title: Effects of community-based follow-up care in managing severely underweight children.
abstract: OBJECTIVE
  The aim of the present study was to assess the effects of community-based follow-up care, food supplementation, and/or psychosocial stimulation on the recovery of severely underweight children.
  
  
  METHODS
  A total of 507 severely underweight children (weight-for-age z score <-3) ages 6 to 24 months hospitalized at the International Center for Diarrheal Disease Research, Bangladesh, were randomly assigned to 1 of the following regimens for 3 months once they recovered from diarrhea: fortnightly follow-up care at the International Center for Diarrheal Disease Research, Bangladesh Hospital, including growth monitoring, health education, and micronutrient supplementation (group H-C, n = 102); fortnightly follow-up at community clinics, using the same treatment regimen as group H-C (group C-C, n = 99); community-based follow-up as per group C-C plus cereal-based supplementary food (SF) (group C-SF, n = 101); follow-up as per group C-C plus psychosocial stimulation (PS) (group C-PS, n = 102); or follow-up as per group C-C plus both SF and PS (group C-SF + PS, n = 103).
  
  
  RESULTS
  There were no significant differences in baseline characteristics by treatment group. Attendance at scheduled follow-up visits was greater in groups C-SF, C-SF + PS, and C-PS than in C-C and H-C; P < 0.05. Rates of weight gain were greater in groups C-SF + PS, C-SF, and C-PS (0.88-1.01 kg) compared with groups C-C and H-C (0.63-0.76 kg), P < 0.05. Three-factor analysis of covariance of the effects of treatment components indicated that weight gain and change in weight-for-age z score and weight-for-length z score were greater in groups that received SF (P < 0.05) and linear growth was greater among children managed in the community (P = 0.002).
  
  
  CONCLUSIONS
  Positioning follow-up services in the community increases follow-up visits and promotes greater linear growth; providing SF, with or without PS, increases clinic attendance and enhances nutritional recovery. Community-based service delivery, especially including SF, permits better rehabilitation of greater numbers of severely underweight children.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Sweden. ihossain@icddrb.org
authors.forename: Md Iqbal
authors.initials: MI
authors.lastname: Hossain
authors.forename: Baitun
authors.initials: B
authors.lastname: Nahar
authors.forename: Jena D
authors.initials: JD
authors.lastname: Hamadani
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Brown
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D001835:Body Weight; D002675:Child, Preschool; D003153:Community Health Services; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010349:Patient Compliance; D013851:Thinness / Q000453:epidemiology* / Q000534:rehabilitation* / Q000628:therapy*; D016896:Treatment Outcome; D015430:Weight Gain