Guidelines for selective feeding programs in emergency situations

Objectives: To describe the characteristics and short-term outcomes of children with malnutrition admitted to Dili National Hospital (DNH), East Timor. Methods: A prospective observational survey using caretaker interviews and medical record review was conducted on the paediatric ward at DNH for 12 months from March 2002. Patients were children aged 2 months to 12 years, admitted with moderate to severe malnutrition as either a primary or secondary diagnosis. Results: Malnutrition was present in 31.8% (280/880) of paediatric admissions during the study period. Sixty-one per cent of the malnutrition cases were severe malnutrition (weight-for-height below -3 Z-scores and/or oedema) and 53.7% were both wasted and stunted. The hospital case-fatality rate was 12.9% (36/280). Immunization coverage was low, with 39% of cases never immunized and 29% incompletely immunized according to the national immunization schedule. Conclusions: There is a high rate of malnutrition among paediatric inpatients at DNH, consistent with results of anthropometric surveys in the newly independent East Timor. Despite the introduction of a standardized protocol following WHO guidelines and associated training on the management of severe malnutrition, the hospital case-fatality rate for severe malnutrition was still high (12.9%).