Stool frequency in Severe Acute Malnutrition

INTERVENTION: 1. Intervention group: conventional disposable diapers will be put on children and will be checked and changed every two hours by healthcare professionals. Mothers can also request to get the diapers changed within the 2 hours if there was a stool episode. 2. Control group: no intervention CONDITION: Severe acute malnutrition in children ; Nutritional, Metabolic, Endocrine ; Malnutrition PRIMARY OUTCOME: 1. Observed stool frequency; 2. Stool consistency measured with the help of the Bristol stool chart and the Amsterdam paediatric stool chart (watery/loose/normal/bloody); ; In the diaper group, diapers will be checked every two hours over a time period of 3 days. The day starts at 8.00 AM, from then on diapers will be checked at 10.00, 12.00, 14.00, 16.00 and 18.00. During the night (between 18.00 and 8.00), the night nurses are instructed to change the diapers whenever necessary (i.e., when there was an episode of stool) and collect those diapers in a bucket. In the control group, mothers are asked every morning during ward rounds (at around 10.00) about the stool episodes during the previous day with the help of a picture chart ('from sunrise to sunset = yesterday', 'from sunset to sunrise = last night', 'since sunrise'). SECONDARY OUTCOME: The mother's opinion on the preferred stool assessment method (disposable diapers or no diapers). This will be assessed after completion of the study, i.e. on the morning after day 3. We are using a scale from 1‐5 (1 = strongly prefer diapers, 5 = strongly prefer verbal recall method). INCLUSION CRITERIA: All children admitted to the Nutritional Rehabilitation Unit of the Queen Elisabeth Central Hospital in Blantyre, Malawi (MOYO) aged 6‐40 months who meet the WHO and Malawi National Guidelines criteria for severe acute malnutrition (SAM) will be eligible to participate in this study: 1. Marasmus = weight‐for‐height less than or equal to ‐3 Z‐scores (WHO growth standards) OR a mid‐upper‐arm circumference of <11.5 cm 2. Kwashiorkor = nutritionally induced bilateral pitting edema