Standardized management reduces mortality among severely malnourished children with diarrhoea

Abstract

Objective: Reduce mortality and cost of treating severely malnourished children with diarrhoea by following a standardized management protocol. Methodology: The mortality rates and the cost of treatment were compared between severely malnourished children aged 0-5 years, who received standardized management (standardized group, SG) and conventional management (comparison group, CG). Key points of SG are the standardized use of rehydration fluids with emphasis on oral rehydration solutions (ORS), slower rehydration, appropriate feeding, routine micronutrient supplementation, antibiotics therapy, and proper management of complications. Conventional management included rehydration within 3-4 hours, giving antibiotics only if there were obvious features of infection, delay in feeding until rehydrated, and supplementing with micronutrients only when indicated. The SG included children admitted to one of the three clinical units from 1 January to 30 June 1997. Children admitted to the same clinical unit from 1 January to 30 June 1996 (before the protocol was implemented) constituted the CG. Odds ratios with 95% confidence intervals were calculated for outcome variables, like mortality rates. Results: Admission characteristics of children in the SG (n=334) and CG (n=293) were comparable except that more SG children had oedema, acidosis, and Vibrio cholerae isolated from stools. Sixty percent of the children in the SG were successfully rehydrated with ORS rather than intravenous fluids compared to 29% in the CG (p=0.00001). The use of expensive antibiotics was less in the SG (p=0.0001). The SG children had fewer episodes of hypoglycaemia (15 vs. 26, p=0.02). Costs of laboratory tests, intravenous fluids, and antibiotics were significantly less in the SG. Thirty children (9%) died in the SG, whereas 49 (17%) died in the CG (p=0.003; OR 0.49,95% CI 0.3-0.8). Conclusion: Standardized management resulted in a 47% reduction in mortality among the severely malnourished children with diarrhoea, fewer episodes of hypoglycaemia, and lesser use of intravenous fluids. The use of expensive antibiotics as well as the cost of laboratory tests and intravenous fluids were also minimized. The use of a standardized approach should be considered in the care of severely malnourished ill children