Assessment and management of severe acute malnutrition in children aged 6–59 months by professional nurses in primary healthcare facilities in the Johannesburg health district, South Africa : a retrospective analysis

Date
2020-03
Journal Title
Journal ISSN
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: Introduction: Severe acute malnutrition (SAM) is a public health concern, due to the high mortality rates observed in children with this condition. The correct classification of children with SAM remains a challenge. Children with SAM usually present at primary healthcare (PHC) with other illness and will only be classified and managed for SAM through the correct measurement, plotting and interpretation of anthropometric data. Children identified with SAM should be referred to the hospital and admitted for further management to reduce case-fatality rates. The management of SAM at PHC and hospitals plays a unique role in child survival. Aim: The aim of the study was to evaluate the assessment and the management of SAM in children aged 6–59 months by professional nurses in PHC facilities in the Johannesburg (JHB) health district. Methods: This was an observational study with a cross-sectional, retrospective descriptive study design. Quantitative data collection methods were used to review clinic records of children in the JHB district. Results: Records of 83 children were selected from 35 clinics. Only 81 (98%) of the children’s weights were recorded, 27 (33%) had height and only 20 (24%) of children had mid-upper arm circumference (MUAC) measurements taken. Only 12 (14%) patients had a record of oedema, 58 (66%) patients had no oedema noted while in 16 (19%) patients there were no entries recorded for either the presence or absence of oedema. Nurses assessed 51 (61%) of children for feeding, of which 18 (35%) were still breastfeeding, 49 (96%) were receiving formula milk and 26 (51%) of the children were recorded as receiving solid food. Only 12 (14%) of the children were correctly identified with SAM. Conclusion: The study concludes that the overall assessment, classification and management for children with SAM in JHB district clinics was poor and often did not adhere to the Integrated Management of Childhood Illnesses (IMCI) guidelines. The practices of professional nurses in this district point to poor recognition of the need for accurate assessment and monitoring in order to reduce the risk of death in children with SAM.
AFRIKAANSE OPSOMMING: Inleiding: Ernstige akute wanvoeding (EAW) is ʼn openbare gesondheidskwessie, as gevolg van die hoe sterftesyfer onder kinders met hierdie toestand. Die korrekte klassifisering van kinders met EAW bly ʼn uitdaging. Kinders met EAW meld gewoonlik met ʼn ander siekte by primere gesondheidsorg- (PGS-) klinieke aan en sal slegs op grond van die korrekte meting, aantekening en interpretasie van antropometriese data as gevalle van EAW geklassifiseer en hanteer word. Kinders wat met EAW geidentifiseer is, moet na die hospitaal verwys word en vir verdere hantering opgeneem word om die sterftesyfer te beperk. Die hantering van EAW by primere gesondheidsorg klinieke en hospitale speel ʼn unieke rol in kinders se oorlewing. Doel: Die doel van die studie was om die evaluering en hantering van EAW in kinders van 6–59 maande deur professionele verpleegkundiges in PGS-klinieke in die Johannesburg-gesondheidsdistrik te evalueer. Metode: Dit was ʼn waarnemingstudie met ʼn retrospektiewe, beskrywende deursnee-navorsingsontwerp. Kwantitatiewe dataversamelingsmetodes is gebruik om die kliniekrekords van kinders in die Johannesburg-distrik te ondersoek. Resultate: Rekords van 83 kinders van 35 klinieke is gekies. Een-en-tagtig (98%) van die kinders se gewig was aangeteken, 27 (33%) se lengte en 20 (24%) se boarm-omtrek (MUAC). Slegs 12 pasiënte (14%) het ʼn rekord van edeem gehad, 58 pasiente (66%) het geen aantekening oor edeem gehad nie en vir 16 pasiente (19%) was daar geen inskrywings oor die aan- of afwesigheid van edeem nie. Verpleegkundiges het 51 kinders (61%) se voeding geassesseer; 18 (35%) van hulle is geborsvoed, 49 (96%) het formulemelk ontvang en 26 (51%) van hulle is aangeteken dat hulle op vaste kos was. Slegs 12 (14%) van die kinders is korrek met EAW geidentifiseer. Gevolgtrekking: Die studie het bevind dat die algemene evaluering, klassifisering en hantering van kinders met EAW in Johannesburgse distriksklinieke swak was en dikwels nie die riglyne vir die Geïntegreerde Bestuur van Kindersiekte (IMCI) gevolg het nie. Die praktyke van professionele verpleegkundiges in hierdie distrik wys op ʼn swak begrip van die behoefte aan akkurate evaluering en monitering ten einde die sterfterisiko in kinders met EAW te verminder.
Description
Thesis (MNutr)--Stellenbosch University, 2022.
Keywords
Malnutrition -- Preschool children -- Johannesburg (South Africa), Preschool children -- Growth -- Johannesburg (South Africa), Children -- Mortality -- Johannesburg (South Africa), UCTD
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