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Effects of community-based follow-up care in managing severely underweight children
Md Iqbal Hossain1, Baitun Nahar, Jena D Hamadani
1International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Sweden. ihossain@icddrb.org
Insights
Community-based care and food supplementation significantly improve recovery for severely underweight children. These interventions increase clinic attendance and promote better linear growth and nutritional recovery.
Area of Science:
- Pediatrics
- Public Health
- Nutrition Science
Background:
- Severely underweight children face significant health risks and require effective interventions for recovery.
- Community-based care models are being explored to improve healthcare accessibility and outcomes for vulnerable populations.
Purpose of the Study:
- To evaluate the impact of community-based follow-up care, food supplementation (SF), and psychosocial stimulation (PS) on the recovery of severely underweight children.
- To determine the effectiveness of integrating these interventions within community settings compared to hospital-based care.
Main Methods:
- A randomized controlled trial involving 507 severely underweight children (age 6-24 months) in Bangladesh.
- Children received one of five regimens for 3 months post-hospitalization: hospital care (H-C), community care (C-C), community care with SF (C-SF), community care with PS (C-PS), or community care with both SF and PS (C-SF + PS).
Main Results:
- Community-based interventions, particularly those including SF, led to higher attendance rates.
- Weight gain was significantly greater in groups receiving SF (C-SF, C-SF + PS) and PS (C-PS) compared to standard community care (C-C) or hospital care (H-C).
- Linear growth was enhanced in children managed within the community setting.
Conclusions:
- Community-based follow-up care increases patient visits and promotes better linear growth.
- Supplementary food (SF), with or without psychosocial stimulation (PS), improves clinic attendance and nutritional recovery.
- Community-based service delivery, especially with SF, offers a more effective approach for rehabilitating severely underweight children.
Objective:
The aim of the present study was to assess the effects of community-based follow-up care, food supplementation, and/or psychosocial stimulation on the recovery of severely underweight children.
Patients And Methods:
A total of 507 severely underweight children (weight-for-age z score <-3) ages 6 to 24 months hospitalized at the International Center for Diarrheal Disease Research, Bangladesh, were randomly assigned to 1 of the following regimens for 3 months once they recovered from diarrhea: fortnightly follow-up care at the International Center for Diarrheal Disease Research, Bangladesh Hospital, including growth monitoring, health education, and micronutrient supplementation (group H-C, n = 102); fortnightly follow-up at community clinics, using the same treatment regimen as group H-C (group C-C, n = 99); community-based follow-up as per group C-C plus cereal-based supplementary food (SF) (group C-SF, n = 101); follow-up as per group C-C plus psychosocial stimulation (PS) (group C-PS, n = 102); or follow-up as per group C-C plus both SF and PS (group C-SF + PS, n = 103).
Results:
There were no significant differences in baseline characteristics by treatment group. Attendance at scheduled follow-up visits was greater in groups C-SF, C-SF + PS, and C-PS than in C-C and H-C; P < 0.05. Rates of weight gain were greater in groups C-SF + PS, C-SF, and C-PS (0.88-1.01 kg) compared with groups C-C and H-C (0.63-0.76 kg), P < 0.05. Three-factor analysis of covariance of the effects of treatment components indicated that weight gain and change in weight-for-age z score and weight-for-length z score were greater in groups that received SF (P < 0.05) and linear growth was greater among children managed in the community (P = 0.002).
Conclusions:
Positioning follow-up services in the community increases follow-up visits and promotes greater linear growth; providing SF, with or without PS, increases clinic attendance and enhances nutritional recovery. Community-based service delivery, especially including SF, permits better rehabilitation of greater numbers of severely underweight children.
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