Micronutrient supplementation practices in relation to the World Health Organisation 2013 guidelines on management of severe acute malnutrition.

In 2013, the World Health Organisation (WHO) updated the recommendations for micronutrient deficiency correction in hospitalised under‐5 children with complicated severe acute malnutrition (SAM). This study aimed to describe the micronutrient deficiency correction practices in relation to WHO 2013 recommendations. Data from medical records of under‐5 children admitted for SAM management at two hospitals in South Africa and three tertiary hospitals in Ghana were extracted. Micronutrient correction practices were compared to the WHO 2013 recommendations by considering the dosage, timing of micronutrient supplementation (vitamin A, iron and folic acid) and therapeutic feeds administered. In total, 723 medical records were included. Nearly half (48.3%) of the children received at least one of the studied micronutrients as a supplement. Vitamin A was supplemented in 27.4% of the children, while iron and folic acid were supplemented in 9.5% and 34.9%, respectively. Among the children who received vitamin A, 60.1% received the first dose on Day 1 of admission. Also, 46.4% of the iron‐supplemented children received iron within the first week of admission. Vitamin A, iron and folic acid were administered within the dose range of 100,000–180,000 IU, 3.1–7.7 mg per kg per day, and 3–5 mg per day, respectively. Additionally, 71.7% of the children reportedly received therapeutic feeds that met WHO recommendations. The micronutrient deficiency correction practices regarding dose and timing differed from the 2013 WHO guidelines. Qualitative studies investigating the reasons for the disparities are recommended. Key messages: Vitamin A supplementation practice among infants and children under 5 years of age hospitalised with complicated severe acute malnutrition (SAM) was not fully based on the World Health Organisation (WHO) 2013 recommendations in some hospitals in Ghana and South Africa. High doses of vitamin A were given irrespective of the therapeutic feeds administered and the presence of deficiency signs.Iron and folic acid supplementation did not follow WHO guidelines for the treatment of complicated SAM in under‐5 children.Higher doses than recommended for both micronutrients were observed. Iron supplementation started in the initial phase of treatment (first week of admission). [ABSTRACT FROM AUTHOR]