Table 3

 Implementation of WHO guidelines*

10 Routine treatment stepsSipetuMary Theresa
* C = carer interviews; O, observations; R, record reviews;
Data from the medical records (R) refer to day 1 unless specified.
Day 3 data are reported only if different from day 1.
Treat/prevent hypoglycaemia (prioritise for immediate admission; feed every 3 h day and night; start straightaway)
    Mean time in outpatient department before admission (C+R) (hours)4.93.9
    % fed within 1 h of admission (R)5251
    % of 3-hourly feeds given (R)9572
    % where intake was correctly totalled on day 2 (R)5662
Treat/prevent hypothermia (keep warm and dry day and night; feed frequently)
    % of children with blankets (C)9465
    % of occasions when room temperature was 25°C or higher (O)7497
Treat/prevent dehydration (rehydrate more slowly than usual; do not give intravenous fluids except in shock; monitor closely for signs of overhydration)
    % given intravenous fluids on days 1–3 (R)5.56.3
    % of those given intravenous fluid where volume was recorded (R)0 (n = 8)0 (n = 3)
    % diagnosed as severely dehydrated who were recorded as given intravenous/oral fluids (R)50 (n = 12)100 (n = 3)
Correct electrolyte imbalance (give extra K and Mg; limit Na; never treat oedema with diuretics)
    % given potassium (R)5665
    % with correct potassium dose (R)2123
    % given magnesium (R)8150
    % wrongly given a diuretic for oedema on days 1–3 (R)0.70
Treat infection (give broad-spectrum antibiotics to all: start straightaway)
    % given antibiotic(s) (R)8894
    % given WHO suggested antibiotics (R)4858
    % of observations when antibiotics were given on time (O)3335
Correct micronutrient deficiencies (give high-dose vitamin A on day 1; give Zn, Cu, folic acid and multivitamins daily. Do not give Fe at first)
    % given vitamin A (R)8648
    % with correct vitamin A dose (R)4441
    % given multivitamins (R)7480
    % given folic acid (R)8357
    % given zinc and copper (R)5230
    % with iron correctly withheld in initial phase (R)98100
    % given iron in catch-up phase (R)921
Feed cautiously initially (give small amounts of starter formula (F-75) every 3 h day and night)
    % given starter formula (F-75) (R)6991
    % prescribed correct feeding volume on day 1 (R)8246
    % prescribed correct feeding volume on day 3 (R)6537
    % of reluctant feeders who were encouraged to eat (O)7767
    Mean number of days on starter formula (R)3.82.6
Rebuild wasted tissues (catch-up growth) (when appetite returns, make a gradual transition to catch-up formula (F-100); give unlimited amounts; also give enriched family foods if aged >6 m)
    % moved to catch-up formula (F-100) at appropriate time (R)3032
    % given catch-up formula (F-100) (R)96100
    % prescribed correct feeding volume on transition day 1 (R)8436
    % prescribed correct feeding volume on transition day 2 (R)5317
    % prescribed correct feeding volume on transition day 3 (R)05
    % fed until full (O)3423
    % of feedings with oil separating out (O)9769
    % of children aged >6 months given modified family foods (R)36100
Provide stimulation, play and loving care (give loving care, play and stimulation to improve mental development)
    % of observations with developmental play sessions (O)00
    % of observations with general play observed (O)2421
    % of contacts when nurses were gentle, caring and loving (O)4750
    % of observations with toys noted in/around beds (O)218
    Mean duration of nurse-child contacts during 4 h observation (O) (min)4.27.7
Prepare for follow-up after discharge (teach carers how to continue feeding and care at home; follow up each child regularly to check progress)
    % of daytime observations with health education discussions (O)354
    % who received a referral letter on discharge (C)7857