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Journal of Tropical Pediatrics 1994 40(4):225-230; doi:10.1093/tropej/40.4.225
© 1994 by Oxford University Press
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Randomized Clinical Trial Comparing Hospital to Ambulatory Rehabilitation of Malnourished Children in Niger

M. K. Chapko, PhD*,, A. Prual, MD, MPH**, Y. Gamatié, MD*** and A. A. Maazou, MD***

*Department of Health Services, University of Washington Seattle, USA
**Faculty of Health Sciences, University of Niamey Niger
***Pediatric Service, National Hospital Niamey, Niger

Correspondence: M. K. Chapko, Department of Health Services, University of Washington, SC-37 Seattle, WA 98195, USA

This study compared hospital to ambulatory nutritional rehabilitation outcomes and costs. Following a hospital stay to resolve initial acute medical conditions, 100 malnourished children (54 per cent male, ages 5 to 28 months) in Niger were randomly assigned to either hospital or ambulatory nutritional rehabilitation. Anthropometric measures were assessed at 15, 30, 60, 90 and 180 days postrandomization. Following randomization, the hospital group received a mean of 12.9 days of hospital rehabilitation and 5.6 days of ambulatory rehabilitation, while the ambulatory group received 2.2 days of hospital rehabilitation and 11.9 days of ambulatory rehabilitation. No significant differences between the two study groups in mortality rates or weight gain were found. The mean cost for hospital rehabilitation was 120 per cent higher (P< 0.001) than ambulatory rehabilitation. This study was the first randomized clinical trial directly comparing hospital to ambulatory nutritional rehabilitation and suggests that ambulatory rehabilitation is more cost-effective.


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