Since 1994 official policy has been to develop an Integrated Nutrition Programme (INP). A national demonstration project for the implementation of the INP was started in 1998 in Mt Frere, Eastern Cape. This comprehensive nutrition project is a collaboration between the Eastern Cape health department, the Health Systems Trust (HST) Initiative for Sub-district Support (ISDS) and the University of the Western Cape's Public Health Programme.
This Kwik-Swiz reports on the process and programme that was undertaken by a district nutrition team, including the paediatric staff in a very under-resourced rural health district to implement one component of the INP, the WHO 10 Steps for improved care of severely malnourished children.
A process of team building has included bringing together doctors, nurses, hospital management, kitchen and pharmacy staff within the hospitals to improve in-patient management of these children.
Despite dramatic improvement in general medical technology, the mortality rate among children admitted to hospital has hardly changed in the past 50 years. Mortality rates of 20-50% are still seen in the 1990s.1 Yet centres who follow the WHO ten steps have rates below 10%. By following the WHO Ten steps, the INP programme hopes to demonstrate a dramatic reduction in the death rate due to severe malnutrition (marasmus and kwashiorkor).
This programme emphasises the importance of taking the child's fragile physiological state into account when prescribing treatment. This means feeding frequently day and night, starting with small amounts, and giving ALL children antibiotics, as infections are often hidden and undetectable. Gentle handling is advised to reduce stress, and mothers and other caregivers are encouraged to be actively involved. |
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