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 24 January 2018

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News

Outpatient treatment could benefit severely malnourished children

Children with severe malnutrition in humanitarian emergencies could be treated effectively as outpatients, according to a report in this week's issue of the Lancet.

News image

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Drs Steve Collins and Kate Sadler studied 170 malnourished children treated as outpatients in Bedwacho, Ethiopia, between 2000 and 2001.

The guidelines for emergency relief operations state that severely malnourished people should be treated as inpatients in therapeutic feeding centers.

85% of the children recovered, while 4% died, 6% were transferred, and 5% defaulted.
Lancet

However, these centers are costly and difficult to set up, and often they cannot treat everyone who needs care.

Furthermore, they can cause community disruption and undermine local health infrastructures. The admission of a child often means that their carer, usually the mother, must leave the rest of the family for approximately 30 days.

The children in the program were aged from 6 months to 10 years.

They had 1 of 3 types of severe malnutrition: marasmus, kwashiorkor, or marasmic kwashiorkor.

The children were enrolled at 10 distribution points, all located in government-run health centers, and clinics.

A nurse supervisor, and 12 outreach and distribution workers staffed the program.

Patients went to their nearest site once a week to receive ready-to-use therapeutic food and a medical check up.

The research team found that 85% of the children recovered, while 4% died, 6% were transferred, and 5% defaulted.

They determined the average time spent in the program before discharge was 42 days.

The average rate of weight gain for patients who recovered varied between 4.8 g/kg per day for marasmic patients, to 2.7 g/kg per day for patients with kwashiorkor.

The team found that treatment met international standards for recovery, default, and mortality, but not for time spent in the program and rates of weight gain.

The authors concluded that outpatient care may be used as a complementary strategy to therapeutic feeding centers in humanitarian relief programs.

Lancet 2002; 360(9348): 1824-30
06 December 2002

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