[Management of severe acute malnutrition in an urban nutritional rehabilitation center in Burkina Faso].
BACKGROUND
Management of acute severe malnutrition greatly contributes to the reduction of childhood mortality rate. In developing countries, where malnutrition is common, number of acute severe malnutrition cases exceeds inpatient treatment capacity. Recent success of community-based therapeutic care put back on agenda the management of acute severe malnutrition. We analysed key issues of inpatient management of severe malnutrition to suggest appropriate global approach.


METHODS
Data of 1322 malnourished children, admitted in an urban nutritional rehabilitation center, in Burkina Faso, from 1999 to 2003 were analyzed. The nutritional status was assessed using anthropometrics indexes. Association between mortality and variables was measured by relative risks. Kaplan-Meier survival curves and Cox model were used.


RESULTS
From the 1322 hospitalized children, 8.5% dropped out. Daily weight gain was 10.18 (+/-7.05) g/kg/d. Among hospitalized malnourished children, 16% died. Patients were at high risk of early death, as 80% of deaths occurred during the first week. The risk of dying was highest among the severely malnourished: weight-for-height<-4 standard deviation (SD), RR=2.55 P<0,001; low MUAC-for-age, RR=2.05 P<0.001. Kaplan-Meier survival curves and Cox model showed that the variables most strongly associated with mortality were weight-for-height and MUAC-for-age. Among children discharged from the nutritional rehabilitation centre, 10.9% had weight-for-height<-3 SD.


CONCLUSIONS
The nutrition rehabilitation centre is confronted with extremely ill children with high risk of death. There is need to support those units for appropriate management of acute severe malnutrition. It is also important to implement community-based therapeutic care for management of children still malnourished at discharge from nutritional rehabilitation centre. These programs will contribute to reduce mortality rate and number of severely malnourished children attending inpatient nutrition rehabilitation centers, by prevention and early management.
Savadogo
L
L
Département de biostatistique, école de santé publique, CP 598, université libre de Bruxelles, Bruxelles, Belgium. gueswende@hotmail.com
Zoetaba
I
I
Donnen
P
P
Hennart
P
P
Sondo
B K
BK
Dramaix
M
M
D000208:Acute Disease; D002050:Burkina Faso; D015362:Child Nutrition Disorders / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation / Q000628:therapy*; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000175:diagnosis / Q000401:mortality / Q000534:rehabilitation / Q000628:therapy*; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D009752:Nutritional Status; D016016:Proportional Hazards Models; D012047:Rehabilitation Centers; D012306:Risk; D013997:Time Factors; D014505:Urban Population; D015430:Weight Gain