Malnutrition - treatment of underlying infections in children

Malnutrition occurs when there is a deficiency in intake of essential nutrients (i.e. proteins, carbohydrates, fats, vitamins and minerals). It is most commonly seen in children less than five years, particularly after weaning. Malnutrition reduces the individual’s ability to fight disease and infection thereby increasing the likelihood of the patient presenting with diarrhoea, vomiting, fever, worm infestation, pneumonia, tuberculosis, otitis media, urinary tract infection etc.

Investigations

FBC
Urea and electrolytes
Serum albumin
Urine culture and sensitivity
Blood culture and sensitivity
Chest X-ray
HIV testing
Gastric lavage for acid fast bacilli
Screen for common infections such as tuberculosis, pneumonia, urinary tract infections, etc. (See relevant sections)

TreatmentTreatment Objectives

To identify and treat associated infections and complications
To correct fluid and electrolyte imbalance and other complications
To correct the nutritional deficiency including Vitamin A
To prevent recurrence by educating caregivers
To adequately manage chronic illnesses

Pharmacological treatment of underlying infections - children

Inpatients

Evidence Rating: [B]

Cefuroxime, IV, 20 mg/kg 8 hourly for 48-72 hours

Then

Cefuroxime, oral,

3 months-12 years; 15 mg/kg 12 hourly for 5-7 days

Outpatients

Evidence Rating: [B]

Amoxicillin, oral,

5-18 years; 500 mg 8 hourly for 10 days

1-5 years; 250 mg 8 hourly for 10 days

1 month-1 year; 125 mg 8 hourly for 10 days

Immunisation (children)

(See section on ‘Immunisation’ and National Expanded Programme in the full Ghana STG.

Treatment of worm infestations

(See section on ‘Worm Infestations’)

Referral Criteria

Refer to appropriate specialist for management of the underlying cause. Also refer to Reproductive and Child Health (RCH) unit for family planning services and Social welfare department within the health facility, district or region.