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Outpatient care for severely malnourished children in emergency relief programmes: a retrospective cohort study
1Valid International, Stockwell, London, UK. steve@validinternational.org
Insights
Outpatient treatment for severe malnutrition in emergencies shows promising recovery and survival rates, though weight gain and duration need improvement. This approach can complement existing feeding centers.
Area of Science:
- Public Health
- Pediatrics
- Nutrition
Background:
- Therapeutic feeding centers are standard for severe malnutrition but face coverage limitations.
- Assessing alternative strategies is crucial for effective emergency nutritional relief.
Purpose of the Study:
- To evaluate the effectiveness of outpatient treatment for severe malnutrition in an emergency relief setting.
Main Methods:
- Retrospective cohort study of 170 children (6-120 months) with severe malnutrition (marasmus, kwashiorkor, marasmic kwashiorkor).
- Analysis of clinical records assessing mortality, default, discharge, weight gain rate, and program duration.
Main Results:
- High recovery rate (85%) and low mortality (4%).
- Median weight gain was 3.16 g/kg/day; higher in marasmic and marasmic kwashiorkor.
- Median discharge time was 42 days, with faster recovery for marasmic patients.
Conclusions:
- Outpatient treatment met minimum standards for recovery, default, and mortality.
- Program duration and weight gain rates did not meet standards.
- Outpatient care offers a complementary strategy to center-based treatment for severe malnutrition.
Background:
In emergency nutritional relief programmes, therapeutic feeding centres are the accepted intervention for the treatment of severely malnourished people. These centres often cannot treat all the people requiring care. Consequently, coverage of therapeutic feeding centre programmes can be low, reducing their effectiveness. We aimed to assess the effectiveness of outpatient treatment for severe malnutrition in an emergency relief programme.
Methods:
We did a retrospective cohort study in an outpatient therapeutic feeding programme in Ethiopia from September, 2000, to January, 2001. We assessed clinical records for 170 children aged 6-120 months. The children had either marasmus, kwashiorkor, or marasmic kwashiorkor. Outcomes were mortality, default from programme, discharge from programme, rate of weight gain, and length of stay in programme.
Findings:
144 (85%) patients recovered, seven (4%) died, 11 (6%) were transferred, and eight (5%) defaulted. Median time to discharge was 42 days (IQR 28-56), days to death 14 (7-26), and days to default 14 (7-28). Median rate of weight gain was 3.16 g kg(-1) x day(-1) (1.86-5.60). In patients who recovered, median rates of weight gain were 4.80 g kg(-1) day(-1) (2.95-8.07) for marasmic patients, 4.03 g x kg(-1) x day(-1) (2.68-4.29) for marasmic kwashiorkor patients, and 2.70 g x kg(-1) x day(-1) (0.00-4.76) for kwashiorkor patients.
Interpretation:
Outpatient treatment exceeded internationally accepted minimum standards for recovery, default, and mortality rates. Time spent in the programme and rates of weight gain did not meet these standards. Outpatient care could provide a complementary treatment strategy to therapeutic feeding centres. Further research should compare the effectiveness of outpatient and centre-based treatment of severe malnutrition in emergency nutritional interventions.
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