title: Controlled trial of three approaches to the treatment of severe malnutrition.
abstract: Domiciliary treatment of severely malnourished children could have economic and practical advantages over other methods. We compared three approaches in a controlled trial. 437 children in Dhaka (< 60% weight-for-height, and/or oedema) aged 12-60 months were sequentially allocated to treatment as inpatients, to day-care, or to care at home after one week of day-care. Institutional and parental costs incurred to reach 80% weight-for-height were compared. Costs for inpatient, day-care, and at-home groups averaged 6363, 2517, and 1552 taka (60 taka = UK pound 1). Mortality was low (< 5%) in all three groups. Day-care treatment approached inpatient care for speed of recovery at less than half the cost, but it was unpopular with parents. The at-home group took significantly longer to attain 80% weight-for-height than the other groups, but did so at the lowest average cost. Parental costs were highest for the at-home group as no food supplements were provided; nevertheless this was the most popular option. We conclude that at-home management of severely malnourished children after 1 week of inpatient care is a cost-effective strategy.
authors.affiliation: Centre for Human Nutrition, London School of Hygiene and Tropical Medicine, UK.
authors.forename: S
authors.initials: S
authors.lastname: Khanum
authors.forename: A
authors.initials: A
authors.lastname: Ashworth
authors.forename: S R
authors.initials: SR
authors.lastname: Huttly
mesh_terms: D002675:Child, Preschool; D003631:Day Care, Medical / Q000191:economics; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D011502:Protein-Energy Malnutrition / Q000178:diet therapy* / Q000191:economics; D015430:Weight Gain