Revista Panamericana de Salud Pública
On-line version ISSN 1680-5348
Print version ISSN 1020-4989
SCHOFIELD, C. and ASHWORTH, A.. Why have mortality rates for severe malnutrition remained so high?. Rev Panam Salud Publica [online]. 1997, vol.1, n.4, pp.295-300. ISSN 1680-5348. http://dx.doi.org/10.1590/S1020-49891997000400006.
A review of the literature that has appeared over the past five decades indicates that the median case fatality from severe malnutrition has remained unchanged over this period and is typically 20-30%, with the highest levels (50-60%) being among those with edematous malnutrition. A likely cause of this continuing high mortality is faulty case-management. A survey of treatment centres worldwide (n = 79) showed that for acutely ill children, inappropriate diets that are high in protein, energy and sodium and low in micronutrients are commonplace. Practices that could have fatal consequences, such as prescribing diuretics for edema, were found to be widespread. Evidence of outmoded and conflicting teaching manuals also emerged. Since low mortality levels from malnutrition can be achieved using appropriate treatment regimens, updated treatment guidelines, which are practical and prescriptive rather than descriptive, need to be implemented as part of a comprehensive training programme.