Simplifying the WHO Guidelines for Managing Severe Malnutrition
ANN ASHWORTH Emeritus Professor of Community Nutrition
This editorial was on the paper by Hossain and colleagues regarding the effectiveness of treatment of severe malnutrition with locally adapted ICMH protocol using locally available foods.
These were the reasons for refuting the claims as detailed in the full report
- Firstly, it was not clear if the children in the two groups were comparable at admission. For example, no comparative anthropometric or morbidity data were reported
- Secondly, the sample size was too small to detect an increased risk of mortality with any confidence, and this was indicated by Hossain and colleagues.
- Thirdly, although the ICMH protocol provides an energy intake from F-100 of 100kcal/kg/day in keeping with the WHO target for the initial phase, the protein and lactose intakes are 2.5 times higher. High lactose at admission may cause or exacerbate diarrhea, and high protein intake stresses the liver and kidneys and may increase the risk of death in children with a compromised metabolic state.
Prof Ann Ashworth concluded that the study by Hossain et al was not robust enough to warrant the claims that their approach was as efficacious as the WHO protocol.
Download full editorial here