The Kingston Project. III. The effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: morbidity and growth
Heikens, G.T.; Schofield, W.N.; Christie, C.D.; Gernay, J.; Dawson, S.
European Journal of Clinical Nutrition 47(3): 174-191
1993
ISSN/ISBN: 0954-3007 PMID: 8458315 Document Number: 414062
In 1985-86 in Jamaica, a community-based health care project randomly allocated 163 malnourished children (mean age 1.2 years) from the slums of greater Kingston to 1 of 4 groups: group visited at home by community health aides within the existing health service (HC); group receiving HC and a high energy supplement (HES) (790 kcal); group receiving HC and a 5-day course of abroad spectrum antibiotic, metronidazole, for 3 months; or group receiving HC, HES, and metronidazole. The researchers wanted to examine morbidity and to relate morbidity to the various interventions and growth velocity. 65% of all the children at enrollment suffered from an illness in addition to malnutrition, especially upper respiratory tract infections (URTIs). URTIs continued to be the most frequent illness in all groups throughout the 6-month study. Children receiving HES had significantly more gastroenteric infections, but this was not the case for those receiving metronidazole. Children receiving just HC suffered from morbidity more frequently and were ill for longer durations than the children in the other 3 groups (at 0-3 months, 96.2% vs. 74.3-92.9%, p .04; at 4-6 months, 96.2% vs. 74.3-82.1%, p .06; and 4-7 days, 46.2% vs. 2.9-5.7%, p .0001). Significant covariates of weight velocity were fever (p .0001), mucoid diarrhea (p .0001), and dysentery (p .0003). These illnesses had the same effect on weight velocity, even though their prevalences were different between treatment groups. The effect of cold and cough on weight velocity approached significance (p .052 and P .094, respectively). These findings showed that some illnesses greatly slowed weight gain in malnourished children. They also indicated that antibiotic use reduced the risk of gastroenteric infections in malnourished children, these infections having the most detrimental effect on weight gain.