Management of severe malnutrition and diarrhea.

Children with severe malnutrition and diarrhea have high mortality rates that have been attributed to faulty case-management. Health workers are often unaware of the unique treatment requirements of severely malnourished children resulting in improper case-management. Moreover, the lack of prescriptive guidelines promotes the exercise of discretion in case-management that is often detrimental. Appropriate feeding from the start of treatment, routine micronutrient supplementation, broad-spectrum antibiotic therapy, less use of intravenous fluids for rehydration, and careful management of complications are factors that can reduce death, morbidity and cost of treating children with severe malnutrition and acute illnesses including diarrhea. In this paper is discussed a standardized protocol based upon the above mentioned factors for the management of severely malnourished children with acute illnesses including diarrhea. Implementation of the protocol resulted in a 47% reduction in mortality in these children.