Table 2 Characteristics of studies reporting case fatality for inpatient treatment of SAM according to WHO protocol
Study | Country | Study Design | Intervention | Variance from WHO protocol and study design issues | CFR for inpatient group |
|---|---|---|---|---|---|
Bachou 2008 | Uganda | Before and after | Improved practice to reduce unnecessary blood transfusions and IV infusions was in accordance with the WHO guidelines | Micronutrients and parenteral antibiotics given in accordance with Ministry of Health recommendations; measles vaccine and sensory stimulation not mentioned | 25% |
Berti 2008 | Ethiopia | Retrospective cohort | Treated according to adapted UNICEF (2004) guidelines | Not clear if micronutrient supplementation aligns with WHO protocol; sensory stimulation not mentioned | 7% |
Chinkhumba 2008, Fergusson 2009 | Malawi | Prospective cohort | Nutritional rehabilitation in accordance with Malawi Ministry of Health guidelines (2003), adapted from WHO guidelines (2003) | HIV-infected children not given ART; unclear approach to rehydration, provision of micronutrients, antibiotics and sensory stimulation; children with severe complications not included | HIV-infected: 35% HIV-uninfected: 10% |
Hossain 2009 | Bangladesh | Quasi-experimental | Treated according to WHO protocol | Protocol not described | 7% |
Manary 2000 | Malawi | Prospective cohort | Treated according to 1971 WHO standards | Children fed at slower rate; did not use ReSoMal ORS; included an additional intensive nursing component; measles vaccination not mentioned | 25% |
Maitland 2006 | Kenya | Retrospective cohort | Treated according to WHO guidelines insofar as staffing allowed | Fed at a higher rate initially; authors state that WHO protocol used but not described in detail. | 19% |
Ahmed 1999 | Bangladesh | Prospective cohort | Adapted WHO criteria | Children fed at slower rate; all children had diarrhea; acute malnutrition assessed using either WFH or WFA | 9% |
Khanum 1994 and 1998 | Bangladesh | cRCT | Protocol not described | High risk of bias with respect to randomization; carers often requested to change groups | 3.40% |
Ashworth 2004 | South Africa | Prospective cohort | Managed according to WHO guidelines insofar as staffing permitted | Age range of children not given; unclear if all children have SAM as defined by WHO | 24% |