Hospital case-fatality rates for severe malnutrition in the developing world remain high, particularly in Africa where they have not changed much over recent decades. In an effort to improve case management, WHO has developed treatment guidelines. The aim of this review is to critically appraise the evidence for the guidelines and review important recent advances in the management of severe malnutrition. We conclude that not only is the evidence base deficient, but also the external generalisability of even good-quality studies is seriously compromised by the great variability in clinical practice between regions and types of health facilities in the developing world, which is much greater than between developed countries. The diagnosis of severe wasting is complicated by the dramatic change in reference standards (from CDC/WHO 1978 to CDC 2000 in EpiNut) and also by difficulties in accurate measurement of length. Although following treatment guidelines has resulted in improved outcomes, there is evidence against the statement that case-fatality rates (particularly in African hospitals) can be reduced below 5% and that higher rates are proof of poor practice, because there is wide variation in severity of illness factors. The practice of prolonged hospital treatment of severe malnutrition until wasting and/or oedema has resolved is being replaced by shorter hospital stays combined with outpatient or community follow-up because of advances in dietary management outside of hospital.

译文

发展中国家严重营养不良的医院病死率仍然很高,特别是在非洲,近几十年来变化不大。为了改善病例管理,世卫组织制定了治疗指南。本次审查的目的是严格评估指南的证据,并审查严重营养不良管理方面的重要最新进展。我们得出的结论是,不仅证据基础不足,而且甚至高质量研究的外部可推广性也受到发展中国家区域和卫生设施类型之间临床实践差异的严重损害,这远远大于发达国家之间的差异。严重消瘦的诊断因参考标准的急剧变化 (从CDC/WHO 1978到EpiNut的CDC 2000) 以及精确测量长度的困难而变得复杂。尽管遵循治疗指南的结果有所改善,但有证据表明,病死率 (尤其是在非洲医院) 可以降低到5% 以下,而较高的病死率证明实践不佳,因为疾病的严重程度差异很大。因素。由于医院外饮食管理的进步,长期住院治疗严重营养不良直至消瘦和/或水肿解决的做法被较短的住院时间结合门诊或社区随访所取代。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录