Submission ID 129639
| Issue/Objective | Issue/Objective: Severe acute malnutrition remains a leading cause of preventable under five mortality in Ethiopia. Despite the availability of national and WHO management guidelines, real world adherence in resource limited settings remains suboptimal and poorly characterized in Northern Ethiopia. This study aimed to assess compliance with national severe acute malnutrition management guidelines and identify critical gaps affecting treatment outcomes among hospitalized children. The work aligns with global priorities on improving quality of pediatric care and reducing preventable mortality. Methodology/Approach: A two year retrospective structured quality assessment was conducted at Ayder Comprehensive Specialized Hospital, a tertiary referral center in Northern Ethiopia. The study included children aged 6 to 59 months admitted with severe acute malnutrition. Guideline adherence was evaluated using a standardized checklist covering admission assessment, stabilization, monitoring, rehabilitation, and discharge practices. Data were analyzed to determine compliance rates and associated treatment outcomes. Results: Overall compliance with management guidelines was 64.6 percent. High adherence was observed in early stabilization components, including antibiotic administration and initiation of therapeutic feeding. However, major gaps were identified in continuity and quality of care. Adequate monitoring was documented in less than half of admissions, while complete multichart documentation was extremely low at 3.5 percent. Key rehabilitation practices were inconsistently implemented, including iron supplementation (54.1 percent) and deworming (26.1 percent). Poor treatment outcomes, including death, default, and non recovery, were observed in 22.1 percent of cases. Discussion/Conclusion: While initial stabilization practices were relatively strong, significant deficiencies in monitoring and rehabilitation phases compromise overall quality of care and patient outcomes. Strengthening adherence to guidelines through structured quality improvement initiatives, staff training, and standardized documentation tools is essential. Addressing these gaps has strong potential for scalable impact in similar low resource settings and contributes to global efforts to improve child survival and healthcare quality. Keywords: Severe acute malnutrition, quality of care, guideline adherence, inpatient management, Ethiopia |
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| Methodology/Approach | Methodology/Approach: This study was conducted at Ayder Comprehensive Specialized Hospital, a tertiary referral and teaching hospital in Mekelle, Northern Ethiopia, serving a large catchment population in Tigray and surrounding regions. A retrospective facility based quality assessment was employed to evaluate inpatient management of severe acute malnutrition among children aged 6 to 59 months. Medical records of eligible admissions were systematically reviewed using a structured and standardized checklist derived from national and World Health Organization guidelines. The assessment covered key domains including admission evaluation, stabilization, ongoing monitoring, nutritional rehabilitation, and discharge practices. Data collection spanned a two year period, allowing evaluation of consistency in care practices over time and identification of persistent gaps in guideline adherence. |
| Results | Overall compliance with severe acute malnutrition management guidelines was 64.6 percent. High adherence was observed in early stabilization measures, particularly routine antibiotic administration and timely initiation of therapeutic feeding. However, significant deficiencies were identified in subsequent phases of care. Adequate clinical and nutritional monitoring was documented in fewer than half of admissions, and complete multichart documentation was present in only 3.5 percent of cases, reflecting major gaps in continuity and quality of care. Key rehabilitation interventions were inconsistently implemented, with iron supplementation provided in 54.1 percent and deworming in 26.1 percent of eligible children. These gaps highlight missed opportunities for comprehensive recovery and relapse prevention. |
| Discussion/Conclusion | This study reveals a significant gap between guideline availability and consistent implementation in severe acute malnutrition care, particularly in monitoring and rehabilitation. Strengthening quality improvement systems, standardized documentation, and routine clinical audits is essential to improve outcomes. Policy efforts should focus on integrating quality indicators into national programs and reinforcing supportive supervision. Scalable strategies such as targeted staff training, simplified monitoring tools, and checklist based care can improve adherence in resource limited settings. Addressing these gaps aligns with the conference focus on improving quality and equity in healthcare and has strong potential to reduce preventable child mortality. |
| Presenters and Affiliations | Ezra Girmay Mekelle Universty, Ayder comprehensive specialized hospital Mohamedawel Ebrahim Mekelle Universty, Ayder comprehensive specialized hospital Nebeyat Teklehaymanot Arefaine Mekelle Universty, Ayder comprehensive specialized hospital Kibrom Weldemariam Mekelle Universty, Ayder comprehensive specialized hospital Kassahun Assefa Mekelle Universty, Ayder comprehensive specialized hospital Ezra Girmay Mekelle Universty, Ayder comprehensive specialized hospital Mengistu Tequare Mekelle Universty, Ayder comprehensive specialized hospital Abraha Gebreegziabher Mekelle Universty, Ayder comprehensive specialized hospital Hailemariam Gebrearegay Mekelle Universty, Ayder comprehensive specialized hospital Zeray Weldegebreal Mekelle Universty, Ayder comprehensive specialized hospital Haftu Hailu Mekelle Universty, Ayder comprehensive specialized hospital Afework Mulugeta Mekelle Universty, Ayder comprehensive specialized hospital Dirar Gebremedhin Mekelle Universty, Ayder comprehensive specialized hospital |
