Introduction: Severe acute malnutrition (SAM) is a public health concern, due to the high mortality rates observed in children with this condition. The correct classification of children with SAM remains a challenge. Children with SAM usually present at primary healthcare (PHC) with other illness and will only be classified and managed for SAM through the correct measurement, plotting and interpretation of anthropometric data. Children identified with SAM should be referred to the hospital and admitted for further management to reduce case fatality rates. The management of SAM at PHC and hospitals plays a unique role in child survival.
Aim: The aim of the study was to evaluate the classification and the management of SAM in children aged 6–59 months by professional nurses in PHC facilities in the Johannesburg (JHB) health district.
Methods: This was an observational study with a cross-sectional, retrospective descriptive study design. Quantitative data collection methods were used to review clinic records of children in the JHB district.
Results: Records of 83 children were selected from 35 clinics. Only 81 (98%) of the children had their weight taken, 27 (33%) had height and only 20 (24%) of children had mid-upper arm circumference (MUAC) measurements taken. Only 12 (14%) patients had a record of oedema, 58 (66%) patients had no oedema noted while in 16 (19%) patients there were no entries recorded for either the presence or absence of oedema. Nurses assessed 51 (61%) of children for feeding, of which 18 (23%) were still breastfeeding, 49 (61%) were on formula milk and 26 (34%) of the children were recorded as receiving solid food. Only 12 (14%) of the children were correctly identified with SAM.
Conclusion: The study concludes that overall classification and management for children with SAM in JHB district clinics was poor and often did not adhere to the Integrated Management of Childhood Illnesses (IMCI) guidelines. The practices of professional nurses in this district point to a poor recognition of the need for accurate assessment and monitoring in order to reduce the risk of death in children with SAM.