[Evaluation of a project for nutritional rehabilitation at home in Benin]

Childhood malnutrition is a public health problem in most developing countries and the rehabilitation of malnourished children is a real challenge for health services. The main aim of this study was to evaluate the implementation of a community-based strategy for nutritional rehabilitation at home (NRH). This strategy was assessed in two districts of Benin. We also evaluated its effects on the nutrition status of the children involved in the study. Screening and rehabilitation protocols were developed for the project and were defined before the study began. The implementation process was evaluated by checking whether the children registered for NRH had received adequate treatment from the health agencies. Intervention was judged to be adequate if it was consistent with that previously set out in the rehabilitation protocol. The variables studied concerned whether the health workers had adequately implemented NRH and had applied UNICEF's three. "A" (Assessment, Analysis and Action). The results of the rehabilitation process were recorded. The weight and age of the children were determined to evaluate changes in their nutrition status. The study population was a group of 452 children aged 0 to 35 months old. The frequency of NRH sessions was adequate in 259 cases (57.9%), the quality of observations and advice was adequate in 284 cases (63.1%) and the protocol was followed properly in 151 cases (34.1%). At inclusion, 191 children (42.3%) were suffering from mild malnutrition and 146 (32.3%) were suffering from severe malnutrition. Seventy children (15.5%) were rehabilitated as defined in the protocol standards. One hundred and fifty nine children (35.2%) were lost to follow-up, 83 (18.4%) stopped the treatment and 83 (18.4%) were declared rehabilitated when they were not. The nutrition status of 69 of the 70 children who completed NRH had improved. Thus, there are flaws in the implementation process, with the three "A" not being reliably applied by health workers, particularly in terms of analysis and action. However, NRH does seem to be effective for the rehabilitation of children suffering from malnutrition, improving their nutrition status at least.