Results of the new WHO therapeutic protocol in the management of severe malnutrition in Syria

ABSTRACT

To test the applicability of the new WHO therapeutic protocol in the management of severe malnutrition in childhood in Syria. Methods and Materials There were 21 children, 12 males and 9 females, suffering from marasmus [16 cases] and marasmic kwashiorkor [5 cases] hospitalized in the Pediatrics Department of Damascus Hospital from January 1, 2001 to September 1, 2001. The new protocol was applied to all of the children included in the study. The children were reevaluated at the end of the treatment period to determine weight, symptoms, infectious status, electrolyte and protein status. The results were compared with the results of the old protocol by comparison with a retrospective study of 21 children hospitalized in 1997-1998. The patients ranged from 40 days to 36 months in age. The weights ranged from 2000-8000 grams. Symptoms were present as follows diarrhea [71.42%], fever [61.9%], irritability [38%], vomiting [52.4%], cough [42.9%], dyspnea [19.4%], edema [present in all marasmic kwashiorkor cases], and dermal hyperpigmentation in 2 cases. There were 2 cases of pneumonia. There were no cases of meningitis. Blood cultures and urine cultures were negative. The potassium was low in one case of marasmus. The sodium was low in two cases of marasmus. Hypoproteinemia was noted in 28.5%. Hypoalbuminemia was noted in 23.8%. Total hospitalization duration was 9.29 days compared with 12.6 days using the old protocol. The average weight gain during hospitalization was 30.41% in the marasmus cases compared with 3.41% using the old protocol. The weight gain in the marasmic kwashiorkor patients was 4.14%. All of the patients were improved at the end of hospitalization with the exception of 2 cases that were discharged before the end of the protocol against medical advice as requested by the parents. There were no deaths with the new protocol whereas 38% died with the old protocol. Patients were symptom free and all electrolyte abnormalities and infections had disappeared by the end of treatment. This study demonstrates the applicability and efficacy of the new protocol. We recommend that it be used in all Syrian centers in the treatment of severe malnutrition cases