Implementing WHO feeding guidelines for inpatient management of malnourished children.

OBJECTIVE To evaluate the efficacy of adopting WHO feeding guidelines on weight gain and case fatality rate in malnourished children. STUDY DESIGN Cross-sectional, observational study. PLACE AND DURATION OF STUDY Department of Pediatrics, Dow University of Health Sciences, Karachi, from 2009 to 2010. METHODOLOGY Patients above 6 months and less than 5 years of age with severe malnutrition were included during the study period, acute complications were treated and nutritional rehabilitation by WHO feeding formulae was done. Demographic details, clinical features, reasons for weight gain and risk factors of mortality were analyzed. RESULTS A total of 131 children were included. Mean age of children was 22 ± 18 months. There were 78% marasmic, 4% kwashiorkor and marasmic kwashiorkor 18% children. Resolution of edema took 8 ± 4 days, dermatosis cleared in 11 ± 3 days. Mean hospital stay was 10 ± 8 days. Case fatality rate was 13%. Mean weight gain was 5.25 ± 4.57 g/kg/day. Weight gain of > 5 gm/kg/day was associated with hospital stay of more than 7 days, acceptability and palatability of feed by the children and mothers and early clearance of infections. CONCLUSION Implementation of WHO feeding guidelines resulted in adequate weight gain of inpatient malnourished children, however, adequate healthcare services are available at the therapeutic feeding centers.