The Identification and Management of Refeeding Syndrome in Inpatient Severely Acutely Malnourished Children Aged 6 to 59 Months in Sub-Saharan African Countries: A Systematic Review and Meta-Analysis

Background: Refeeding syndrome is a potentially fatal complication that occurs in inpatient, severely acutely malnourished children during the early phase of nutritional management. Its early identification and management are critical to preventing adverse outcomes. Addressing refeeding syndrome in inpatient settings is critical in Sub-Saharan Africa, where severe acute malnutrition is common and under-researched. Objective: To systematically review and meta-analyse current evidence on the identification and management of refeeding syndrome in hospitalised severely malnourished children (6 to 59 months) in Sub-Saharan Africa. Methods: A comprehensive search was conducted across academic databases such as PubMed and the Cochrane Library, from 2010 to 2024. Articles reporting on the identification and management of refeeding syndrome in inpatient children with severe acute malnutrition in Sub-Saharan Africa were included. Data extractions were performed by two reviewers using Rayyan software. A meta-analysis of proportions was conducted using STATA 19. Results: Nine studies were included. The identification and management of refeeding syndrome were impacted by the lack of a standardised definition. Significant heterogeneity (Q = 27.17, p < 0.001) was observed, indicating a significant variation in the prevalence rates ranging from 8.7% to 34.8%. Management strategies varied; most studies adhered to World Health Organisation guidelines for severe acute malnutrition but lacked specific protocols for refeeding syndrome. Conclusions: Evidence highlights the need for standardised, evidence-based and context-specific protocols for refeeding syndrome in children with severe acute malnutrition. Early screening, electrolyte monitoring, and cautious feeding remain important, although current evidence is of low certainty. Future prospective studies are needed to develop effective management strategies.