Impact of the new WHO growth standards on management of severe acute malnutrition
Dear colleagues
We are still discussing the impact of the new WHO growth standards on management of malnutrition. This was the question we received
"We have now changed over from the old NCHS growth reference standards to the new WHO growth standards. On the malnutrition ward we have noticed that this means that more children are admitted for inpatient care. The problem is that we don't have space to treat more children. We are already overcrowded. What shall we do?"
Send us your comments or share your experiences on this issue.
Thank you for the opportunity to get involved with this discussions on the WHO Child Growth Standards. The new standards reflect reality. We are now able to get almost all the children who need intervention. What needs to be done is to take advantage of the RUTF for the management of malnutrition. This product can be used at home without hospitalization. This way hospitals will not be congested. Only very severe cases will need to be hospitalized.
Comment by Anna Lartey — 2009-03-18 04:55 | # - re
I agree perfectly with you Dr Assumpta Muriithi regarding the fact that with the new standards, malnourished children are identified earlier. I also agree that the CTC aspect of management should be strengthened so that the pressure on the in-patient facility would be lessened. Of course, the hospital-based management has always been inadequate to meet the demands even before the new standards were introduced.
But don't you think that there is a genuine concern regarding increasing numbers of children that require in-patient management even if the CTC model is developed? Also, is it possible that the problem of overcrowding is being experienced in even more facilities as well since this was also experienced in Kenya?
It is essential for more people to contribute and share their experiences as this would give us the full picture and provide a better way forward.
Let us keep discussing.
Comment by reggie — 2009-03-06 13:43 | # - re
Yes it is true that the new WHO Growth Standards picks up more children which is good because you now get them before they are too far gone. To get round the problem of over admission into inpatient care, there is a need to develop the CTC model of management of severe malnutrition which has both out-patient and in-patient management. In CTC, those with good appetite can be managed as out patients and be assessed daily until they are on the recovery phase there the visits to the facility can be reduced. The in-patient care is reserved for those who have severe complications and those who cannot feed due to whatever reason. Please we should note that management of these children, both OTP and In-patient, requires a team: a clinician and nutritionist/dietician, hence each time the child should be reviewed by both.
Comment by Assumpta Muriithi — 2009-03-06 06:21 | # - re