New protocol for malnutrition management to save lives

Improved measures to tackle acute malnutrition in Mozambique are expected to save the lives of thousands of children and adults. During a five-day workshop supported by the UN Children's Fund (UNICEF) last week, about 100 health workers in the capital, Maputo, adopted a protocol outlining step-by-step guidelines for the management of acute malnutrition in children. The protocol has been implemented in Angola, Burundi and Ethiopia and is credited with directly reducing child mortality rates. In 2003 UNICEF estimated that around 5 percent of children from birth to five years were suffering from severe malnutrition, while chronic malnutrition in the same age group had reached 41 percent. Workshop facilitator and international nutrition expert Michael Golden told PlusNews that "mistakes" were often made when treating malnourished children. "A child who is suffering from kwashiorkor cannot handle the same type of rehydration treatment as a well-nourished child. Inappropriate rehydration could lead to a fluid overflow, cardiac arrest and death." Golden explained that previous remedies, which had recommended a high-protein diet to tackle the nutritional disease, had led to death in some cases. "When the protein in the diet of a child being treated for kwashiorkor was reduced to moderate or low levels, mortality was halved," he noted. The new protocol was expected to have a significant impact in Mozambique, where health authorities have forecast rising mortality rates from severe malnutrition as the number of HIV cases continues to increase unabated. An estimated 14.9 percent of the population aged 15 to 49 is living with the HI virus. "We found that if you treat HIV positive patients for severe malnutrition, they respond extremely well under the new protocol: they have the same weight gain and the same rate of recovery as the malnourished HIV negative person," Golden said. He also noted that "adaptations will have to be made to cope with the large numbers of HIV patients. Home treatment will have to be worked out and should be freely available." Mozambique is expected to formally adopt the country-specific version of the protocol by March 2005.