Controlled trial of three approaches to the treatment of severe malnutrition

Khanum, Sultana; Ashworth, Ann; Huttly,

doi:10.1016/s0140-6736(94)92885-1

Cited by 81 publications

(50 citation statements)

References 7 publications

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“…There was also one cluster RCT that compared inpatient treatment to home-care and day-care treatment [34,35]; this study contained methodological issues and did not adequately describe the intervention (see additional file 3 for study assessment).…”

Section: Resultsmentioning

confidence: 99%

“…One moderate quality study in Niamey, Niger, enrolled children with MAM and SAM who were about to be discharged from the hospital [45]. The other study, graded as low quality, allocated children presenting to the nutrition unit in Dhaka, Bangladesh, to receive either home-based or inpatient care [35]. A third arm of this trial, day care, was not analyzed because it could not be pooled.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of severe and moderate acute malnutrition in low- and middle-income settings: a systematic review, meta-analysis and Delphi process

et al. 2013

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BackgroundGlobally, moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) affect approximately 52 million children under five. This systematic review evaluates the effectiveness of interventions for SAM including the World Health Organization (WHO) protocol for inpatient management and community-based management with ready-to-use-therapeutic food (RUTF), as well as interventions for MAM in children under five years in low- and middle-income countries.MethodsWe systematically searched the literature and included 14 studies in the meta-analysis. Study quality was assessed using CHERG adaptation of GRADE criteria. A Delphi process was undertaken to complement the systematic review in estimating case fatality and recovery rates that were necessary for modelling in the Lives Saved Tool (LiST).ResultsCase fatality rates for inpatient treatment of SAM using the WHO protocol ranged from 3.4% to 35%. For community-based treatment of SAM, children given RUTF were 51% more likely to achieve nutritional recovery than the standard care group. For the treatment of MAM, children in the RUSF group were significantly more likely to recover and less likely to be non-responders than in the CSB group. In both meta-analyses, weight gain in the intervention group was higher, and although statistically significant, these differences were small. Overall limitations in our analysis include considerable heterogeneity in many outcomes and an inability to evaluate intervention effects separate from commodity effect. The Delphi process indicated that adherence to standardized protocols for the treatment of SAM and MAM should have a marked positive impact on mortality and recovery rates; yet, true consensus was not achieved.ConclusionsGaps in our ability to estimate effectiveness of overall treatment approaches for SAM and MAM persist. In addition to further impact studies conducted in a wider range of settings, more high quality program evaluations need to be conducted and the results disseminated.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Treatment of severe and moderate acute malnutrition in low- and middle-income settings: a systematic review, meta-analysis and Delphi process

et al. 2013

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“…Studies in Bangladesh observed that, although the recovery rate (time needed to attain weight-for-height of 80% of the National Center for Health Statistics (NCHS) median) of very severely-malnourished children treated for one week in an inpatient ward followed by home management was somewhat longer (median=35 days) than the recovery rate of those treated in a specialized residential unit (median=18 days), the cost of home-treatment was less than one-fourth that of hospital-based care, and mothers preferred the home management (38,39). The same investigators also reported that, during a one-year follow-up period, children treated at home had less morbidity (episodes of cough and fever) compared to children managed in the residential unit, although other morbidities were similar (40).…”

Section: Management Of Children With Severe Malnutritionmentioning

confidence: 99%

Nutrition: Basis for Healthy Children and Mothers in Bangladesh

Faruque

Ahmed

et al. 2009

J Health Popul Nutr

114

112

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Recent data from the World Health Organization showed that about 60% of all deaths, occurring among children aged less than five years (under-five children) in developing countries, could be attributed to malnutrition. It has been estimated that nearly 50.6 million under-five children are malnourished, and almost 90% of these children are from developing countries. Bangladesh is one of the countries with the highest rate of malnutrition. The recent baseline survey by the National Nutrition Programme (NNP) showed high rates of stunting, underweight, and wasting. However, data from the nutrition surveillance at the ICDDR,B hospital showed that the proportion of children with stunting, underweight, and wasting has actually reduced during . Inappropriate infant and young child-feeding practices (breastfeeding and complementary feeding) have been identified as a major cause of malnutrition. In Bangladesh, although the median duration of breastfeeding is about 30 months, the rate of exclusive breastfeeding until the first six months of life is low, and practice of appropriate complementary feeding is not satisfactory. Different surveys done by the Bangladesh Demographic and Health Survey, United Nations Children's Fund (UNICEF), and Bangladesh Breastfeeding Foundation (BBF) showed a rate of exclusive breastfeeding to be around 32-52%, which have actually remained same or declined over time. The NNP baseline survey using a strict definition of exclusive breastfeeding showed a rate of exclusive breastfeeding (12.8%) until six months of age. Another study from the Abhoynagar field site of ICDDR,B reported the prevalence of exclusive breastfeeding to be 15% only. Considerable efforts have been made to improve the rates of exclusive breastfeeding. Nationally, initiation of breastfeeding within one hour of birth, feeding colostrum, and exclusive breastfeeding have been promoted through the Baby-Friendly Hospital Initiative (BFHI) implemented and supported by BBF and UNICEF respectively. Since most (87-91%) deliveries take place in home, the BFHI has a limited impact on the breastfeeding practices. Results of a few studies done at ICDDR,B and elsewhere in developing countries showed that the breastfeeding peer-counselling method could substantially increase the rates of exclusive breastfeeding. Results of a study in urban Dhaka showed that the rate of exclusive breastfeeding was 70% among mothers who were counselled compared to only 6% who were not counselled. Results of another study in rural Bangladesh showed that peer-counselling given either individually or in a group improved the rate of exclusive breastfeeding from 89% to 81% compared to those mothers who received regular health messages only. This implies that scaling up peercounselling methods and incorporation of breastfeeding counselling in the existing maternal and child heath programme is needed to achieve the Millennium Development Goal of improving child survival. The recent data showed that the prevalence of starting complementary food among infants ag...

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“…The mortality risk of these children is thought to relate to several factors [17], including electrolyte imbalance [18], hepatic dysfunction, infection, anthropometric status [19], and micronutrient status, as well as to differences between treatment regimens. The pathophysiology of primary malnutrition [20] and kwashiorkor [21] is to a large extent understood and has informed treatment guidelines improving the case fatality from primary malnutrition to levels below 5% [22,23]. Equally important, understanding the pathophysiology of primary malnutrition and kwashiorkor has enabled nutrition rehabilitation to grow to an unprecedented scale through humanitarian assistance and community-based programs [1,24].…”

Section: Who's Treatment Guidelines For Severe Malnutrition In Childrenmentioning

confidence: 99%