Adherence to Treatment Guidelines and Short-Term Outcomes of Children Under Five Years Admitted with Severe Acute Malnutrition at Mama Lucy Kibaki Hospital, Nairobi County, Kenya

Abstract

Background: Severe Acute Malnutrition (SAM) is associated with an increased risk of infections and high mortality. Nutrition-related factors contribute to nearly half of deaths among children under five years, with high mortality persisting despite the existence of guidelines. This study was conducted to assess adherence to the World Health Organization (WHO) treatment guidelines and to determine short-term outcomes among children under five years admitted to Mama Lucy Kibaki Hospital, a level five Kenyan hospital.
Method: This was a prospective cohort study conducted at Mama Lucy Kibaki Hospital between 28 October and 31 January 2025. A total of 136 children aged 6-59 months admitted with SAM were consecutively enrolled and followed up until discharge. Data were collected via an interviewer-administered questionnaire and checklist covering the 10 WHO steps. Each WHO guideline step was scored dichotomously (1=complete assessment and recommended management; 0=otherwise). Good adherence was defined a priori as a total score of ≥7 of 10 steps and complete adherence as fulfilment of all 10 steps. Descriptive statistics, logistic regression, Poisson regression and Kaplan-Meier survival analysis were used to describe short-term outcomes and their association with guideline adherence.
Results: The majority, 125 (91.9%) out of 136 children, were aged below 24 months. The most common comorbidities were pneumonia 99 (73%) and acute gastroenteritis 98 (72%). Adherence to SAM WHO guidelines were highest for treating infections step 5 (99.3%) and lowest for sensory stimulation step 9 at 5.9%. The median duration of hospitalisation was 10 days (IQR 8-13) and in-hospital mortality was 10.3% (14). Only 78 (57.4%) achieved good adherence (≥7 steps). Good adherence was associated with lower mortality (P<.001) and shorter hospital stays (median 9 vs 11 days, P<.001), but not with weight gain (P =.257). Each additional step adhered to was associated with shorter length of stay (adjusted IRR 0.91, 95% CI: 0.88–0.94) and lower odds of death (adjusted OR 0.29, 95% CI: 0.15–0.47, P<.001).
Conclusion: Adherence to the WHO SAM guidelines for the inpatient management of SAM was suboptimal and good adherence was significantly associated with improved survival and shorter hospitalisation. Strengthening implementation of these guidelines may improve clinical outcomes among children with SAM.