BACKGROUND AND OBJECTIVES:
Every day, on average, 26 000 children <5 years of age die of malnutrition, mostly from preventable causes, and nearly all of them live in the developing countries. One-third of the malnourished children in the world live in India. Tackling malnutrition in children is a national emergency. Nearly 50% of children between 1 month and 5 years of age are malnourished, with a mortality rate among children <5 years old of ∼36% in the state of Maharashtra. Malnutrition increases this rate almost fourfold. During the rehabilitation phase of severe acute malnutrition (SAM) management, a diet based on energy-dense local foods (EDLF) along with multivitamin and multimineral supplements given at regular intervals under supervision, with counseling and play therapy, results in rapid weight increases (>10 g/kg per day) in children with SAM in 14 days. This weight gain facilitates early discharge from inpatient care, reducing chances of secondary infections and subsequent mortality. This study aimed to determine catchup growth in children with SAM treated with EDLF, our “magic potion,” in a hospital-based nutrition rehabilitation center (NRC).
We conducted a prospective hospital-based interventional study at the NRC of a tertiary teaching government hospital in Pune, India. Data are from July 2012 to August 2013. We enrolled children between the ages of 1 and 60 months who met World Health Organization criteria for SAM. The children were started on a specially prepared food consisting of puffed rice, sugar, milk powder, oil, groundnut powder, and water in predetermined proportions to provide 75, 100, and then 150 to 200 kcal per 100 mL. Supervised feedings with daily weight monitoring and structured play therapy were implemented. The data were analyzed to assess the effect of this diet on the daily weight gain in each child.
Of the 120 children with SAM, 70% were girls, and the mean age was 14 months (range 1–60 months). Underlying systemic illness was seen in 73%; the most common were pneumonia and diarrhea with dehydration and shock. Risk factors for SAM were inappropriate feeding habits (60%; odds ratio [OR] = 2.02; 95% confidence interval [CI], 0.68–5.94), incomplete vaccination (55%; OR = 1.30; 95% CI, 0.45–3.72), and poverty (39%; OR = 2.28; 95% CI, 0.78–6.69). Mean weight gain on the prescribed diet (EDLF) was good (>8 g/kg per day) in 52%. Weight gain was higher by almost 40% in the absence of underlying systemic illness in any week. No mortality was noted during the study period. All mothers and caretakers confidently prepared the diet themselves at the time of discharge. Follow-up at 6 months showed steady weight gain in all.
The diet of EDLF was found to be suitable and cost-effective for nutrition rehabilitation of children with SAM, with good weight gain, as recommended by the World Health Organization. The cost of 100 g of this special feed is only 10 rupees (<25 cents) per 130 kcal, and it can be used for community management of SAM.
- Copyright © 2015 by the American Academy of Pediatrics