Abstract
Objects: A hospital based descriptive study was carried out among under-5 children
suffering from severe protein-energy-malnutrition (PEM)
Methodology: This was a descriptive analytical study conducted during June 2002
to May 2003 in three purposively selected hospitals of Dhaka city, Bangladesh.
Results: Mean±SD age of the children was 15.1±10.9 months, majority being under
three years (91.5%), 47.2% were female, and 51% did not receive or complete
immunization according to their age. No significant age and sex difference was found
among the admitted children in different hospitals. Most of their parents were illiterate
(mothers 71%, fathers 56%) with low family income and social status. Marasmus
cases were 61%, followed by kwashiorkor 25% and marasmic kwashiorkor 14%. The
children were managed broadly according to standard protocol based on the guideline
of World Health Organization but adopted/modified by the individual hospitals. Overall
outcome of the patients were: recovery 62.4%, default 21.4%, death 13.7% and
transfer 2.6%. Mean duration of hospital stay was 14.2±9.9 (ranging from 0 to 59)
days. Recovery rate was better among male (67.3%) than female (56.8%) children,
p=0.033. Default rate was higher among female (27.3%) than male (16.1%) children,
p=0.007. Case fatality rate was highest (40%, p=0.001) in children suffering from
septicaemia.
Conclusion: Evidences of faulty case management practices viz. over use of
intravenous fluids and blood transfusion, inappropriate diets, less use of micronutrients,
incorrect antibiotics were observed occasionally in all the three hospitals. Updated
and comprehensive treatment guidelines need to be implemented, and every hospital
should review its own clinical management procedures and performance with a view
to improving practice.
Key words: Case management; protein-energy-malnutrition; severe acute malnutrition
under-five children