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Effects of Community-based Follow-up Care in Managing Severely Underweight Children
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
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2011 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 53, no 3, 310-319 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of the present study was to assess the effects of community-based follow-up care, food supplementation, and/or psychosocial stimulation on the recovery of severely underweight children.

Patients and Methods: A total of 507 severely underweight children (weight-for-age z score <-3) ages 6 to 24 months hospitalized at the International Center for Diarrheal Disease Research, Bangladesh, were randomly assigned to 1 of the following regimens for 3 months once they recovered from diarrhea: fortnightly follow-up care at the International Center for Diarrheal Disease Research, Bangladesh Hospital, including growth monitoring, health education, and micronutrient supplementation (group H-C, n = 102); fortnightly follow-up at community clinics, using the same treatment regimen as group H-C (group C-C, n = 99); community-based follow-up as per group C-C plus cereal-based supplementary food (SF) (group C-SF, n = 101); follow-up as per group C-C plus psychosocial stimulation (PS) (group C-PS, n - 102); or follow-up as per group C-C plus both SF and PS (group C-SF + PS, n = 103).

Results: There were no significant differences in baseline characteristics by treatment group. Attendance at scheduled follow-up visits was greater in groups C-SF, C-SF + PS, and C-PS than in C-C and H-C; P<0.05. Rates of weight gain were greater in groups C-SF + PS, C-SF, and C-PS (0.88-1.01 kg) compared with groups C-C and H-C (0.63-0.76 kg), P<0.05. Three-factor analysis of covariance of the effects of treatment components indicated that weight gain and change in weight-for-age z score and weightfor- length z score were greater in groups that received SF (P< 0.05) and linear growth was greater among children managed in the community (P = 0.002).

Conclusions: Positioning follow-up services in the community increases follow-up visits and promotes greater linear growth; providing SF, with or without PS, increases clinic attendance and enhances nutritional recovery. Community-based service delivery, especially including SF, permits better rehabilitation of greater numbers of severely underweight children.

Place, publisher, year, edition, pages
2011. Vol. 53, no 3, 310-319 p.
Keyword [en]
community-based care, management of acute malnutrition, psychosocial stimulation, randomized trial, severely underweight children, supplementary food
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-158574DOI: 10.1097/MPG.0b013e31821dca49ISI: 000294247000014OAI: oai:DiVA.org:uu-158574DiVA: diva2:440493
Available from: 2011-09-13 Created: 2011-09-12 Last updated: 2017-12-08Bibliographically approved

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