advanced search

<< Back To Home

Efficacy of World Health Organization guideline in facility-based reduction of mortality in severely malnourished children from low and middle income countries: A systematic review and meta-analysis

Thursday, 19th of January 2017

J Paediatr Child Health. 2017 Jan 4. doi: 10.1111/jpc.13443. [Epub ahead of print]

Efficacy of World Health Organization guideline in facility-based reduction of mortality in severely malnourished children from low and middle income countries: A systematic review and meta-analysis

Hossain M¹, Chisti MJ¹, Hossain MI¹, Mahfuz M¹, Islam MM¹, Ahmed T¹.

• ¹Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.

Abstract

AIM:

Globally more than 19 million under-five children suffer from severe acute malnutrition (SAM). Data on efficacy of World Health Organizations (WHO) guideline in reducing SAM mortality are limited. We aimed to assess the efficacy of the WHO facility-based guideline for the reduction of under-five SAM children mortality from low and middle income countries (LMICs).

METHODS:

A systematic search of literature published in 1980-2015 was conducted using electronic databases. Additional articles were identified from the reference lists and grey literature. Studies from LMICs where SAM children (0-59 months) were managed in facilities according to WHOs guideline were included. Outcome was reduction in SAM mortality measured by case fatality rate (CFR). The review was reported following the Grading of Recommendations Assessment Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and meta-analyses done using RevMan 5.3®.

RESULTS:

This review identified nine studies, which demonstrated reductions in SAM mortality. CFR ranged from 8 to 16% where WHO guideline applied. High rates of poverty, malnutrition, severe co-morbid condition, lack of resources and differences in treatment practices played a key role in large CFR variation. Most death occurred within 48 h of admission in Asia, between 4 days and 4 weeks in Africa and in Latin America. CFR was reduced by 41% (odds ratio: 0.59; 95% confidence interval: 0.46-0.76) when WHO guideline were applied. A 45% reduction in CFR was achieved after excluding human immunodeficiency virus positive cases. Dietary management also differed among WHO and conventional management.

CONCLUSION:

Children receiving SAM inpatient care as per WHO guideline have reduced CFR compared to conventional treatment.

© 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).