Hospital management of severely malnourished children: comparison of locally adapted protocol with WHO protocol

Indian Pediatr. 2009 Mar;46(3):213-7. Epub 2009 Jan 1.


Objectives: To compare the effectiveness of locally adapted Institute of Child and Mother Health (ICMH) protocol with the WHO protocol for the management of severely malnourished children in Bangladesh.

Design: Quasi-experimental non-randomized clinical trial.

Setting: Hospital based.

Participants: Severely malnourished children (2-59 mo) with weight for height<70% (n=60).

Intervention: Children treated with either WHO protocol (Group I, n=30) or ICMH protocol (Group II, n=30).

Outcome variables: Clinical improvement, weight gain, time taken to achieve target weight gain, and mortality among the study subjects.

Results: Mean (SD) weight related to gain in Group I and Group II was 11.2 (4.1) and 11.1 (3.9) g/kg/day, respectively. The weight gain was not related to the age group or type of malnutrition. The time taken for edema to subside (7.3 d vs 8 d) and for improvement of appetite (6.5 d to 7.3 d vs 6.7 d to 8.4 d) was similar between the groups. The target weight gain was achieved in 28.3 (11.5) days in Group I against 27.9 (6.2) days in Group II (P=0.88). The mortality rate was 6.7% in each group.

Conclusion: Treatment of severe malnutrition with locally adapted ICMH protocol using locally available foods is as efficacious as the WHO protocol.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bangladesh / epidemiology
  • Child Nutrition Disorders / diet therapy*
  • Child Nutrition Disorders / drug therapy*
  • Child Nutrition Disorders / mortality
  • Child Welfare
  • Child, Preschool
  • Energy Intake
  • Female
  • Global Health
  • Hospitalization
  • Humans
  • Infant
  • Male
  • Minerals / therapeutic use*
  • Nutritional Status
  • Time Factors
  • Vitamins / therapeutic use*
  • Weight Gain
  • World Health Organization


  • Minerals
  • Vitamins