Scaling Up Improved Inpatient Treatment of Severe Malnutrition: Key Factors and Experiences From South Africa, Bolivia, Malawi, and Ghana


Severe acute malnutrition (SAM) can have high mortality, especially in very ill children treated in the hospital. Many medical and nursing schools do not adequately, if at all, teach how to manage children with SAM. There is a dearth of experienced practitioners and trainers to serve as exemplars of good practice or participate in capacity development.

We consider 4 country studies of scaling up implementation of WHO guidelines for improving the inpatient management of SAM within underresourced public sector health services in South Africa, Bolivia, Malawi, and Ghana.

We show that the WHO guidelines are scalable to a national level, and their effectiveness in improving survival appears to be retained at scale. Key features for success include collaborations to build capacity and undertake operational research and advocacy for guideline adoption; specialist teams to mentor and build confidence and competency through supportive supervision; and political commitment and administrative policies for sustainability.

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