Nutrition Rehabilitation in Hospital--a Waste of Time and Money? Evaluation of Nutrition Rehabilitation in a Rural District Hospital in South-west Tanzania. II. Long-term Results

Growth, morbidity, and mortality of children in Dhaka after treatment for severe malnutrition: a prospective study

“…This, again, is very low in contrast with some centers where postdischarge relapse rates ranging from 13% to 30% have been reported (3,6,7,9). Reasons for the low mortality and relapse rates in our study unquestionably include access to skilled medical care, availability of essential drugs, the practical instruction that mothers had received at the unit during the initial treatment period, and the fact that they were aware of the consequences of illness and used the available health services when needed.…”

“…Disproportionate mortality among girls is well-documented in Bangladesh (37). In Tanzania, 8% of malnourished children treated in hospitals died within 1 y and the death rate was 41% in those who left during treatment (7). In Zaire, 19% of those aged < 4 y died during the first year after discharge, after an average inpatient stay of 10 wk (8).…”

Long term mortality after community and facility based treatment of severe acute malnutrition: Analysis of data from Bangladesh, Kenya, Malawi and Niger

“…A literature search in Medline and Google scholar without period restriction was conducted using the term "protein energy malnutrition", "protein caloric malnutrition", "severe malnutrition", "marasmus", "kwashiorkor", "mortality" and "after recovery", "postdischarge" or "long term" Eight studies examining post-discharge mortality were retrieved (Chapko et al, 1994;Pecoul et al, 1992;Reneman and Derwig, 1997;Roosmalen-Wiebenga et al, 1987;Khanum et al, 1998;Kerac, 2010, Hennart et al, 1987Keet et al, 1971) but five studies were excluded either because the definition of SAM was different from what is currently used (n = 2) or because of incomplete data for the calculation of the incidence of deaths (n = 3) (Chapko et al, 1994;Roosmalen-Wiebenga et al, 1987;Kerac, 2010;Hennart et al, 1987;Keet et al, 1971). Among those included in this paper, the first study was carried out in Tahoua, a region of Niger.…”

“…Surprisingly, despite a recent renewed focus on nutrition by the international community, treatment of SAM is still not receiving due attention which translates into inadequate funding. Although it is unanimously recognised that undernutrition, including SAM, contributes directly and indirectly to a high proportion of deaths of under-five children, debate that started in the early seventies on whether it is worth investing in the treatment of SAM particularly in the community based management of SAM, continues Black et al, 2008;Cook, 1971;Roosmalen-Wiebenga et al, 1987). This is despite the fact that most countries and NGOs that have adopted the CTC approach have been able to reduce the case fatality rate to levels lower than 10%, with some programmes reporting case fatality rates of lower than 5% (Bezanson and Isenman, 2010;Collins et al, 2006b).…”

“…A commonly cited reason behind this resistance is the supposed persistence of a high risk of mortality after recovery from SAM once the patient has exited the treatment programme (Ashworth, 2006). Data on the longer term mortality associated with discharge from inpatient therapeutic feeding centres is variable; some studies have reported a cumulative mortality rate of 1 to 1.5 years after discharge of up to 41% (Ashworth, 2006;Chapko et al, 1994;Pecoul et al, 1992;Reneman and Derwig, 1997;Roosmalen-Wiebenga et al, 1987), whilst others have reported lower figures of 2.3% after 12 months of follow up, and 4.1% after 1.5 years of follow up (Bahwere et al, 2008;Khanum et al, 1998). An earlier study reported a mortality of 1.5%, 12 months after discharge among children treated using the domiciliary approach (Khanum et al, 1998).…”