Long-stay versus short-stay hospital treatment of children suffering from severe protein-energy malnutrition.
OBJECTIVE
To contrast early discharge versus attempted full nutritional rehabilitation in hospital of children suffering from severe protein-energy malnutrition (PEM).


METHODS
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.


METHODS
Primary health care, Kingston, Jamaica.


METHODS
n = 81; mean age 11 months; 79 contribute longitudinal data; 44 every measurement.


METHODS
When concurrent illnesses had been treated and normal feeding re-established (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 & length for age at discharge, and at 12, 18, 24 and for length also 30 months (P < 0.05 to P < 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 approximately 2 years is developmentally advantageous during the critical time after weaning.
Heikens
G T
GT
Nijmegen Institute for International Health, Faculty of Medical Sciences, University of Nijmegen, The Netherlands.
Schofield
W N
WN
Dawson
S M
SM
Waterlow
J C
JC
D000704:Analysis of Variance; D001827:Body Height; D001835:Body Weight; D015362:Child Nutrition Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007902:Length of Stay; D009749:Nutrition Surveys; D011502:Protein-Energy Malnutrition / Q000175:diagnosis / Q000534:rehabilitation*