Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
Int Health. 2009 Sep;1(1):10-6. doi: 10.1016/j.inhe.2009.03.001.
The care of severely malnourished children in sub-Saharan Africa is challenging, especially in HIV-prevalent settings. Recent improvements to facility-based individual case management, and increased community-based management focusing on early identification and high programme coverage have led to reductions in mortality. Further interventions are urgently needed to address resistant mortality, mostly attributable to HIV. This paper explores strategies in three main areas to improve survival for children with severe acute malnutrition (SAM): identifying HIV and improving case management for HIV-infected children; strengthening existing strategies to improve outcomes for all children with SAM, regardless of HIV status; and improving early identification and increasing programme coverage. Although interventions to further improve survival among children with SAM in sub-Saharan Africa must firstly ensure best care for all children, HIV-infected children are at particular risks for mortality. Integration of specific interventions for HIV testing and treatment into SAM care is essential. International guidelines should reflect best evidence, and are in urgent need of updating and adapting to local country context. Effective interventions already exist that can improve survival in children with SAM in HIV-prevalent settings. The challenge is to implement what we know and to research what we do not.
撒哈拉以南非洲地区严重营养不良儿童的护理工作极具挑战性，在艾滋病毒流行地区更是如此。最近，医疗机构中针对个体病例的管理以及社区层面针对早期发现和高方案覆盖率的管理得到了改善，从而降低了死亡率。为了解决主要由艾滋病毒引起的顽固性死亡率问题，迫切需要进一步采取干预措施。本文探讨了三个主要领域的策略，以提高严重急性营养不良（SAM）儿童的生存率：确定艾滋病毒并改善感染艾滋病毒儿童的病例管理；加强现有战略，改善所有 SAM 儿童的预后，无论其艾滋病毒状况如何；以及改善早期发现和提高方案覆盖率。尽管在撒哈拉以南非洲地区进一步提高 SAM 儿童生存率的干预措施首先必须确保所有儿童都得到最佳护理，但感染艾滋病毒的儿童的死亡率尤其高。将艾滋病毒检测和治疗的具体干预措施纳入 SAM 护理中是必要的。国际指南应反映最佳证据，并且迫切需要更新和适应当地国情。在艾滋病毒流行地区，已经存在可以提高 SAM 儿童生存率的有效干预措施。挑战在于实施我们所知道的，研究我们所不知道的。
