Cost-effective Treatment for Severely Malnourished Children: What is the Best Approach?

Ashworth, Ann; Khanum, Sultana

doi:10.1093/heapol/12.2.115

Cited by 108 publications

(155 citation statements)

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“…In this study, the cost of community-based rehabilitation was approximately 25% of the cost of inpatient care. 61 However, this programme did not provide any nutritional supplements for those treated in the community. The additional cost of 10-15 kg of RUTF (the average amount required to obtain a cure in OTP), of approximately US$35-US$52.5 would still have resulted in a 50% reduction in inpatient costs.…”

Section: The Cost Of Ctcmentioning

confidence: 99%

Treating severe acute malnutrition seriously

Collins¹

2007

Archives of Disease in Childhood

125

128

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Section: The Cost Of Ctcmentioning

confidence: 99%

Treating severe acute malnutrition seriously

Collins¹

2007

Archives of Disease in Childhood

125

128

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“…As a result, it is often recommended to keep malnourished children in hospital or a nutritional rehabilitation unit to feed them with LF until they achieved the desirable weight for height. This is not cost-effective because of the high indirect costs associated with hospital admission (Ashworth & Khanum, 1997).…”

Section: Introductionmentioning

confidence: 99%

Comparison of gastric emptying of a solid and a liquid nutritional rehabilitation food

2001

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Objective: To compare gastric emptying of a solid and a liquid nutritional rehabilitation food. Design: Cross-over trial. Eight volunteers took, in random order at least 1 week apart, 2100 kJ of a solid and a liquid nutritional rehabilitation food with added labelled [13 C] glycine. Setting: Research ward for healthy volunteers. Subjects: Eight healthy volunteers. Methods: Appearance of 13 CO 2 was monitored in expired gas every 15 min for 240 min after meal intake and compared between solid and liquid meals. Parameters of gastric emptying were then calculated. Results: Gastric half-emptying time was slightly longer for solid meal compared to liquid meal (101 AE 6.0 vs 88 AE 9.8 min, P ¼ 0.24).13 CO 2 excretion peaked 138AE 5.3 min after the solid meal compared with 119 AE 8.6 min with liquid meal (P ¼ 0.06).13 CO 2 excretion was higher for the liquid food up to 110 min after the meal but then became higher for the solid food. Analysis of variance for repeated measures of 13 CO 2 excretion showed a significant interaction term between the type of food and time indicating a delayed elimination of 13 CO 2 for the solid food (P ¼ 0.018). Conclusions: Attempts to replace liquid nutritional rehabilitation foods by a solid food in malnourished patients should take into account a possible slower gastric emptying. Sponsorship: Supported by a grant from Nutriset (Malaunay, France) and ANVAR (Agence Nationale de la Valorisation de la Recherche, contract no. A9703021P).

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“…26 The essential complication to assess for carefully is anorexia; all children with SAM should thus undergo a supervised test feeding of approximately 30 g of ready-to-use therapeutic food (RUTF). Other common complications include severe dehydration, high fever, respiratory distress, hypoglycaemia with lethargy and evidence of severe anaemia that may require blood transfusion.…”

Section: Treatmentmentioning

confidence: 99%

“…Details of moderate malnutrition therapy are outlined elsewhere 41. Details of inpatient 10-step therapy are given in figure 3 and in 2003 WHO guideline 26. Details of management of severe acute malnutrition are given in the text and in 2007 and 2013 WHO guidelines 30 32…”

Section: Treatmentmentioning

confidence: 99%

“…Inpatient therapy consists of a coordinated 10-step protocol (figure 3) whose core element is slow, cautious feeding with F-75 formula every few hours, progressing to F-100 formula as recovery proceeds and when they are able to tolerate this increased solute load 26. Additional elements of inpatient therapy address hypoglycaemia, hypothermia, dehydration, electrolyte imbalances and micronutrient deficiencies, although these traditional protocols are being reconsidered in many cases 34.…”

Section: Treatmentmentioning

confidence: 99%

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Management of severe acute malnutrition in low-income and middle-income countries

Trehan

Manary²

2014

Arch Dis Child

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Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environmental enteropathy, poor complementary feeding practices, and chronic and acute infections, contribute to the development of SAM. Careful anthropometry is key to making an accurate diagnosis of SAM and can be performed by village health workers or even laypeople in rural areas. The majority of children can be treated at home with ready-to-use therapeutic food under the community-based management of acute malnutrition model with recovery rates of approximately 90% under optimal conditions. A small percentage of children, often those with HIV, tuberculosis or other comorbidities, will still require inpatient therapy using fortified milk-based foods.

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Cost-effective Treatment for Severely Malnourished Children: What is the Best Approach?

Abstract: With careful training and an efficient referral system, domiciliary care preceded by one week of day care is the most cost-effective treatment option for severe malnutrition in this setting.

Cited by 108 publications

References 0 publications

Treating severe acute malnutrition seriously

Treating severe acute malnutrition seriously

Comparison of gastric emptying of a solid and a liquid nutritional rehabilitation food

Management of severe acute malnutrition in low-income and middle-income countries

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