Could nutritional rehabilitation at home complement or replace centre-based therapeutic feeding programmes for severe...

Area of Science:

• Public Health
• Pediatrics
• Nutrition Science

Background:

• Médecins Sans Frontières (MSF) implemented large-scale therapeutic nutritional rehabilitation programs in Niger.
• Severe malnutrition in children remains a critical global health challenge requiring effective treatment strategies.

Purpose of the Study:

• To evaluate the success rates of three distinct treatment strategies for severe malnutrition.
• To compare daily weight gain, length of stay, recovery, case fatality, and defaulting rates across different approaches.

Main Methods:

• Prospective analysis of 1937 children aged 6-59 months with severe malnutrition.
• Three cohorts were studied: therapeutic feeding centre (TFC) only, TFC followed by home-based treatment, and home-based treatment exclusively.
• Data collected from August 2002 to October 2003.

Main Results:

• All strategies met international standards for average time in the program (30-40 days) and average weight gain (>8 g/kg/day).
• Home-based alone strategy showed the lowest default rate (5.6%) and case fatality rate (1.7%).
• The TFC-only strategy had the highest default rate (28.1%) and case fatality rate (18.9%).

Conclusions:

• A combined approach of hospital and home-based treatment for severe malnutrition yields satisfactory outcomes.
• Home-based treatment strategies significantly reduce default and case fatality rates.
• Integrating home-based care into nutritional rehabilitation programs is a viable and effective model.