The following abstract was presented at the Implementation Science and Global Health satellite meeting on March 17, 2010 at Bethesda, Maryland.
Md Iqbal Hossain, MD, DCH
Associate Scientist, Clinical Sciences Division
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR-B)
Department of Nutrition and Program in International and Community Nutrition, University of California, Davis
- Dr. Baitun Nahar, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR-B), Institute of Mother and Child Health, Uppsala University, Sweden
- Dr. JD Hamadani, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR-B)
- Dr. Tahmeed Ahmed, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR-B)
- Kenneth H Brown, MD, Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, and Helen Keller International, Dakar, Senegal
- Maternal and Child Health and Nutrition in Bangladesh, D43-TW001267 (Project Information in NIH RePORTER)
- International Clinical, Operational, and Health Services research and Training Award (ICOHRTA)
- PIs: Kenneth H Brown, MD, Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, and Helen Keller International, Dakar, Senegal
Malnutrition contributes to child morbidity and mortality, impaired psycho-motor development, and loss in national productivity in low-income countries, such as Bangladesh. Because of the high cost of inpatient treatment and limited accessibility of clinical facilities, effective, low-cost regimens for the treatment of severely malnourished children need to be developed for implementation in community settings. The study was done to assess the effects of community-based follow-up care, with/without food supplementation and/or psychosocial stimulation, as alternatives to hospital-based follow-up of children previously hospitalized for treatment of diarrhea and severe underweight.
507 severely underweight (WAZ <-3) children 6-24 months of age hospitalized at the Dhaka Hospital of ICDDR,B were randomly assigned to one of five outpatient treatment regimens once they recovered from diarrhea: 1) fortnightly follow-up at the hospital, including growth monitoring, health education, and micronutrient supplementation (Group H-C, n=102); 2) fortnightly follow-up at community-clinics, using the same treatment regimen as Group H-C (Group C-C, n=99); 3) follow-up as per Group C-C plus supplementary food made from toasted rice and lentil powders, molasses, and soy bean oil (SF) to provide 150-300 kcal/d (Group C-SF, n=101); 4) follow-up as per Group C-C plus psychosocial stimulation (PS) (Group C-PS, n=102); or 5) follow-up as per Group C-C plus both SF and PS (Group C-SF+PS, n=103).
At baseline, the children’s mean (+SD) age was 12.6 + 4.0 months, WAZ was -3.83 + 0.61, and WLZ was -2.71 + 0.76. There were no significant differences in baseline characteristics by treatment group. Attendance at scheduled follow-up visits was significantly greater in Groups C-SF, C-SF+PS, and C-PS than Groups C-C and H-C; p<0.05. The mean rates of weight gain (expressed as kg/3 months) differed significantly by treatment groups: Groups C-SF+PS, C-SF, and C-PS (0.88 to 1.01 kg) > Groups C-C and H-C (63 to 0.76 kg), P<0.05. Three-factor ANCOVA of the effects of treatment components (SF, PS, and hospital vs. community) indicated that weight gain and change in WAZ and WLZ were significantly greater in groups that received SF (P<0.05), and linear growth and change in LAZ were significantly greater among children managed in the community compared to those assigned to hospital follow-up (P=0.002). Wasted children (admission WLZ <-2) gained more weight than non-wasted children, but initial WLZ was positively associated with subsequent linear growth.
Positioning follow-up services in the community rather than the hospital increases attendance at scheduled follow-up visits during nutritional rehabilitation and promotes greater linear growth; providing SF, with or without PS, increases clinic attendance and enhances the rate of nutritional recovery. Community-based service delivery, especially including supplementary food, permits better rehabilitation of greater numbers of severely underweight children.
The study was supported by the Program in International and Community Nutrition, UC Davis; the Fogarty International Center (D43 TW01267); SIDA-SAREC, Sweden and ICDDR-B.
Updated April 2010