Long-stay versus short-stay hospital treatment of children suffering from severe protein-energy malnutrition
Heikens, G.T.; Schofield, W.N.; Dawson, S.M.; Waterlow, J.C.
European Journal of Clinical Nutrition 48(12): 873-882
1994
ISSN/ISBN: 0954-3007 PMID: 7889896 Document Number: 430001
Objective: To contrast early discharge versus attempted full nutritional rehabilitation in hospital of children suffering from severe protein-energy malnutrition (PEM). Design: Field experiment, two-way analysis of variance with one between group (short-versus long-stay) and one repeated measures factor (admission, then 12, 18, 24, 30 and 36 months post-admission). Covariates introduced. Setting: Primary health care, Kingston, Jamaica. Subjects: n = 81; mean age 11 months; 79 contribute longitudinal data; 44 every measurement. Interventions: When concurrent illnesses had been treated and normal feeding reestablished (weight gain 5 g/kg. day-1), subjects were randomly allocated to short-stay (SS) or long-stay (LS) group. LS retained in hospital for full nutritional rehabilitation mean 40 days). SS discharged immediately (mean 18 days) for standard Health Service care at home for 6 months plus high-energy supplement (3.31 MJ with 20.6 g protein daily) for first 3 months. After discharge LS received 6 months home care, but without supplementation. Results: Significant advantages for LS group on NCHS weight and length for age at discharge, and at 12, 18, 24 and for length also 30 months (P lt 0.05 to P lt 0.001). Weight advantage peaked at 12 and 18 months, length later at 18 and 24 months. Conclusions: Contrary to earlier reports, full nutritional rehabilitation can be achieved in hospital for children suffering from PEM. Although in the long-term both groups move towards expected levels in their home community, a significant advantage maintained for apprx 2 years is developmentally advantageous during the critical time after weaning.