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Re: Challenges to in-patient treatment of malnutrition

Dear Editor,

Jackson and colleagues (1) raise important points regarding the global prevention and treatment of malnutrition and the challenges to successful implementation of WHO guidelines.

We have recently started to treat children with severe malnutrition according to these guidelines in our hospital. As mentioned, high caseloads are a constraint to quality care; in the malarial season, our ward of up to 100 patients may be staffed by only one or two trained nurses. Although mothers are keen to be involved in care, finding adequate time to train and supervise them is, at times, impossible.

Children admitted for the treatment of severe malnutrition remain on the ward for significantly longer than children admitted for other medical reasons. This lengthier stay, in addition to impaired immune function puts them at added risk of infections. We have experienced patients and their carers becoming sick with malaria or gastroenteritis which they have contracted during their hospital stay. It is essential that hospitals providing treatment for severe malnutrition pay meticulous attention to infection control measures; adequate facilities for hand washing and cleaning of utensils, general ward hygiene, insecticide treatment of bed nets and hospital wards. Problems with shortages of soap, reliable running water and regular re-treatment and repair of bed nets have previously resulted in an unacceptably hazardous environment for this vulnerable group of patients in our hospital.

As commented in the article, caring for children with less severe malnutrition in the community would reduce both the workload and overcrowding, with consequent infection spread in hospital facilities. However a lack of staff, vehicles and money for fuel present obstacles to reliable outreach for supervision of these cases.

With close attention to ensuring a safe environment for our in- patients, we are now starting to see encouraging results. Staff confidence in managing these challenging cases is slowly improving but it will take sustained interest and effort from the hospital management to ensure we continue to provide safe, appropriate care for these children.

S Rylance

Songea Regional Hospital
Songea
Tanzania

sarahrylance@doctors.net.uk

I declare I have no competing interests

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