Caring for Severely Malnourished Children
Full Review

Reviewed by: Meg Wirth, MPA, International Public Health Consultant, USA
Review posted 14 April 2005
Review No. 38

CD-ROM Information

Content: A practical, accessible set of training materials for educating nurses on clinical hospital-level management of severely malnourished children in developing countries.
Publication Date: 1 December 2003
Audience: Trainers (clinicians) and coordinators of training course for nurses on severe child malnutrition in the developing world.

Size: 158 MB
Price: £5 plus shipping (Book and CD-ROM)
Manual needed: No
How to order:

Order online.*

Order by mail:
Teaching-Aids At Low Cost (TALC)
PO Box 49
St Albans, Herts, AL1 5TX
United Kingdom

E-mail: info@talcuk.org
E-mail: e-talc@talcuk.org
Tel: +44 (0) 1727 853869
Fax: +44 (0) 1727 846852

e-TALC website.*

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Full Review

Teaching-Aids at Low Cost (TALC), in collaboration with the London School of Hygiene and Tropical Medicine has put together a concise, simple learning tool on the care of severely malnourished children in a hospital setting. The CD and book were inspired and supported by Professor David Morley. They were based on training modules developed in South Africa to improve treatment of severe malnutrition in hospitals. The authors note that when the materials have been used to train staff, treatment practices have improved and hospital deaths reduced by 50% or more. The materials are relevant for training staff in other countries.

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Users

The materials contained in this CD-ROM are largely for clinical trainers and workshop coordinators planning a workshop for hospital workers on how to treat severe malnutrition. The target audience of the training is those who have daily responsibility for the care of severely malnourished children in a hospital setting (e.g. nurses including pediatric sisters, matrons, dieticians, and nutritionists). It is certainly possible that an individual clinician could use the materials for self-directed learning purposes as well, particularly the first document on the CD-ROM, which is a book on caring for severely malnourished children.

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Content

Caring for Severely Malnourished Children

This entire book is included in the CD-ROM. The book was developed by Ann Ashworth and Ann Burgess in response to requests from the field for a simpler more accessible version of the WHO Guidelines on Management of Severe Malnutrition: A Manual for Physicians and other Senior Health Workers (1999). The target audience of this alternative book is nurses. Although the book is based on training modules developed in South Africa (see below) the authors note that the content is relevant elsewhere. In addition to the well-explained ten-step clinical protocol outlined in chapters, the book includes appendices on equipment and supplies, recipes, feeding charts, and checklists. 

Improving the Management of Severe Malnutrition: A Guide for Trainers

This guide provides a step-by-step set of directions for holding a 5-day workshop to train hospital providers to reduce deaths due to severe malnutrition. This workshop is meant to be an alternative to the 6-day WHO workshop on the same topic. However, this workshop is specifically tailored to nurses, less dependent on reading, and need not take place in a clinical setting. The guide includes the clinical information and protocols outlining the 10 steps for proper care for the severely malnourished child. In addition, the guide includes careful notes on preparing for and executing a successful workshop on this subject. For example, guidelines are given for pre-workshop activities: assessing the baseline hospital data on child mortality and interviewing hospital staff on current practices. Practical materials for post-workshop activities are also included: protocol to be posted in hospital wards, and action plans for each hospital.

3.   Slide set on the Treatment of Severely Malnourished Children

The slide set gives the basic principles of inpatient care of severely malnourished children. The expert section provides guidelines for the inpatient medical and dietary treatment of severely malnourished children. Photos of children with the symptoms of kwashiorkor, marasmus and marasmic kwashiorkor, the three forms of severe malnutrition, are accompanied by a detailed text on the clinical symptoms and treatment for each (to be read by the trainer). In the text notes for the trainer, there are specific instructions on how to use the slide set for teaching purposes, including questions and answers to engage the trainees. The TALC Slide Set is available in Powerpoint format while the text for the trainer is available in pdf format.

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User Friendliness

The CD-ROM is extremely user friendly, with a clear table of contents. Each document is downloadable chapter by chapter. Although explanations of each document are fairly thorough, it may be worth noting which documents are specifically for trainers (the second two) and which might be amenable to self-study by an individual clinician (the first document).

When the CD-ROM is first inserted, a screen asks whether the user is a first-time user. When this button is clicked, a screen advises that the CD-ROM is best used with a web browser, PowerPoint viewer or adobe acrobat reader, each of which is available for downloading off this same CD-ROM.

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Navigability

The CD-ROM is readily navigable, with links to the internet.

Interactive Facilities

The CD-ROM contains only readings and is not interactive.

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Distribution

An inquiry to TALC received a quick reply that the CD-ROM costs £5.00 plus postage. It would be useful to note this price directly on the CD-ROM as well as information on all the points from which the CD-ROM could be ordered. While TALC has wide distribution of CD-ROMS, in some 200 countries, their online store does not include reference to this CD-ROM. Similarly, a search of the website does not yield reference to this CD-ROM. Although this publication is mentioned on the fantaproject.org* website, links to the TALC website again do not yield access to the publication.

N.B. TALC has remedied this problem and the title is listed in the online store.* [Ed. 12 May 2005]

Given the immense need for capacity-building of human resources in the developing world, this CD-ROM would certainly be worthy of a much more active dissemination strategy, with information on the strategy on the TALC website, the AED and USAID websites and active promotion with Ministries of Health.

It would be worthwhile for TALC to include more information on their mission and reach on this CD-ROM as they are a non-profit with goals and products that would likely interest the users of this CD-ROM. The majority of TALC’s work is focused on the production and supply of low cost books, which includes many essential texts on tropical medicine, nursing, surgery, HIV/AIDS, child-to-child teaching books and infectious diseases.

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Sustainability

The CD-ROM does include a list of websites containing information and/or references on the management of severe malnutrition that will help to keep readers current on new developments in the field. However, as the Integrated Management of Childhood Illness and other initiatives develop and evolve, standards and protocols may change. Thus it would be useful to have explicit instructions in the CD-ROM on where to check for such changes (perhaps even the TALC website) so that training materials remain current.

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