The impact of a short-term intervention using the WHO guidelines for the management of severe malnutrition at a rural facility in Angola

Objective To measure the impact of practice review and in-service supervision based on WHO guidelines on outcomes of severely malnourished children in a rural facility with minimal resources staffed only by nurses. Design Intervention (January to August 2006) with historical comparison of outcomes (January to August 2005). Setting Therapeutic feeding centre in rural Angola. Patients All children admitted to the feeding centre during the study period. Intervention Medecins Du Monde implemented an intervention that consisted of weekly physician supervision of staff activities and establishment of a study group composed of nurses in the centre. Main outcome measures Routine practices in the centre and measured indicators for outcomes of admitted children, which were compared to indicators before the intervention. Results During the intervention the authors observed improved delivery of important tasks such as frequent feeding and avoidance of intravenous rehydration. Among the 379 children admitted during the intervention, compared to the 358 children admitted previously, successful treatment increased from 73.2% to 82.6% (RR 1.13; 95% CI 1.04 to 1.22) and fatalities decreased from 15.6% to 8.7% (RR 0.56; 95% CI 0.37 to 0.83). Conclusion This short-term intervention with in-service supervision based on the WHO guidelines in a setting of limited resources apparently contributed to a reduction in fatality rates. These findings support the view that such guidelines can be effectively implemented in under-resourced facilities in Angola and similar settings if they are introduced using an interactive approach and if in-service supervision continues to be provided.