Factors Associated with Nurses’ Adherence to WHO’s Guidelines for Managing Severe Acute Malnutrition: A Cross-Sectional Study in Northern Ghana

Abstract

Introduction

Severe acute malnutrition (SAM) contributes to approximately 400,000 child deaths annually worldwide, with sub-Saharan Africa bearing 70% of the global burden (Kellerhals, S. 2017). Despite evidence-based WHO guidelines for SAM management, poor adherence among healthcare providers, particularly nurses who provide direct patient care, remains a critical implementation challenge (Vaismoradi, M., Tella, S., A. Logan, P., Khakurel, J., & Vizcaya-Moreno, F., 2020). This study assessed nurses’ adherence to World Health Organization (WHO) guidelines for managing severe acute malnutrition (SAM) at Tamale Teaching Hospital in Ghana.

Methods

We conducted a cross-sectional study among 83 nurses providing paediatric care at Tamale Teaching Hospital, Northern Ghana’s largest referral hospital (Saani, A. M. 2021). Data were collected using a validated questionnaire assessing knowledge of SAM protocols and self-reported adherence to the ten essential WHO management steps. Results were presented through frequency tables, bar charts, and statistical tests, including Pearson’s and Fisher’s exact Chi-square, T-test, and analysis of variance.

Results

Among participants, 91.6% (95% CI: 84.2-96.3%) provided direct SAM patient care, yet only 28.9% (95% CI: 19.8-39.4%) had received formal SAM management training. Knowledge assessment revealed that 59.0% of nurses scored ≥60% (adequate knowledge) while only 16.9% achieved ≥80% (good knowledge) on the standardized knowledge scale. Overall adherence was poor, with only 41.0% of nurses implementing ≥70% of the ten essential WHO protocol steps correctly. Nurses with SAM training were significantly more likely to adhere to the guidelines (χ2 =16.17, P<0.0001), as were those who frequently used the protocol (χ2=18.44, P<0.0001).

Conclusion

Poor guideline adherence highlights the urgent need for structured in-service training programs and system-level interventions to improve SAM management quality in resource-limited settings.