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 post-randomization. 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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The 461 0-2-year-old children admitted to the paediatric ward of the National Hospital in Niamey over a 2-month period were closely followed up from admission to discharge or death. The in-hospital mortality rate was 30 per cent, a great proportion of deaths occurring during the first 24 h of hospitalization. Malnutrition was highly prevalent (76 per cent). Children referred from other health facilities (72 per cent) did not experience a higher probability of survival. Using multivariate analysis, three variables remained significantly associated with death: nutritional status, consultation of a traditional practitioner, and a neonate disease. Neonate diseases are the third major cause of death because of a high case fatality rate. For the other causes, the main underlying factor is malnutrition. Most in-hospital deaths are due to events that occurred prior to hospitalization. The role of hospitals' pediatric wards of developing countries is discussed.

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