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Evaluation of a partial day treatment realimentation program for malnourished children in the Dominican Republic
John D McLennan1, Rosanne M T Mills
1Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. jmclenna@ucalgary.ca
Insights
Malnourished children in a day treatment program showed slower growth than recommended, with only 27% meeting targets. Attendance was high, but barriers like childcare and illness hindered progress, suggesting alternative strategies are needed.
Area of Science:
- Pediatrics
- Public Health
- Nutrition Science
Background:
- Child malnutrition remains a significant global health issue.
- Realimentation programs are crucial for recovery.
- Partial day treatment programs offer a flexible approach to care.
Purpose of the Study:
- To evaluate growth rates and clinical attendance in a partial day treatment realimentation program for malnourished children.
- To assess adherence to recommended growth velocity standards.
- To identify barriers to consistent program attendance.
Main Methods:
- Prospective study of 88 malnourished children admitted to a partial day treatment program in the Dominican Republic.
- Anthropometric measurements (weight, height) at baseline and follow-up.
- Analysis of clinical attendance records and caregiver interviews.
Main Results:
- Mean weight gain was 3.9 g/kg/day in the first 4 weeks, with only 27% achieving the target of ≥5.0 g/kg/day.
- Children attended 80% of possible clinic days, but growth rates on attendance days (4.2 g/kg/day) were only slightly higher than non-attendance days (3.7 g/kg/day).
- Caregiver-reported barriers included difficulty finding childcare and personal illness.
Conclusions:
- The partial day treatment program did not consistently achieve recommended growth rates for malnourished children.
- High attendance did not translate to optimal growth, indicating potential program inefficiencies.
- Alternative strategies, such as home-based care or enhanced day treatment, should be explored to improve outcomes and resource utilization.
Abstract:
The study determined the growth rates and clinical attendance patterns of malnourished children treated at an existing partial day treatment realimentation program. It was hypothesized that at least 50% of the children would achieve a minimum recommended growth rate of 5 g/kg/day and would attend at least 50% of the possible treatment days. All children consecutively admitted to a partial day treatment realimentation program on the outskirts of Santo Domingo, Dominican Republic between 2 July 2004 and 30 November 2005 were invited to participate in the study. Out of 92 caregivers, 88 (95.6%), agreed. Caregivers were interviewed and child anthropometrics were obtained at baseline and follow-up. Clinical attendance patterns were extracted from medical records. Mean rate of weight gain in the rehabilitation phase up to 4 weeks following admission was 3.9 g/kg/day (SD 4.5 g/kg/day) with only 27% of the children achieving a minimum recommended rate of > or =5.0 g/kg/day. On consecutive clinic attendance days, the mean growth rate was 4.2 (SD 8.6) g/kg/day, while on non-attendance days it was approximately 3.7 (SD 4.5) g/kg/day. Children attended 80% of the possible clinic days during the first 4 weeks of treatment. Within this time, 20% achieved the target of > or =-1 SD of the median weight for height. Caregivers reported having difficulty finding caretakers for their other children and their own illnesses as barriers to regular attendance. There was a substantial variation in growth rates of children attending the clinic with mean growth rates failing to achieve minimal standards. Though some children may have benefited from the partial day treatment program, alternative strategies should be considered at this clinic to improve resource utilization and outcomes including the use of a home recovery option and an enhanced day treatment program.
