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Why do some families become defaulters in a hospital based nutrition rehabilitation follow-up programme?
C C Nielsen1, M A Islam, S H Thilsted
1International Centre for Diarrhoeal Disease Research, Bangladesh, ICDDR,B.
Insights
Mothers of children with malnutrition often stopped attending nutrition rehabilitation follow-up (NFU) because they believed their child was healthy. This perception difference highlights the need for clear communication about the benefits of continued nutrition support for undernourished children.
Area of Science:
- Nutrition Science
- Pediatrics
- Public Health
Background:
- A nutrition rehabilitation follow-up (NFU) service has been available since 1989 at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in Dhaka.
- Children diagnosed with moderate to severe protein-energy malnutrition (PEM) alongside diarrhea are referred to NFU, with encouragement for severely undernourished children to attend.
Purpose of the Study:
- To investigate the reasons behind families defaulting from the nutrition rehabilitation follow-up (NFU) program.
- To understand the differing perceptions of child health between families who complete NFU and those who default.
Main Methods:
- A case-control study matching 32 defaulter families with 32 non-defaulter families based on child's age, gender, and follow-up visit number.
- Interviews were conducted with mothers from both groups to gather information on reasons for attending or defaulting from NFU.
Main Results:
- The primary reason for defaulting was the belief that 'follow-up was not needed since the child was okay,' contrasting with non-defaulters who attended for 'the child's improvement.'
- Children in both groups had similar nutritional status, socio-economic background, and parental education levels, suggesting perception is key.
- A significantly higher proportion of defaulter mothers (75%) were accompanied by another adult compared to non-defaulter mothers (41%).
Conclusions:
- Parental perception of a child's nutritional status significantly influences adherence to nutrition rehabilitation follow-up (NFU).
- It is not possible to predict which families will default, necessitating consistent attention and clear communication for all participants.
- Emphasizing the risks of poor nutrition and the benefits of NFU to mothers and family members is crucial for improving program adherence.
Abstract:
Since 1989, a nutrition rehabilitation follow-up (NFU) service is being offered in the Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. Parents bring their children for treatment of diarrhoea and those with additional diagnosis of moderate to severe protein energy malnutrition (PEM) are referred to NFU. Families with severely undernourished children are encouraged to attend NFU. Some of them do not come back to NFU after the first or subsequent visits and are considered as 'defaulters'. This paper focuses on the reasons why some families become defaulters. Thirty-two defaulter families were matched with an equal number of non-defaulter families for age and gender of the child and follow-up visit number. All families were interviewed. Children from both groups had similar nutritional, socio-economic status and parental education level. The main reason stated by defaulter mothers for not coming to NFU was 'follow-up was not needed since the child was okay'. The main reason for coming to NFU stated by non-defaulter mothers was for 'the child's improvement', indicating that parental perception of the child's nutritional status differ in the two groups. A greater proportion (75%) of defaulter mothers as compared to non-defaulter mothers (41%) came to NFU accompanied by another adult. It was not possible to identify potential defaulters. Thus all families accepting NFU must be given equal attention. The poor nutritional status of the child and associated risks must be explained to the mother and other family members. The benefits of NFU to the child and family must be stressed.(ABSTRACT TRUNCATED AT 250 WORDS)