Back
 OJPed  Vol.5 No.4 , December 2015
Outcomes of Severely Malnourished Children Aged 6 - 59 Months on Outpatient Management Program in Kitui County Hospital, Kenya
Abstract: Severe acute malnutrition is a widely prevalent problem in developing countries and a major cause of morbidity and mortality. Traditionally, children with severe acute malnutrition were rehabilitated within inpatient services. Advent of ready to use therapeutic food made it possible to treat majority of these children in their homes. However, there is limited data about the outcomes of the program. Objectives: To determine the outcomes (recovery, default, mean weight gain and non-response rates) of severely malnourished children aged 6 - 59 months enrolled in outpatient therapeutic program at Kitui County Hospital. Methodology: A prospective longitudinal study design was carried out for one month. Hundred and four (104) children with SAM were recruited in the study. Anthropometric measurements, physical examination and appetite test of the children were conducted on a weekly basis for 28 days. Descriptive analysis was conducted using means, frequency and proportions. Paired t test was computed for mean weight gain and mid-upper arm circumference between admission and subsequent visits. Results: The findings of the study revealed that the recovery rate was 73.3%, weight gain rate of 5.1 g/kg/day, defaulter rate was 2.9% and non-response rate was 13.9% (WHZ = -3SD). Mean weight increased from 6.8 kg on the 1st visit to 7.5 kg in the 4th visit (P = 0.000) and the meanmid-upper arm circumferenceincreased from 11.1 cm at admission to 11.9 cm at 4th visit (P = 0.000). Conclusion: The recovery and weight gain rates were below the global acceptable SPHERE of minimum standards (recovery rate > 75% and weight gain rate > 8 g/kg/day). The defaulter rate was within the acceptable international standards (<15%).
Cite this paper: Mbaya, D. , Bitok, L. , Karani, A. , Osano, B. and Habtu, M. (2015) Outcomes of Severely Malnourished Children Aged 6 - 59 Months on Outpatient Management Program in Kitui County Hospital, Kenya. Open Journal of Pediatrics, 5, 326-333. doi: 10.4236/ojped.2015.54049.
References

[1]   Isanaka, S., Villamor, E., Shepherd, S. and Grais, R.F. (2009) Assessing the Impact of the Introduction of the World Health Organization Growth Standards and Weight-for-Height Z-Score Criterion on the Response to Treatment of Severe Acute Malnutrition in Children: Secondary Data Analysis. Malnutrition in Children. Paediatrics, 123, e54-e59.
http://dx.doi.org/10.1542/peds.2008-1375

[2]   Collins, S., Sadler, K., Dent, N., Khara, T., Guerrero, S., Myatt, M., Saboya, M. and Walsh, A. (2006) Key Issues in the Success of Community-Based Management of Severe Malnutrition. Food and Nutrition Bulletin, 27, S49-S82.
http://dx.doi.org/10.1177/15648265060273S304

[3]   Briend, A. and Collins, S. (2010) Therapeutic Nutrition for Children with Severe Acute Malnutrition Summary of African Experience. Indian Pediatrics, 47, 655-659.
http://dx.doi.org/10.1007/s13312-010-0094-2

[4]   Black, R.E., Morris, S.S. and Bryce, J. (2003) Where and Why 10 Million Children Are Dying Every Year? Lancet Child Survival Series 1, 361, 2226-2234.

[5]   Alderman, H. (2006) Long Term Consequences of Early Childhood Malnutrition. Oxford Economic Papers, 58, 450-474.
http://dx.doi.org/10.1093/oep/gpl008

[6]   Del, R. and Joy, M. (2008) Madagascar’s Pilot Program for Community Management of Acute Malnutrition: Evaluation Highlights. Basic Support for Institutionalizing Child Survival (BASICS) for USAID 2008, Arlington.

[7]   Lapidus, N., Luquero, F.J., Gaboulaud, V., Shepherd, S. and Grais, R.F. (2009) Prognostic Accuracy of WHO Growth Standards to Predict Mortality in a Large-Scale Nutritional Program in Niger. PLOS Medicine, 6, e1000039.
http://dx.doi.org/10.1371/journal.pmed.1000039

[8]   Econinck, H., Swindale, A., Grant, F. and Navarro-Colorado, C. (2008) Review of Community-Based Management of Acute Malnutrition (CMAM) in the Postemergency Context: Synthesis of Lessons on Integration of CMAM into National Health Systems. The Cases of Ethiopia, Malawi and Niger. FANTA Project, Academy for Educational Development, Washington DC.

[9]   WHO (2013) Guideline Update: Technical Aspects of the Management of Severe Acute Malnutrition in Infants and Children. World Health Organization, Geneva.

[10]   Ciliberto, M.A., Sandige, H., Ndekha, M.J., Ashorn, P., Briend, A., Ciliberto, H.M. and Manary, M.J. (2005) Comparison of Home-Based Therapy with Ready-to-Use Therapeutic Food with Standard Therapy in the Treatment of Malnourished Malawian Children: A Controlled, Clinical Effectiveness Trial. American Journal of Clinical Nutrition, 81, 864-870.

