Community rehabilitation of malnourished children: effects of nutritional supplementation on morbidity - abstract

ABSTRACT

Fifty-one moderately and severely malnourished children were studied in the community. They were randomly allocated to receive either medical care and an energy dense dietary supplement for three mons and then medical care alone for a further three months (supplemented) or to receive medical care alone for the six months (unsupplemented). All children were seen at two-weekly intervals, alternately in their homes by community Health Aides and in the clinic by a paediatrician. At each visit, a morvidity questionnaire was administered to obtain the mother's history of the child's illness during the previous two weeks. Weight was measured every two weeks and height monthly. Clinical assessment was done montly. During the first 3 months, growth velocity was higher in the supplemented than the unsupplemented children (2.4 and 1.2 times normal growth rate). During the second 3 months, growth rate was equal in the two groups (1.1 times normal growth rate). The mean ñ SD number of days of respiratory illness and diarrhoea (3 or more loose stools daily) were as follows FOLLOW-UP PERIOD Respiratory infection (1-3 MONTHS - Unsuppl. 22ñ17, Suppl. 23ñ12), (4-6 MONTHS - Unsuppl. 15ñ13, Suppl. 20ñ15); Diarrhoea (1-3 MONTHS - Unsuppl. 6ñ9), (4-6 MONTHS Unsuppl. 2ñ3, Suppl. 8ñ12) No. Of Children With > 7 Days (1-3 MONTHS Unsuppl. 8/25, Suppl. 18/26), (4-6 MONTHS Unsuppl. 1/24, Suppl. 7/25). In the first three months, the supplement was not associated with any significant decrease or increase in morbidity from respiratory illness or diarrhoea. Although more of the children had diarrhoea lasting for over seven days, these latter children did not show a diminution in rate of weight gain. In the second three-month period, there were fewer days of both respiratory illness and of diarrhoea in the unsupplemented children than in the children who had been supplemented during the previous three months. There were fewer children who had diarrhoea for more than seven days in the three-month period amongst the unsupplemented than the previously supplemented. Their preliminary analysis shows that dietary supplementation with an energy dense formula does not lead to a reduction in morbidity in malnourished children. It is possible that the supplement is associated with an increased in incidence of diarrhoea following its cessation (AU)