Adherence to treatment guidelines and Short-Term Outcomes of children under 5 years admitted with Severe Acute Malnutrition at a Nairobi County Hospital: A prospective cohort study
1
Paediatric and Child Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Severe acute malnutrition (SAM) is associated with increased risk of infections and higher mortality. Nutrition related factors contribute to almost half of deaths in children under five years old, with high mortality persisting despite the existence of guidelines. This study aimed to establish the level of adherence to the World Health Organization (WHO) guidelines and short-term outcomes of children from 6 months to 59 months admitted with Severe Acute Malnutrition at a Kenyan hospital.
METHODS:
In this prospective cohort study, 136 children admitted with Severe Acute Malnutrition were enrolled and followed up until discharge. Data were collected via an interviewer administered questionnaire and checklist for 10 steps of Severe Acute Malnutrition. Both descriptive and inferential statistics were used to assess short term outcomes and their association with guidelines adherence.
RESULTS:
The majority, 125 (91.9%) out of 136 children, were aged below 24 months. The most common comorbidities were pneumonia (73%) and acute gastroenteritis (72%). Adherence to SAM WHO guidelines was highest for treating infections step 5 (99.3%) and lowest for sensory stimulation step 9 at 5.9%. The mean duration of hospitalization was 10.28 days (SD = 3.81) and mortality rate was 14 (10.3%). Higher adherence was associated with shorter hospitalisation and lower mortality however there was no association with weight gain.
CONCLUSIONS:
Adherence to WHO inpatient SAM guidelines was suboptimal (mean score 6.78/10). Higher adherence (≥7 steps) was strongly associated with shorter hospital stay and lower in-hospital mortality; however, causality cannot be inferred from this observational study. Interventions to improve guidelines implementation and qualitative research to explore barriers are recommended.
Severe acute malnutrition (SAM) is associated with increased risk of infections and higher mortality. Nutrition related factors contribute to almost half of deaths in children under five years old, with high mortality persisting despite the existence of guidelines. This study aimed to establish the level of adherence to the World Health Organization (WHO) guidelines and short-term outcomes of children from 6 months to 59 months admitted with Severe Acute Malnutrition at a Kenyan hospital.
METHODS:
In this prospective cohort study, 136 children admitted with Severe Acute Malnutrition were enrolled and followed up until discharge. Data were collected via an interviewer administered questionnaire and checklist for 10 steps of Severe Acute Malnutrition. Both descriptive and inferential statistics were used to assess short term outcomes and their association with guidelines adherence.
RESULTS:
The majority, 125 (91.9%) out of 136 children, were aged below 24 months. The most common comorbidities were pneumonia (73%) and acute gastroenteritis (72%). Adherence to SAM WHO guidelines was highest for treating infections step 5 (99.3%) and lowest for sensory stimulation step 9 at 5.9%. The mean duration of hospitalization was 10.28 days (SD = 3.81) and mortality rate was 14 (10.3%). Higher adherence was associated with shorter hospitalisation and lower mortality however there was no association with weight gain.
CONCLUSIONS:
Adherence to WHO inpatient SAM guidelines was suboptimal (mean score 6.78/10). Higher adherence (≥7 steps) was strongly associated with shorter hospital stay and lower in-hospital mortality; however, causality cannot be inferred from this observational study. Interventions to improve guidelines implementation and qualitative research to explore barriers are recommended.
| eISSN: | 2654-1459 |
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