Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol
Abstract
Background Severely malnourished children have high mortality rates. Death commonly occurs during the first 48 h after hospital admission, and has been attributed to faulty case-management. We developed a standardised protocol for acute-phase treatment of children with severe malnutrition and diarrhoea, with the aim of reducing mortality.Methods We compared severely malnourished children with diarrhoea aged 0-5 years managed by non-protocol conventional treatment, and those treated by our standardised protocol that included slow rehydration with an emphasis on oral rehydration. The standardised-protocol group included children admitted to the ICDDR,B Hospital, Dhaka between Jan 1, 1997, and June 30, 1997, while those admitted between Jan 1, 1996, and June 30, 1996, before the protocol was implemented, were the non-protocol group.Findings Characteristics on admission of children on standardised protocol (n=334) and non-protocol children (n=293) were similar except that more children on standardised protocol had oedema, acidosis, and Vibrio cholerae isolated from stools. 199 (59.9%) of children on standardised protocol were successfully rehydrated with oral rehydration solution, compared with 85 (29%) in the non-protocol group (p<0.0001). Use of expensive antibiotics was less frequent in children on standardised protocol than in the other group (p<0.0001). Children on standardised protocol had fewer episodes of hypoglycaemia than non-protocol children (15 vs 30, p=0.005). 49 (17%) of children on non-protocol treatment died, compared with 30 (9%) children on standardised protocol (odds ratio for mortality, 0.49, 95% CI 0.3-0.8, p=0.003).Interpretation Compared with non-protocol management, our standardised protocol resulted in fewer episodes of hypoglycaemia, less need for intravenous fluids, and a 47% reduction in mortality. This standardised protocol should be considered in all children with diarrhoea and severe malnutrition.
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The standardized SAM treatment protocol has reduced mortality.
“The result has been a reduction in mortality rate, although the extent to which this protocol results in long-term restoration of normal growth and development needs to be ascertained through longitudinal studies5,6.”
From Persistent gut microbiota immaturity in malnourished Bangladeshi children (2014) · cites this paper as [1]
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Persistent gut microbiota immaturity in malnourished Bangladeshi children
Subramanian, S., Huq, S., Yatsunenko, T., Haque, R., Mahfuz, M., Alam, M. A., Benezra, A., DeStefano, J., Meier, M. F., Muegge, B. D., et al. (2014) · Nature · doi:10.1038/nature13421 · Cited by 1,270 · see citing works
Self-citationEffects of microbiota-directed foods in gnotobiotic animals and undernourished children
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- Authors
- Ahmed, T., Ali, M., Ullah, M. M., Choudhury, I. A., Haque, M. E., Salam, M. A., Rabbani, G. H., Suskind, R. M., & Fuchs, G. J.
- Affiliations
- International Centre for Diarrhoeal Disease Research (BD)
- Louisiana State University (US)
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1999-06
- Volume
- 353
- Issue
- 9168
- Pages
- 1919-1922
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2051206108
- Cited by
- 288
- References
- 14
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 5 · 2023: 8 · 2022: 13 · 2021: 11 · 2020: 19 · 2019: 14 · 2018: 8 · 2017: 27 · 2016: 12 · 2015: 13 · 2014: 19 · 2013: 13 · 2012: 10
- FWCI
- 6.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- severe malnutrition, childhood diarrhea, child mortality, oral rehydration therapy, hypoglycemia, antibiotic use, edema, acidosis, Vibrio cholerae, case management
- MeSH terms
- Anti-Bacterial Agents, Bangladesh, Child, Preschool, Clinical Protocols, Combined Modality Therapy, Dehydration, Diarrhea, Diarrhea, Infantile, Diet Therapy, Drug Therapy, Combination, Fluid Therapy, Humans, Infant, Child Nutrition Disorders, Case-Control Studies, Treatment Outcome
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