Bilal Jalal A, Elsheikh Anas E, Mahgoub Hyder M, Adam Ishag
College of Medicine, Qassim University, Buraydah, Kingdom of Saudi Arabia.
Faculty of Medicine, Omdurman University, Sudan.
Sudan J Paediatr. 2018;18(1):63-70. doi: 10.24911/SJP.2018.1.9.
Severe acute malnutrition (SAM) constitutes about a third of the estimated 8 million deaths in under 5-year-old children, and the World Health Organisation (WHO) protocol of management is used in hospital management. The present study aims to assess adherence to the WHO guidelines of management of SAM in children aged 6-59 months at Kalakla Turkish Hospital in Khartoum, Sudan. Medical records/files of 169 children, mean (standard deviation) age was 18.5 (10.4) months with a range of 6-54 months, admitted to the hospital were reviewed. The male/female ratio was 1.5:1. No records of history and the proportion of missing examination information were >5%. Weight-for-height score was not calculated for 61% of children and other anthropometric measurements were inadequately recorded. Seven classifications of acute malnutrition were recorded instead of two. Oedema, mid-upper arm circumference and score were neglected as tools of classification. Blood sugar, haemoglobin concentration and malaria film/rapid diagnostic tests were the only requested tests in 122 (72.2%), 14 (8.3%) and 49 (29%), respectively. Appropriate treatment was documented in 68 (40.2%) children for intravenous (IV) dextrose for hypoglycaemia, 25 (14.8%) for kangaroo technique, 32 (18.9%) covering with blanket for hypothermia, 106 (62.7%) for F75 milk formula and 115 (68%) for F100 milk formula feeding; and there were no records of receiving oral/IV rehydration. The case fatality rate was 5.9%. Quality of care can be improved by training. Improvement of hospital infrastructure with attention to specifying rooms for management of acute malnutrition will be of benefit to the application of the guidelines.
重度急性营养不良（SAM）约占5岁以下儿童估计800万死亡人数的三分之一，医院管理采用世界卫生组织（WHO）的管理方案。本研究旨在评估苏丹喀土穆卡拉克拉土耳其医院6至59个月儿童SAM管理中对WHO指南的遵循情况。回顾了该医院收治的169名儿童的病历/档案，这些儿童的平均（标准差）年龄为18.5（10.4）个月，年龄范围为6至54个月。男女比例为1.5:1。病史记录缺失及检查信息缺失比例均>5%。61%的儿童未计算身高别体重分数，其他人体测量数据记录不完整。记录了七种急性营养不良分类而非两种。水肿、上臂中部周长及分数被忽视作为分类工具。血糖、血红蛋白浓度及疟原虫涂片/快速诊断检测分别是仅122例（72.2%）、14例（8.3%）和49例（29%）患儿所要求的检测项目。68例（40.2%）儿童记录了针对低血糖的静脉注射葡萄糖的适当治疗，25例（14.8%）记录了袋鼠护理技术，32例（18.9%）记录了针对体温过低的用毯子覆盖，106例（62.7%）记录了F75奶粉喂养，115例（68%）记录了F100奶粉喂养；且无接受口服/静脉补液的记录。病死率为5.9%。通过培训可提高护理质量。改善医院基础设施并注意指定急性营养不良管理病房将有助于指南的应用。
