Objective: There is still controversy about the efficacy and cost-effectiveness of outreach nutrition rehabilitation centres (NRCs) for severely malnourished children. We wanted to compare the mortality rates and nutritional status of severely malnourished children admitted to rural NRCs in Gabu region, Guinea Bissau, with other severely malnourished children who were not rehabilitated and stayed in their villages.
Design: Retrospective cohort study over a 3-year period. Mortality rates and nutritional outcome compared for children who were admitted to rural NRCs and those who were not rehabilitated. Selection for admission to the NRCs was based on availability of places only.
Setting: 19 health areas of the Gabu region, Guinea Bissau, West Africa.
Subjects: 1038 severely malnourished children (< 60% weight-for-age using NCHS standards) aged 6 to 47 months. 354 were rehabilitated in NRCs and 684 received no rehabilitation.
Results: Up to 36 months follow-up the relative risk of death in the rehabilitated group was 0.75 [95% confidence interval (c.i.) = 0.57-0.99], equivalent to a 25% reduction in mortality. The difference in mortality between the two groups was much higher during the first 3 months [P < 0.02, relative risk = 0.59 (95% c.i. = 0.39-0.91)]. Rehabilitated children had a higher mean weight gain in the first 3 months (1.63 compared to 0.56 weight-for-age standard deviation score, P < 0.001), and weight gain differences lasted up to 18 months (P < 0.01).
Conclusions: Low-cost, outreach NRCs are effective both in the short term and in the mid-term to improve the nutritional situation and reduce the mortality of severely malnourished children.
PIP: Whether or not to provide nutrition rehabilitation for children with protein-energy malnutrition remains controversial. Hospital-based rehabilitation has been criticized as a waste of time and money due to the high levels of case fatality during treatment, after discharge, and among children who abscond. Nutrition rehabilitation centers (NRCs) were strongly recommended during the 1970s as an alternative to hospital treatment. International agencies have not, however, generally promoted NRCs as an integral part of primary health care. The authors measured the efficacy of rural NRCs in nineteen health areas in Gabu region, Guinea-Bissau, in reducing the mortality rates and improving the nutritional outcomes of severely malnourished children. The mortality rates and nutritional status of severely malnourished children admitted to the rural NRCs were compared with data on other severely malnourished children who were not rehabilitated and remained in their villages. 1038 children aged 6-47 months were involved in the study; 354 were rehabilitated and 684 were not. Up to 36 months follow-up, the relative risk of death in the rehabilitated group was 0.75, equivalent to a 25% reduction in mortality. The difference in mortality between the two groups was much higher during the first three months following intervention, with rehabilitated children having a higher mean weight gain during the first three months with weight gain differences lasting up to 18 months. Low-cost, outreach NRCs were therefore found to be effective both in the short term and in the mid term in improving the nutritional situation and reducing the mortality of severely malnourished children.