Diagnostic Performance of Visible Severe Wasting for Identifying Severe Acute Malnutrition in Children Admitted to Hospital in Kenya/Resultats Diagnostiques De L'emaciation Severe et Visible Dans L'identification De la Malnutrition Aigue Severe Chez Des Enfants Hospitalises Au Kenya/Desempeno Diagnostico De la Emaciacion Grave Visible Para Identificar la Malnutricion Aguda Grave En Ninos Ingresados En Hospitales De Kenia

Introduction Complicated severe acute malnutrition is a life-threatening condition requiring urgent, specialized treatment. The World Health Organization (WHO) defines severe acute malnutrition as a mid-upper arm circumference (MUAC) Few studies have examined the performance of visible severe wasting in identifying children with severe acute malnutrition. Bern et al. observed that visible severe wasting identified a group of children with a very high short-term mortality risk and that it was as strongly associated with mortality as a low WHZ (i.e. below -3 by National Center for Health Statistics growth reference standards). (7) The sensitivity of visible severe wasting for detecting children with severe wasting diagnosed anthropometrically in a practical setting was 56% when assessed by Gambian nurses and 67% when assessed by Ethiopian health workers immediately following training. (6,8) The aim of this study is to evaluate the diagnostic value of visible severe wasting for diagnosing severe acute malnutrition, as defined by MUAC and WHZ using WHO growth reference standards, in children admitted to one rural and one urban public hospital in Kenya. Methods Location The study was conducted at two hospitals on the Kenyan coast that were chosen to reflect urban and rural settings. Coast Provincial General Hospital in Mombasa is the largest provincial public hospital in Kenya, with 113 paediatric beds. The hospital, together with three smaller district hospitals, serves approximately 1 million people living in the urban and periurban areas of greater Mombasa, which includes several informal settlements, (9) and it also receives provincial referrals. Inpatient care is provided by medical officers, and by medical officer and clinical officer interns under the supervision of two consultant paediatricians. Kilifi District Hospital, located in a rural area about 60 km north of Mombasa, has 89 paediatric beds or cots. The hospital serves about 240 000 people, mainly farmers. A Kenya Medical Research Institute (KEMRI) centre and the KEMRI/Wellcome Trust Research Programme, which are based at this hospital, conduct research on severe childhood illness and malnutrition. (10,11) Full-time research clinicians provide inpatient paediatric medical care, including care in a high-dependency unit. The long-term presence of the research programme at Kilifi District Hospital ensures the availability of additional resources, including a comprehensive microbiology laboratory, the capability to measure blood gases and other biochemical parameters, increased medical and nursing staff, and support for making available essential drugs and other clinical supplies. Both hospitals used the treatment approach recommended in current WHO guidelines, including standardized antimicrobials, fluids, electrolytes, micronutrients and therapeutic feeding. …