title: Treatment of severe acute malnutrition in infants aged <6 months in Niger.
abstract: OBJECTIVE
  To report a nutritional rehabilitation program in Niger for the management of severe acute malnutrition in infants aged <6 months.
  
  
  METHODS
  This is a presentation of a case series (n = 632) of young infants who were admitted to a nutrition rehabilitation program in 2010-2011. The main characteristics of the inpatient treatment protocol where the use of diluted F-100 milk via a supplementary suckling technique until exclusive breastfeeding was reinitialized, coaching of mothers on infant feeding, and intensive antibiotic therapy as indicated during the stabilization phase. Semistructured interviews were conducted with 103 mothers.
  
  
  RESULTS
  Rates of recovery, mortality, and default were 85% (537 of 632), 6% (37 of 632), and 9% (55 of 632), respectively. The majority of infants had an infectious disease at study entry (81%), particularly acute watery diarrhea and respiratory tract infections. Infection on admission was a predictor of death during treatment (OR, 3.9; 95% CI, 1.6-9.2). Anorexia at entry was a risk factor for treatment failure (OR, 4.4; 95% CI, 1.71-11.1). Interviews revealed a very low rate of exclusive breastfeeding (3%), with delayed initiation in 68% of cases. Traditional beliefs, perceived insufficiency of breast milk, and psychological problems played important roles in feeding choices.
  
  
  CONCLUSIONS
  Severe acute malnutrition in infants aged <6 months can be successfully treated by managing cases as inpatients with an adapted protocol, intensive clinical supervision, and intensive drug treatment if indicated. Whether similar outcomes are achievable in community-based programs remains to be verified. Effective interventions for improving breastfeeding practices are needed.
authors.affiliation: Institute of Tropical Medicine and International Health, Charité Medical University, Berlin, Germany; Médecins Sans Frontières, Geneva, Switzerland. s.vygen@yahoo.de
authors.forename: Sabine B
authors.initials: SB
authors.lastname: Vygen
authors.forename: Dominique
authors.initials: D
authors.lastname: Roberfroid
authors.forename: Valérie
authors.initials: V
authors.lastname: Captier
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
mesh_terms: D000208:Acute Disease; D001942:Breast Feeding; D005260:Female; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000453:epidemiology / Q000401:mortality / Q000534:rehabilitation*; D008297:Male; D008895:Milk, Human; D009035:Mothers; D009548:Niger / Q000453:epidemiology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome