Puoane, T., et al. (2004). Improving hospital management of malnourished children by participatory research. INT. JOURNAL FOR QUALITY IN HEALTH CARE, 16 (1): 31-40

Objective: To improve the clinical management of severely malnourished children in rural hospitals in South Africa. Study design: A preand post-intervention descriptive study in three stages: assessment of the clinical management of severely malnourished children, planning and implementing an action plan to improve quality of care, and monitoring and evaluating targeted activities. A participatory approach was used to involve district and hospital nutrition teams in all stages of the research. Setting: Two rural first-referral level hospitals (Mary Theresa and Sipetu) in Mount Frere District, Eastern Cape Province. Main measures. A retrospective record review of all admissions for severe malnutrition to obtain patient characteristics and case fatality rates, a detailed review of randomly selected cases to illustrate general case management, structured observations in the paediatric wards to assess adequacy of resources for care of malnourished children, and in-depth interviews and focus group discussions with nursing and medical staff to identify barriers to improved