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A Treatment Package without Escape Extinction to Address Food Selectivity
Published on: August 21, 2015
Controlled trial of three approaches to the treatment of severe malnutrition
S Khanum1, A Ashworth, S R Huttly
1Centre for Human Nutrition, London School of Hygiene and Tropical Medicine, UK.
Insights
Home-based treatment for severely malnourished children is a cost-effective strategy. While it takes longer, this approach is preferred by parents and significantly reduces costs compared to inpatient or day-care options.
Area of Science:
- Pediatrics
- Public Health
- Health Economics
Background:
- Severe childhood malnutrition poses significant challenges.
- Domiciliary treatment offers potential economic and practical benefits.
- Comparing treatment modalities is crucial for optimizing care.
Purpose of the Study:
- To compare the costs and effectiveness of inpatient, day-care, and home-based treatment for severely malnourished children.
- To evaluate institutional and parental economic burdens across different treatment settings.
- To assess parental preference and treatment outcomes.
Main Methods:
- A controlled trial involving 437 severely malnourished children (aged 12-60 months) in Dhaka.
- Sequential allocation to inpatient, day-care, or a hybrid home-care model (1 week day-care followed by home care).
- Comparison of costs (institutional and parental) and time to reach 80% weight-for-height.
Main Results:
- Home-based care achieved the lowest average cost (1552 taka), significantly less than day-care (2517 taka) and inpatient (6363 taka).
- Mortality rates were low (<5%) across all groups.
- The home-based group took longer to recover but was the most popular option, despite higher parental costs due to lack of food supplements.
Conclusions:
- At-home management of severely malnourished children, following an initial inpatient or day-care period, is a highly cost-effective strategy.
- This approach balances economic benefits with parental acceptance.
- Further research into optimizing home-based care delivery, including nutritional support, is warranted.
Abstract:
Domiciliary treatment of severely malnourished children could have economic and practical advantages over other methods. We compared three approaches in a controlled trial. 437 children in Dhaka (< 60% weight-for-height, and/or oedema) aged 12-60 months were sequentially allocated to treatment as inpatients, to day-care, or to care at home after one week of day-care. Institutional and parental costs incurred to reach 80% weight-for-height were compared. Costs for inpatient, day-care, and at-home groups averaged 6363, 2517, and 1552 taka (60 taka = UK pound 1). Mortality was low (< 5%) in all three groups. Day-care treatment approached inpatient care for speed of recovery at less than half the cost, but it was unpopular with parents. The at-home group took significantly longer to attain 80% weight-for-height than the other groups, but did so at the lowest average cost. Parental costs were highest for the at-home group as no food supplements were provided; nevertheless this was the most popular option. We conclude that at-home management of severely malnourished children after 1 week of inpatient care is a cost-effective strategy.
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