Malnourished children (mean age 1.2 years) referred from public health clinics to a paediatric metabolic ward in Kingston, Jamaica, were enrolled for treatment in a community-based health care project and were randomly allocated to one of two groups. The first group was treated at home with metronidazole and then for 6 months using the standard health care provided from local clinics by community health aides. The second group was given the same drug and home treatment, but in addition received a high energy supplement of 3.31 MJ daily for 3 months. We have previously shown a significant advantage in both weight and height gain for a group given the same supplement in contrast with standard health care controls (Heikens et al., 1989, Eur. J. Clin. Nutr. 43, 145-160), and in this study test the addition of a drug treatment aimed at reducing malabsorbtion due to a possible microbial overgrowth of the small bowel in malnourished children. This paper reports anthropometric findings showing significant benefits from both the drug and nutritional treatments. Greatest gains were by the group given both treatments, but the group given the antibiotic treatment, without energy supplementation, also made better growth recovery than did controls. Only 8% of the children treated with metronidazole failed to respond to community-based intervention and were admitted to hospital, compared with 19% for the other groups (P < 0.05). These findings support targetted high-energy supplementation for the rehabilitation of moderately malnourished children receiving health clinic care, and suggest further that such programs should include antibiotic treatment directed at SBBO.
PIP: In 1985-86 in Jamaica, a community-based health care project randomly allocated 81 3-36 month old malnourished children from the slums of metropolitan Kingston to either a group receiving home health care/clinic-based care and a 5-day course of a broad spectrum antibiotic, metronidazole (20 mg/kg/day), for 6 months or a group receiving these same interventions and a high energy supplement (HES) (790 kcal) containing 20.6 gm protein for 3 months to test the effect of these interventions on anthropometric measures of growth. The researchers also wanted to determine whether metronidazole would overcome malabsorption of nutrients due to small bowel bacterial overgrowth. Children of both groups benefited considerably from the interventions. For example, significant improvements in weight occurred almost immediately followed by improvements in length, resulting in a significant improvement in the body mass index (BMI) (p = .0001). Children receiving both HES and metronidazole made significantly greater gains than those who only received HES (weight, p = .02; length, p = .0002; and BMI, p = .0001). A significantly greater proportion of children did not respond to treatment and had to be hospitalized for infections, especially respiratory infections, in the HES only group than did those in the HES and metronidazole group (19% vs. 8%; p .05). None of the children receiving metronidazole died. Reduced morbidity, absence of case fatalities, and anthropometric improvements support the belief that home visits by community health aides in combination with clinic-based health services providing HES and antibiotic treatment to moderately malnourished children can indeed rehabilitate them.