[11]   Khanum, S., Ashworth, A. and Huttly, S.R. (1994) Controlled Trial of Three Approaches to the Treatment of Severe Malnutrition. The Lancet, 344, 1728-1732.
http://dx.doi.org/10.1016/S0140-6736(94)92885-1

[12]   Israel, G.D. (1992) Sampling: The Evidence of Extension Program Impact. Program Evaluation and Organizational Development, IFAS, University of Florida; PEOD-5.
http://edis.ifas.ufl.edu/pdffiles/PD/PD00500.pdf3/6/2011

[13]   Teferi, E., Lera, M., Sita, S., Bogale, Z., Datiko, D.G. and Yassin, M.A. (2010) Treatment Outcome of Children with Severe Acute Malnutrition Admitted to Therapeutic Feeding Centers in Southern Region of Ethiopia. Ethiopian Journal of Health Development, 24, 234-238.

[14]   Dent, N. (2009) Outpatient Management of Acute Malnutrition in a Kenyan Urban Slum Context: Caseloads and Challenges. Malawi Medical Journal, 21, 123-159.

[15]   Nalwa, G.M. (2012) Outcomes of Severely Malnourished Children Aged 6 to 60 Months on Outpatient Management in Nairobi.

[16]   Yebyo, H.G., Kendall, C., Nigusse, D. and Lemma, W. (2013) Outpatient Therapeutic Feeding Program Outcomes and Determinants in Treatment of Severe Acute Malnutrition in Tigray, Northernethiopia: A Retrospective Cohort Study. PLoS ONE, 8, e65840.

[17]   Tadesse, E., Berhane, Y., Hjern, A., Olsson, P. and Ekstrom, E. (2015) Perceptions of Usage and Unintended Consequences of Provision of Ready-to-Use Therapeutic Food for Management of Severe Acute Child Malnutrition. A Qualitative Study in Southern Ethiopia. Health Policy and Planning, 2015, 1-8.

[18]   Messina, M.J. (1999) Legumes and Soybeans: Overview of Their Nutritional Profiles and Health Effects. American Journal of Clinical Nutrition, 70, 439S-450S.

[19]   Perdigón, G., Nader de Macías, M.E., álvarez, S., Oliver, G. and Pescede Ruiz Holgado, A. (1986) Effect of Perorally Administered Lactobacilli on Macrophage Activation in Mice. Infection and Immunity, 53, 104-410.

[20]   Defourny, I., Drouhin, E., Terzian, M., Tatay, M., Sekkenes, J., et al. (2006) Scaling up the Treatment of Acute Childhood Malnutrition in Niger. Field Exchange, 28, 2-4.

[21]   Taylor, A. (2002) Outpatient Therapeutic Programme (OTP): An Evaluation of a New SC UK Venture in North Darfur, Sudan. Taken from Field Exchange Issue 16, 2002.

[22]   Chaiken, S., Deconinck, H. and Degefie, T. (2006) The Promise of a Community-Based Approach to Managing Severe Malnutrition: A Case Study from Ethiopia. Food and Nutrition Bulletin, 27, 95-104.
http://dx.doi.org/10.1177/156482650602700201

[23]   Collins, S. (2002) Outpatient Care for Severely Malnourished Children in Emergency Relief Programs: A Retrospective Cohort Study. The Lancet, 360, 1824-1830.
http://dx.doi.org/10.1016/S0140-6736(02)11770-3

[24]   Chane, T., Oljira, L., Atomesa, G.E. and Agedew, E. (2014) Treatment Outcome and Associated Factors among Under-Five Children with Severe Acute Malnutrition Admitted to Therapeutic Feeding Unit in Woldia Hospital, North Ethiopia. Journal of Nutrition & Food Sciences, 4, 329.
http://dx.doi.org/10.4172/2155-9600.1000329

[25]   Hossain, M.I., Dodd, N.S., Ahmed, T., et al. (2009) Experience in Managing Severe Malnutrition in a Government Tertiary Treatment Facility in Bangladesh. Journal of Health, Population and Nutrition, 27, 72-80.
http://dx.doi.org/10.3329/jhpn.v27i1.3319

[26]   Gebremichael, M., Bezabih, A.M. and Tsadik, M. (2014) Treatment Outcomes and Associated Risk Factors of Severely Malnourished under Five Children Admitted to Therapeutic Feeding Centers of Mekelle City, Northern Ethiopia. Open Access Library Journal, 1, e446.
http://dx.doi.org/10.4236/oalib.1100446

[27]   Patel, D., Gupta, P., Shah, D. and Sethi, K. (2010) Home-Based Rehabilitation of Severely Malnourished Children in Resource Poor Setting. Indian Paediatrics, 47, 694-710.
http://dx.doi.org/10.1007/s13312-010-0102-6

 
 
Top