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Home-based rehabilitation of severely malnourished children in resource poor setting
Deepak Patel1, Piyush Gupta, Dheeraj Shah
1Department of Pediatrics, University College of Medical Sciences (University of Delhi), Delhi 110 095, India.
Insights
Home-based rehabilitation for severely malnourished children showed slower recovery rates compared to hospital-based interventions. This study highlights the need for optimized home-based strategies to improve nutritional outcomes in children.
Area of Science:
- Pediatric Nutrition
- Global Health
- Malnutrition Rehabilitation
Background:
- Severe childhood malnutrition remains a critical global health challenge.
- Effective rehabilitation strategies are essential for improving child survival and development.
- Home-based care models offer potential for wider reach but require careful evaluation.
Purpose of the Study:
- To assess the feasibility and effectiveness of home-based rehabilitation for severely malnourished children.
- To compare outcomes of home-based versus hospital-based management phases.
- To evaluate nutritional intake, anthropometric changes, and morbidity during rehabilitation.
Main Methods:
- A prospective, observational study involving 34 severely malnourished children (6 months to 5 years).
- Children underwent initial hospital assessment, with some receiving inpatient stabilization.
- Home-based rehabilitation (16 weeks) utilized home-prepared diets, with hospital follow-up.
Main Results:
- Of 29 children qualifying for home-based care, 26 completed the 16-week follow-up.
- Calorie and protein intake significantly increased, but weight gain was slower (3.2 g/kg/d) than during hospitalization (9.0 g/kg/d).
- Weight-for-length percentile improved significantly (62.9% to 80.3%), with 45% achieving complete recovery (>80%) and 51.7% partial recovery (>70%).
Conclusions:
- Home-based management, while feasible, resulted in sub-optimal and slower nutritional recovery.
- Hospital-based follow-up and home-prepared foods require optimization for better outcomes.
- Further research is needed to enhance home-based rehabilitation protocols for severe malnutrition.
Objective:
To evaluate the feasibility and outcome of home-based rehabilitation of severely malnourished children.
Design:
Prospective and observational.
Setting:
Rehabilitation at home (16 weeks) following initial assessment or/and stabilization at hospital.
Participants:
Thirty-four severely malnourished (weight for length < 70% of WHO reference) children between the ages of 6 months to 5 years.
Intervention:
Initial assessment of the patient was done in hospital. Those with complications or loss of appetite were admitted in hospital and managed as per WHO guidelines. After discharge, they were managed at home using home based diets. Those without complications and with preserved appetite were directly eligible for home-based rehabilitation. Follow up was done in hospital up to 16 weeks. Dietary intake, anthropometry and morbidities were recorded during follow-up.
Results:
Of the enrolled 34 children, 19 children were admitted in hospital and 15 children were sent home after initial assessment in hospital. Five did not clear the initial stabilization phase (2 died, 3 left hospital). Finally 29 children qualified for home based rehabilitation out of which 26 completed 16 week follow-up. During the home based management phase, the reported mean (±SD) calorie intake increased from 100 (± 5) kcal/kg/d at entry point to 243 (± 13) kcal/kg/d at 16 weeks (P=0.000). Similarly, reported protein intake increased from 1.1 (± 0.3) g/kg/d to 4.8 (± 0.3) g/kg/d (P=0.000). During hospital stay (n=19), children had weight gain of 9.0 (±5.3) g/kg/d, while during home based follow up (n=29), weight gain was 3.2 (± 1.5) g/kg/d only. During home based rehabilitation, only 3 (11.5%) children had weight gain of more than 5 g/kg/d by the end of 16 weeks. Weight for height percent increased from an average (± SD) of 62.9% (± 6.0%) to 80.3% (± 5.7%) after the completion of 16 weeks (P=0.000). Thirteen (45%) children recovered completely from malnutrition achieving a weight for length of >80; % whereas 15 (51.7%) recovered partly achieving weight for length >70;%. There was no death during the home stabilization.
Conclusion:
Home based management using home prepared food and hospital based follow up is associated with sub-optimal and slower recovery.
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