Nutrition rehabilitation centers--an evaluation of their performance

The recovery of Guatemalan children with mild to moderate wasting: factors enhancing the impact of supplementary feeding

OBJECTIVES

The purpose of this study was to identify factors that enhance the recovery due to supplementary feeding in wasted children.

METHODS

Recovery rates were obtained in mild to moderately wasted 6- to 48-month-old rural Guatemalan children living in four villages. Children in two villages received a high protein-energy supplement (supplemented children), while children in the other villages received a low protein-energy supplement (nonsupplemented children). The difference in recovery rates between the groups was the attributable benefit. The net supplementation amounted to 11% of the recommended energy intake and its associated nutrients.

RESULTS

Attributable supplement benefits were achieved in younger children (6 to 24 months old) and increased with decreasing weight for length, longer duration of supplementation, and duration of diarrhea, but not with chronicity of wasting.

CONCLUSIONS

Supplementation's effectiveness can be improved in similar populations by programs targeted according to these findings.

Children discharged following nutritional rehabilitation: a follow-up study

The results of a 1-year follow up of children discharged from a nutritional rehabilitation centre (NRC) in eastern Nepal are presented. One hundred and one children were visited at home on discharge from the NRC, at 6 months and 1 year later. Data were collected concurrently on one sibling and two neighbouring children matched for age and sex. Anthropometry was carried out at each visit and information collected on socio-economic variables and child feeding practices. A significantly higher death rate was observed in index children as compared with controls. Index children demonstrated catch-up growth with both greater weight gain and faster increases in height than either control group post-discharge. At 6 months, mean weight-for-height was similar in all three groups but at one year mean height-for-age was still lower in the index children as compared with controls. The prognosis for female children appeared to be poorer than for boys.

Community based, effective, low cost approach to the treatment of severe malnutrition in rural Jamaica

Moderate and severe malnutrition are endemic in much of the developing world and in association with pockets of deprivation in the developed world. The cost in terms of individual and social development is high. The principles of effective management are clearly documented. A low cost, community based treatment programme for moderately and severely malnourished children under 3 years of age was established at a health centre in rural Jamaica. Children were followed up monthly and defaulters were rigorously recalled. Management consisted of carefully delivered dietary advice, antibiotics, anthelminthics, and vitamin supplements. All children improved and the response of 36 children, who were treated in the first year, showed an accelerated weight gain, with catch-up growth and the maintenance of length gain. There was a significant increase in the weight for age, at 1.9% per month over six months, which exceeds the rate reported with food supplementation programmes and nutrition rehabilitation centres.

Efficacy of a therapeutic feeding centre evaluated during hospitalization and a follow-up period, Tahoua, Niger, 1987-1988

Between 1 February 1987 and 31 May 1988 an evaluation of a nutritional rehabilitation centre in Tahoua, Niger was conducted. Among the 381 children admitted to the centre, 61 (16%) had kwashiorkor and 347 (91.3%) were aged between 6 and 29 months. Recovery and death rates were 46.2% and 14.4%, respectively. The median duration of stay until recovery was 21 days. Sixty-two per cent of deaths occurred during the 1st week of hospitalization. Three risk factors for death were identified by the study: patients with kwashiorkor with a weight/height (W/H) less than -3 SD, those with marasmus with a W/H less than -5 SD, and those dehydrated with marasmus. Among children included in the follow-up study after leaving the centre, the risk of dying during the follow-up period among children who absconded was 7.1 times higher than the risk observed among children who recovered. Among the children who recovered, no relapse was observed 3-18 months after they left the centre. This investigation indicates the importance of intensive therapeutic feeding centres in areas with a high prevalence of malnutrition.