the minimum acceptable standards for community based programmes. Primary care clinics did not perform MUAC measurements adequately and relied only on weight-for-height. The usual co-morbidities were seen, although none of the children were HIV positive.
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