Journal of Tropical Pediatrics Advance Access published online on March 17, 2007
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmm005
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Day-care Management of Children with Severe Malnutrition in an Urban Health Clinic in Dhaka, Bangladesh
aClinical Sciences Division, ICDDR, B, Dhaka 1212, Bangladesh
bRadda MCH-FP Centre, Dhaka 1216, Bangladesh
cDepartment of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Correspondence: Dr Hasan Ashraf, Clinical Sciences Division, ICDDR,B, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh. Tel: 880-2-88 60523-32/Ext. 2355, 2357, Fax: 880-2-8823116/9885657, E-mail < ashrafh{at}icddrb.org;>.
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Abstract |
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Management of severely malnourished children with associated complications relies on hospital-based treatment. Implementation of a standardized protocol at the Dhaka Hospital, ICDDR,B reduced case fatality approximately 50%. We developed and prospectively evaluated a day-care clinic approach that provided antibiotics, micronutrients and feeding during the day with continued care by parents at home at night as an alternative to hospitalization. Severely malnourished children aged 6–23 months denied admission to hospital were enrolled at Radda Clinic, Dhaka and received protocolized management with antibiotics, micronutrients and milk-based diet from 8:00 am to 5:00 pm each day, while mothers were educated on continuation of care at home. They were transitioned to the day-care nutrition rehabilitation (NR) unit of Radda Clinic following resolution of acute illness, received NR diet (Khichuri, halwa and milk-based) daily until children attained 80% weight-for-length. From February 2001 to November 2003, 264 children were enrolled; 52% were boys and 78%, 21% and 1% had marasmus, marasmus–kwashiorkor and kwashiorkor, respectively. Only 13% had severe malnutrition alone while 35% had pneumonia, 35% had diarrhea and 17% had both pneumonia and diarrhea. The mean (SD) duration of acute and NR phases were 8 (4) and 14 (13) days, respectively. Children gained weight [mean (SD) g/kg day] more rapidly during acute 10 (7) than NR phase 6 (5). Successful management was possible in 82% (95% CI 77–86%) children, 12% discontinued treatment and 6% referred to hospitals. Only one child died during NR phase. Severely malnourished children can be successfully managed at existing day-care clinics using a protocolized approach.
Key Words: day-care management • severe malnutrition • children