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ORIGINAL ARTICLES
Open Access

Scaling Up Improved Inpatient Treatment of Severe Malnutrition: Key Factors and Experiences From South Africa, Bolivia, Malawi, and Ghana

Shuaib Kauchali, Thandi Puoane, Ana Maria Aguilar, Sylvester Kathumba, Alice Nkoroi, Reginald Annan, Sunhea Choi, Alan Jackson and Ann Ashworth
Global Health: Science and Practice April 2022, 10(2):e2100411; https://doi.org/10.9745/GHSP-D-21-00411
Shuaib Kauchali
aNelson Mandela University, University Way, Summerstrand, Gqeberha, South Africa.
bNational Department of Health, Pretoria, South Africa.
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Thandi Puoane
cSchool of Public Health, University of the Western Cape, Bellville, South Africa.
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Ana Maria Aguilar
dInstituto de Investigación en Salud y Desarrollo, Universidad Mayor de San Andrés, La Paz, Bolivia.
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Sylvester Kathumba
eMinistry of Health, Lilongwe, Malawi.
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Alice Nkoroi
fFood and Nutrition Technical Assistance Project (FANTA)/FHI360, Washington, DC, USA.
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Reginald Annan
gDepartment of Biochemistry and Biotechnology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Sunhea Choi
hHuman Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
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Alan Jackson
hHuman Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
iInternational Malnutrition Task Force of the International Union of Nutritional Sciences, London, United Kingdom.
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Ann Ashworth
iInternational Malnutrition Task Force of the International Union of Nutritional Sciences, London, United Kingdom.
jDepartment of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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  • For correspondence: ann.hill@lshtm.ac.uk
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Key Findings

  • We report our “how-to” approaches and lessons learned from scaling up implementation of the World Health Organization (WHO) guidelines on inpatient treatment of severe acute malnutrition within routine health services in 4 countries.

  • Substantial improvements in survival were evident within a few months of guideline implementation, but it took many years to improve treatment practices at scale.

  • We show that the WHO guidelines are scalable to a national level, and their effectiveness in improving survival appears to be retained at scale. Key features for success include collaborations to build capacity and undertake operational research and advocacy for guideline adoption; specialist teams to mentor and build confidence and competency through supportive supervision; and political commitment and administrative policies for sustainability.

Key Implications

  • Policy makers, health professionals, and their national societies should bring together all the talent available and establish alliances such as communities of practice to implement and scale up WHO malnutrition treatment guidelines and use new opportunities such as eLearning to build workforce capacity.

  • Health educators should review medical and nursing curricula and re-align pre-service training so that it is fit-for-purpose and competency-based for effective practice.

ABSTRACT

Severe acute malnutrition (SAM) can have high mortality, especially in very ill children treated in the hospital. Many medical and nursing schools do not adequately, if at all, teach how to manage children with SAM. There is a dearth of experienced practitioners and trainers to serve as exemplars of good practice or participate in capacity development. We consider 4 country studies of scaling up implementation of WHO guidelines for improving the inpatient management of SAM within under-resourced public sector health services in South Africa, Bolivia, Malawi, and Ghana. Drawing on implementation reports, qualitative and quantitative data from our research, prospective and retrospective data collection, self-reflection, and our shared experiences, we review our capacity-building approaches for improving quality of care, implementation effectiveness, and lessons learned. These country studies provide important evidence that improved inpatient management of SAM is scalable in routine health services and scalability is achievable within different contexts and health systems. Effectiveness in reducing inpatient SAM deaths appears to be retained at scale.

The country studies show evidence of impact on mortality early in the implementation and scaling-up process. However, it took many years to build workforce capacity, establish monitoring and mentoring procedures, and institutionalize the guidelines within health systems. Key features for success included collaborations to build capacity and undertake operational research and advocacy for guideline adoption; specialist teams to mentor and build confidence and competency through supportive supervision; and political commitment and administrative policies for sustainability. For frontline staff to be confident in their ability to deliver appropriate care competently, an enabling environment and supportive policies and processes are needed at all levels of the health system.

  • Received: September 12, 2021.
  • Accepted: February 2, 2022.
  • Published: April 28, 2022.
  • © Kauchali et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-21-00411

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Global Health: Science and Practice: 10 (2)
Global Health: Science and Practice
Vol. 10, No. 2
April 28, 2022
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Scaling Up Improved Inpatient Treatment of Severe Malnutrition: Key Factors and Experiences From South Africa, Bolivia, Malawi, and Ghana
Shuaib Kauchali, Thandi Puoane, Ana Maria Aguilar, Sylvester Kathumba, Alice Nkoroi, Reginald Annan, Sunhea Choi, Alan Jackson, Ann Ashworth
Global Health: Science and Practice Apr 2022, 10 (2) e2100411; DOI: 10.9745/GHSP-D-21-00411

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Scaling Up Improved Inpatient Treatment of Severe Malnutrition: Key Factors and Experiences From South Africa, Bolivia, Malawi, and Ghana
Shuaib Kauchali, Thandi Puoane, Ana Maria Aguilar, Sylvester Kathumba, Alice Nkoroi, Reginald Annan, Sunhea Choi, Alan Jackson, Ann Ashworth
Global Health: Science and Practice Apr 2022, 10 (2) e2100411; DOI: 10.9745/GHSP-D-21-00411
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  • Article
    • ABSTRACT
    • INTRODUCTION
    • SOUTH AFRICA COUNTRY STUDY
    • BOLIVIA COUNTRY STUDY
    • MALAWI COUNTRY STUDY
    • GHANA COUNTRY STUDY
    • CURRENT CHALLENGES IN LMICS
    • DISCUSSION
    • CONCLUSION
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