Inpatient management of children with severe acute malnutrition: a review of WHO guidelines

statements, the 1999 guidelines and the revisions of 2003 and 2013 constitutes the current WHO severe acute malnutrition guidelines and underpins WHO's related training material. lthough weak health systems and the inadequate implementation of guidelines undoubtedly contribute to the high number of preventable deaths attributed to complicated severe acute malnutrition, 14 this condition causes high case fatality even in relatively well resourced centres that report full implementation of the WHO guidelines. This review attempts to identify evidence gaps within the guidelines on inpatient management of severe acute malnutrition that, if filled, may help reduce mortality below the levels that can be accomplished solely by adherence to existing guidelines. We reviewed each individual recommendation contained within current WHO guidelines -including those relating to the post-discharge Objective To understand how the World Health Organization's (WHO's) guidelines on the inpatient care of children with complicated severe acute malnutrition may be strengthened to improve outcomes. Methods In December 2015, we searched Google scholar and WHO's website for WHO recommendations on severe acute malnutrition management and evaluated the history and cited evidence behind these recommendations. We systematically searched WHO International Clinical Trials Registry Platform, clinicaltrials.gov and the Controlled Trials metaRegister until 10 August 2015 for recently completed, ongoing, or pending trials. Findings WHO's guidelines provide 33 recommendations on the topic. However, 16 (48.5%) of these recommendations were based solely on expert opinion -unsupported by published evidence. Another 11 (33.3%) of the recommendations were supported by the results of directly relevant research -i.e. either randomized trials (8) or observational studies (3). The other six recommendations (18.2%) were based on studies that were not conducted among children with complicated severe malnutrition or studies of treatment that were not identical to the recommended intervention. Trials registries included 20 studies related to the topic, including nine trials of alternative feeding regimens.