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Sally Mugabe Children’s Hospital: A snapshot

This is a summary of a Field Exchange field article that was included in issue 67. The original article was authored by Svitlana Austin, Molifia Manyasha-Kuona, Elizabeth Ngarivhume and David Musorowegomo.  

Svitlana Austin is the Paediatrician in charge of the Malnutrition Unit (MU) at the Sally Mugabe Children’s Hospital (SMCH).

Molifia Manyasha-Kuona is a Dietitian at SMCH.

Elizabeth Ngarivhume is a Senior House Officer at the MU, SMCH.

David Musorowegomo is a Paediatrician at SMCH.

Wasting carries a significant health burden in Zimbabwe. At the Sally Mugabe Children’s Hospital (SMCH), increased cases of complicated severe wasting, and associated high mortality, led to its development into a Centre of Excellence for wasting management.

  • A specialist multidisciplinary inpatient service was established with strong links to outpatient care which has reduced mortality and improved outcomes
  • The SMCH Malnutrition Unit (MU) is now a centre for targeted teaching. and research in childhood wasting and, once finalised and approved by the Ministry of Health and Child Care, its standard operating procedures will be nationally distributed to streamline inpatient care.
  • Continued efforts are being made to improve the quality of care for wasted patients and further reduce deaths, particularly for high-risk patients such as those with cerebral palsy.

Background

Zimbabwe faces a significant burden of child wasting, reaching a prevalence of 4.5% in 2020. At the Sally Mugabe Children’s Hospital (SMCH), the average monthly cases of complicated severe wasting increased from 34 to 86 per month between 2019 and 2020 and inpatient mortality reached 45.7%. This article describes the SMCH’s experience in becoming a National Centre of Excellence for wasting management and the progress made towards improved quality of care.

Wasting services at the SMCH

Role of the Paediatric Association of Zimbabwe (PAZ)

The PAZ is a group of paediatricians and other health professionals who have worked with UNICEF and the Ministry of Health and Child Care (MoHCC) to support capacity building and mentorship in wasting management across Zimbabwe. The first phase of the collaboration focused on capacity building in health facilities, training doctors, nurses and nutritionists in the integrated management of acute malnutrition (IMAM) and developing online IMAM training videos, providing clinical mentorship and supporting clinical audits.

Phase 2 of the collaboration aimed to scale up and implement a sustainable, quality of care improvement intervention for children presenting to inpatient care with complicated severe wasting. Project activities were planned over a nine-month period towards the following objectives:

Patient flow and staffing

Prior to the MU’s inception, care for patients with severe wasting was provided as a part of general paediatric services at the SMCH. There was no prioritisation of children with complicated severe wasting and these patients were often refused admission to the intensive care unit in favour of children perceived as having a ‘better chance of survival’. Patients were also not triaged according to the severity of malnutrition. The following changes have been made to address these issues:

Data collection and audit

The paucity of data on inpatients managed for wasting was one of the major challenges when the MU was established. Within the first quarter of the PAZ/UNICEF collaboration, a data collection system was set up in electronic and paper formats. The MU is the first facility in the country to conduct routine formal audits of paediatric deaths. The intention is to nationally disseminate this practice following MoHCC approval.

Key outcomes 

Successes and challenges

Conclusion

The SMCH’s MU has achieved a significant reduction in mortality since its inception. While improvements are ongoing, this model can and should be replicated in other SCs across Zimbabwe. A key starting point would be identifying malnutrition champions such as doctors, nurses and nutritionists who are passionate about improving outcomes for wasted children admitted to their facilities. Their efforts should be supported by SOPs developed at the SMCH MU to standardise care for this vulnerable group of patients.

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Svitlana Austin, Molifia Manyasha-Kuona, Elizabeth Ngarivhume and David Musorowegomo (). Sally Mugabe Children’s Hospital: A snapshot. FEX 67 Digest, May 2022. www.ennonline.net/fexdigest/67/sallymugabehospital

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