Why Do Some Hospitals achieve better care of severely malnourished children

Thandi Puoane, Katie Cuming, David Sanders, and Ann Ashworth

Despite training and support aimed at implementing the WHO case-management guidelines for SAM, some hospitals reduced their case-fatality rates by at least half, whereas others did not.

Pouane and colleagues found that staff in the successful hospitals were more attentive and assiduous than staff in the poorly performing hospitals, especially in relation to rehydration procedures, feeding and the recording of vital signs. There was a strong emphasis on in-service training and induction of incoming staff in the successful hospitals and better supervision of junior staff and carers. Nurses had more positive attitudes towards malnourished children and their carers, and were less judgmental. Underlying factors were differences in leadership, teamwork, and managerial supervision and support.

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