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Improving the hospital management of malnourished children by participatory research
Thandi Puoane1, David Sanders, Ann Ashworth
1School of Public Health, University of the Western Cape, Private Bag X17, Bellville 7535, South Africa. tpuoane@uwc.ac.za
Insights
Improving care for severely malnourished children in South African rural hospitals significantly reduced child mortality. A participatory approach empowered nutrition teams to enhance clinical management and resources, leading to a substantial decrease in case fatality rates.
Area of Science:
- Global Health
- Pediatric Nutrition
- Healthcare Quality Improvement
Background:
- Severe malnutrition in children presents a critical challenge in resource-limited settings.
- Rural hospitals in South Africa face significant obstacles in managing severe pediatric malnutrition.
- High case fatality rates underscore the urgent need for improved clinical management strategies.
Purpose of the Study:
- To enhance the clinical management of severely malnourished children within rural South African hospitals.
- To implement and evaluate a quality improvement initiative using a participatory research approach.
- To identify and address barriers affecting the care of severely malnourished children.
Main Methods:
- A pre- and post-intervention descriptive study was conducted in two rural hospitals.
- Methods included retrospective record reviews, case study analysis, direct observations, and staff interviews/focus groups.
- A participatory approach engaged district and hospital nutrition teams throughout the research process.
Main Results:
- Initial case fatality rates were high (50% and 28%).
- Identified deficiencies included gaps in knowledge, resources, and clinical practices.
- Following intervention, case fatality rates decreased by approximately 25% in both facilities.
Conclusions:
- Participatory research effectively established hospital nutrition teams.
- These teams identified and addressed critical shortcomings in malnutrition care.
- The implemented actions were directly associated with reduced child mortality from severe malnutrition.
Objective:
To improve the clinical management of severely malnourished children in rural hospitals in South Africa.
Study Design:
A pre- and post-intervention descriptive study in three stages: assessment of the clinical management of severely malnourished children, planning and implementing an action plan to improve quality of care, and monitoring and evaluating targeted activities. A participatory approach was used to involve district and hospital nutrition teams in all stages of the research.
Setting:
Two rural first-referral level hospitals (Mary Theresa and Sipetu) in Mount Frere District, Eastern Cape Province.
Main Measure:
A retrospective record review of all admissions for severe malnutrition to obtain patient characteristics and case fatality rates, a detailed review of randomly selected cases to illustrate general case management, structured observations in the paediatric wards to assess adequacy of resources for care of malnourished children, and in-depth interviews and focus group discussions with nursing and medical staff to identify barriers to improved quality of care.
Results:
Before the study, case fatality rates were 50% and 28% in Mary Theresa and Sipetu hospitals, respectively. Information from case studies, observations, interviews, and focus group discussions revealed many inadequacies in knowledge, resources, and practices. The hospital nutrition team developed and implemented an action plan to improve the quality of care and developed tools for monitoring its implementation and evaluating its impact. In the 12-month period immediately after implementation, case fatality rates fell by approximately 25% in both hospitals.
Conclusion:
Participatory research led to the formation of a hospital nutrition team, which identified shortcomings in the clinical management of severely malnourished children and took action to improve quality of care. These actions were associated with a reduction in case fatality rates.
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