In the Solomon Islands, the survival odds for children with severe acute malnutrition have dramatically improved. Mortality rates have fallen from nearly 30 percent in 2017 to 9 percent by 2024—a change driven not just by better treatment, but also better information. 

Before 2016, the Solomon Islands lacked a standardized and functional system for medical cause-of-death reporting. Multiple death notification forms were used, and death notification was handled by nurses, with minimal involvement from doctors. At the largest hospital, the National Referral Hospital (NRH) in Honiara, multiple admissions for the same child were often recorded as separate cases, and causes of death were inconsistently documented—typically noting only the final event, not the underlying illness.

A turning point came when the NRH began using tools such as the international medical certificate of cause of death (MCCD) to help better understand why children were dying. With support from the Bloomberg Philanthropies’ Data for Health Initiative, these efforts helped reveal that malnutrition was being overlooked as a primary cause of death.

“Until we had the systems in place and the training for the MCCD, we were just reporting them [deaths] as numbers,” said Dr. Titus Nasi, head of pediatrics at NRH. “Kids with malnutrition can come in with other issues ... they might come in with pneumonia, and we thought, oh, that’s pneumonia. But pneumonia was the common cause of admission, but not the common cause of death. The MCCD helped us see that.”
 

Finding the True Causes

Once the NRH introduced the right tools, the pediatric team could investigate deaths in a systematic way. Beginning in 2016, the hospital adopted pediatric hospital registration (PHR) software, provided by the Centre for International Child Health, part of the University of Melbourne’s Department of Pediatrics and the Royal Children’s Hospital. The PHR software functions as a specialized case-tracking tool, allowing staff to link multiple hospital admissions for the same patient, even without a national patient identification system. This created a continuous medical history for each child, enabling the team to review care from the community level, through local clinics, to the hospital. It also helped the team begin seeing patterns in the hospital deaths.

In 2017, MCCD training was introduced. Globally known as the gold standard, MCCD provides accurate data essential for public health planning and policy. The MCCD training was initiated at the NRH and was later extended to other hospitals in the Solomon Islands.  

Weekly death audits also brought together doctors, nurses and trainees to review each case and agree on the final cause of death before it was entered into the official MCCD. The pediatric team now reviews deaths, confirms causes using the MCCD standard and submits this data to both hospital medical records and the Ministry of Health and Medical Services.

“With these tools and the MCCD coming on board we began clearly identifying the immediate cause of deaths and contributory factors. It really worked together for us,” Dr. Nasi explained.

Turning Data into Action: Treatment

That data showed that severe acute malnutrition was a major killer, yet treatment for it had previously relied on improvised formulas like diluted milk with added sugar and oil. Starting in 2017, the hospital, supported by UNICEF, the World Health Organization (WHO) and the Ministry of Health, began implementing UNICEF and WHO guidelines for the treatment of severe acute malnutrition. This included the High-Impact Nutrition Interventions (HINI) training package, which gives health workers practical skills in child nutrition, along with milk formula feed support. The hospital introduced therapeutic products such as ReSoMal (an oral rehydration solution formulated for malnourished children), F-75 and F-100 therapeutic milks and ready-to-use therapeutic food (RUTF). These items have since been incorporated into the Solomon Islands Essential Medicines list, ensuring sustained availability and alignment with international standards.

The Ministry of Health also helped build a nutrition kitchen at NRH, which demonstrates proper preparation of therapeutic foods for both staff and caregivers. Nurses and doctors from provincial hospitals and clinics are now trained to diagnose and manage malnutrition locally, reducing costly and dangerous delays from referrals.

“After having the guidelines and getting the training, we realized maybe the formulas we [previously] were using were not the treatment,” Dr. Nasi recalled. “Until we got the right formulas and the proper training, we weren’t seeing improvement. Now mortality for severe acute malnutrition cases is less than 10%.”

Lessons for the Future

The MCCD approach has helped change how the country thinks about health data. “The MCCD helped all of us to think about the causes of death, and what are the reasons for that … it also helped communicate better with provincial hospitals, and getting down to the community level,” Dr. Nasi said. “It helped us improve our referral system and plan better for resources.”

Dr. Nasi has been a champion for improved data. “I’ve had a real interest to make sure it works … from the MCCD, now we know where we are in terms of clinical care and can address the underlying causes.”

The work is not over: electronic health records, national patient identifiers and further community outreach remain on the horizon. But in the Solomon Islands, the link between accurate data and saved lives is now proven.

Key Takeaways

• In the Solomon Islands, child mortality from severe acute malnutrition has dropped from nearly 30 percent to 9 percent in less than a decade.
• Before 2016, paper records and inconsistent documentation meant underlying causes of death were often missed.
• Pediatric hospital registration (PHR) software now links multiple hospital admissions and helps reveal patterns of deaths.
• The international medical certificate of cause of death (MCCD) and weekly death audits transformed how the pediatric team identified, learned from and prevented deaths.
• Identifying malnutrition as a hidden cause of death led to the adoption of UNICEF and WHO-recommended treatments, staff training and a dedicated nutrition kitchen.
• The new system improved care for malnourished children and strengthened communication between the national referral hospital, provincial facilities and communities.
   

Photos: Juan Arredondo