Abstract
Objective
To evaluate the feasibility and outcome of home-based rehabilitation of severely malnourished children.
Design
Prospective and observational.
Setting
Rehabilitation at home (16 weeks) following initial assessment or/and stabilization at hospital.
Participants
Thirty-four severely malnourished (weight for length <70% of WHO reference) children between the ages of 6 months to 5 years.
Intervention
Initial assessment of the patient was done in hospital. Those with complications or loss of appetite were admitted in hospital and managed as per WHO guidelines. After discharge, they were managed at home using home based diets. Those without complications and with preserved appetite were directly eligible for home-based rehabilitation. Follow up was done in hospital up to 16 weeks. Dietary intake, anthropometry and morbidities were recorded during follow-up.
Results
Of the enrolled 34 children, 19 children were admitted in hospital and 15 children were sent home after initial assessment in hospital. Five did not clear the initial stabilization phase (2 died, 3 left hospital). Finally 29 children qualified for home based rehabilitation out of which 26 completed 16 week follow-up. During the home based management phase, the reported mean (±SD) calorie intake increased from 100 (±5) kcal/kg/d at entry point to 243 (±13) kcal/kg/d at 16 weeks (P=0.000). Similarly, reported protein intake increased from 1.1 (±0.3) g/kg/d to 4.8 (±0.3) g/kg/d (P=0.000). During hospital stay (n=19), children had weight gain of 9.0 (±5.3) g/kg/d, while during home based follow up (n=29), weight gain was 3.2 (±1.5) g/kg/d only. During home based rehabilitation, only 3 (11.5%) children had weight gain of more than 5 g/kg/d by the end of 16 weeks. Weight for height percent increased from an average (±SD) of 62.9% (±6.0%) to 80.3% (±5.7%) after the completion of 16 weeks (P=0.000). Thirteen (45%) children recovered completely from malnutrition achieving a weight for length of >80% whereas 15 (51.7%) recovered partly achieving weight for length >70%. There was no death during the home stabilization.
Conclusion
Home based management using home prepared food and hospital based follow up is associated with sub-optimal and slower recovery.
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References
Ashworth A, Khanum S, Jackson A, Schofield C. Guidelines for the Inpatient Treatment of Severely Malnourished Children. Geneva: World Health Organization; 2003.
Bhatnagar S, Lodha R, Choudhary P, Sachdev HPS, Shah N, Narayan S, et al. IAP Guidelines 2006 on Hospital based Management of Severely Malnourished Children (adapted from WHO guidelines). Indian Pediatr 2007;44:443–461.
Gabouland V, Dan-Bouzoua N, Brasher G, Fedida G, Gergonne B, Brown V. Could nutritional rehabilitation at home complement or replace centre-based therapeutic feeding programmes for severe malnutrition? J Trop Pediatr 2007;53:49–51.
Ashraf H, Ahmed T, Hossain MI, Alam NH, Mahmud R, Kamal SM, et al. Day-care management of children with severe malnutrition in an urban health clinic in Dhaka, Bangladesh. J Trop Pediatr 2007;53:171–178.
Orach C, Kolsteren P. Outpatient care of severely malnourished children. Lancet 2002;360:1800–1801.
Ashworth A, Khanum S. Cost effective treatment of severely malnourished children: what is best approach? Health Policy Plan 1997;12:115–121.
Khanum S, Ashworth A, Hulty SR. Controlled trial of three approaches to the treatment of severe malnutrition. Lancet 1994;344:1728–1732.
Bredow M, Jackson A. Community-based, effective, low cost approach to the treatment of severe malnutrition in rural Jamaica. Arch Dis Child 1994;71:297–303.
Community-Based Management Of Severe Acute Malnutrition: A Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund. World Health Organization; 2007.
de Onis M, Garza C, Onyango AW, Martorell R. WHO Child Growth Standards. Acta Paediatr 2006;95(Suppl 450):1–104.
Mishra D, Singh HP. Kuppuswamy’s socioeconomic status scale: A revision. Indian J Pediatr 2003;70:273–274.
Physical Status: The Use and Interpretation of Anthropometry-Report of a WHO Expert Committee. WHO Technical Report Series; 854. Geneva: World Health Organization; 1995.
Gupta P, Shah D, Sachdev HPS, Kapil U. National Workshop on Development of Guidelines for Effective Home Based Care and Treatment of Children Suffering from Severe Acute Malnutrition. Indian Pediatr 2006;43:131–139.
Ferguson EL, Briend A, Darmon N. Can optimal combinations of local foods achieve the nutrient density of the F 100 catch-up diet for severe malnutrition? J Pediatr Gastroenterol Nutr 2008;46:447–452.
Ashworth A. Efficacy and effectiveness of community-based treatment of severe malnutrition. Food Nutr Bull 2006;27(3 Suppl):S24–S48.
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Patel, D., Gupta, P., Shah, D. et al. Home-based rehabilitation of severely malnourished children in resource poor setting. Indian Pediatr 47, 694–701 (2010). https://doi.org/10.1007/s13312-010-0102-6
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DOI: https://doi.org/10.1007/s13312-010-0102-6