Nutrition researchers at the Centre of Excellence for Nutrition (CEN) of the North-West University (NWU) are doing important research on the treatment effects of severe acute malnutrition in Sub-Sahara Africa. Their findings will be used by the World Health Organization (WHO).

According to the United Nations Children’s Fund (UNICEF), 17 million children from developing countries, especially Africa and Asia, are affected by severe acute malnutrition (SAM) and approximately 3,8 million are infants of six months and younger. SAM claimed the lives of 400 000 children in 2013. In African countries one in every 12 children die from malnutrition.

The research team of the Severe Acute Malnutrition in African Children (SAMAC) unit at CEN is developing a large, comparative international database representing different African countries via a multi-country, multi-hospital retrospective case-control study. The primary outcome is to assess mortality rates, length of stay in hospital and relapse back into in-patient care, as well as to determine the factors that influence these.

Their aim is to evaluate and compare different practices in the treatment of SAM, the different SAM protocols and the WHO’s recommendations on admission criteria and treatment protocols of conditions related to SAM.

Dr Tani Lombard from the CEN says the WHO developed a list of updated recommendations for the treatment of children with SAM in 2013, but the update called for further research on the treatment of SAM. The reason is that the majority of treatment guidelines, although regarded as strong recommendations, are based on low or very low-quality evidence.

Strong team gathers sound evidence

Dr Lombard is part of a formidable research team formed in 2015 to provide the WHO with a sizeable database for future treatment protocol research. The team consists of herself, two other dietitians at the NWU – Dr Robin Dolman and Cornelia Conradie, Dr Cristian Ricci, a biostatistician at CEN, and Prof Etienne Nel, a paediatrician of the University of Stellenbosch.

Their objectives are to compare international, national, provincial and hospital practices for the admission, discharge and in-hospital management of SAM, as well as to compare treatment protocols for hypoglycaemia, hypothermia, therapeutic feeding approaches, hydration treatment and prescription of medication. The study will include infants and children from birth to 59 months.

“We plan a sample size of between 10 000 and 15 000 medical records of children in more than 10 African countries and hope to complete the study within five years,” Dr Lombard says.

“We started in Ghana with the cooperation of the government and universities and currently have nine postgraduate students from Lesotho, South Africa, Botswana, Ghana and Kenya to help with the capturing of data from the different countries.”

New data from collaborating countries will be pooled and a large dataset will be created. “This dataset can then be used for sub-studies and further research based on healthcare systems in the different countries, as well as social and welfare conditions,” says Dr Lombard.

“The study will give the WHO properly researched evidence on how to adjust their guidelines in the treatment of SAM.

“Many of the deaths of children can be prevented if they received the proper treatment.”