ABSTRACT

Background

Severe acute malnutrition (SAM) is common in low-income countries and is associated with high mortality in young children.

Objective

To improve recognition and management of SAM in a tertiary hospital in Malawi.

Methods

The impact of multifaceted quality improvement interventions in process measures pertaining to the identification and management of SAM was assessed. Interventions included focused training for clinical staff, reporting process measures to staff, and mobile phone-based group messaging for enhanced communication. This initiative focused on children aged 6–36 months admitted to Kamuzu Central Hospital in Malawi from September 2019 to March 2020. Before-after comparisons were made with baseline data from the year before, and process measures within this intervention period which included three plan-do-study-act (PDSA) cycles were compared.

Results

During the intervention period, 418 children had SAM and in-hospital mortality was 10.8%, which was not significantly different from the baseline period. Compared with the baseline period, there was significant improvement in the documentation of full anthropometrics on admission, blood glucose test within 24 hours of admission and HIV testing results by discharge. During the intervention period, amidst increasing patient census with each PDSA cycle, three process measures were maintained (documentation of full anthropometrics, determination of nutritional status and HIV testing results), and there was significant improvement in blood glucose documentation.

Conclusion

Significant improvement in key quality measures represents early progress towards the larger goal of improving patient outcomes, most notably mortality, in children admitted with SAM.

中文翻译：

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在马拉维的一家三级转诊医院提高对复杂性严重急性营养不良儿童的识别和管理：一项质量改进举措

摘要

背景

严重急性营养不良 (SAM) 在低收入国家很常见，并且与幼儿的高死亡率有关。

客观的

提高马拉维一家三级医院对SAM的识别和管理。

方法

评估了多方面质量改进干预措施对与识别和管理 SAM 相关的过程措施的影响。干预措施包括针对临床工作人员的重点培训、向工作人员报告流程措施以及基于手机的群发消息以加强沟通。该倡议的重点是 2019 年 9 月至 2020 年 3 月在马拉维卡穆祖中央医院收治的 6-36 个月的儿童。与前一年的基线数据进行了前后比较，并在此干预期内处理措施，包括三个计划-比较了做-学习-行动（PDSA）周期。

结果

干预期间，418名儿童出现SAM，住院死亡率为10.8%，与基线期无显着差异。与基线期相比，入院时的完整人体测量记录、入院后 24 小时内的血糖检测和出院时的 HIV 检测结果有显着改善。在干预期间，随着每个 PDSA 周期的患者人口普查增加，维持了三个过程措施（完整的人体测量记录、营养状况的确定和 HIV 检测结果），并且在血糖记录方面有显着改善。

结论

关键质量指标的显着改善代表了朝着改善 SAM 入院儿童患者预后这一更大目标的早期进展，尤其是死亡率。