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Table 2 Characteristics of studies reporting case fatality for inpatient treatment of SAM according to WHO protocol

From: Treatment of severe and moderate acute malnutrition in low- and middle-income settings: a systematic review, meta-analysis and Delphi process

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%
  1. WHO: World Health Organization
  2. UNICEF: United Nations Children’s Fund
  3. HIV: Human immunodeficiency virus
  4. cRCT: Cluster randomized controlled trial
  5. WFH: weight-for-height
  6. WFA: weight-for-age
  7. ORS: oral rehydration solution
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