The Kingston Project. II. the efects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: anthropometry

ABSTRACT

Malnourished children (mean age 1.2 years) referred from public health clinics to a paediatric metabolic ward in Kingston, Jamaica, were enrolled for treatment in a community-based health care project and were randomly allocated to one of two groups. The first group was treated at home with metronidazole and then for 6 months using the standard health care provided from local clinics by community health aides. The second group was given the same drug and home treatment, but in addition received a high energy supplement of 3.31 MJ daily for 3 months. We have previously shown a significant advantage in both weght and height gain for a group given the same supplement in contrast with standard health care controls (Heikens et al., 1989, Eur. J. Clin. Nutr. 43, 145-160), and in this study test the addition of a drug treatment aimed at reducing malabsorbtion due to a possible microbial overgrowth of the small bowel in malnourished children. This paper reports anthropometric findings showing significant benefits from both the drug and nutritional treatments. Greatest gains were by the group given both treatments, but the group given the antibiotic treatment, without energy supplementation, also made better growth recovery than did controls. Only 8 percent of the children treated with metronidazole failed to respond to community-based intervention and were admitted to hospital, compared with 19 percent for the other groups (P<0.05). These findings support targetted high-energy supplementation for the rehabilitation of moderately malnourished children receiving health clinics care, and suggest further that such programs should include antibiotic treatment directed at SBBO (AU)