Integrated program achieves good survival but moderate recovery rates among children with severe acute malnutrition in India.
BACKGROUND
At any point in time, an average 8 million Indian children suffer from severe acute malnutrition (SAM).


OBJECTIVE
This article assesses the effectiveness of an integrated model for the management of SAM (IM-SAM) in India comprising facility- and community-based care and using locally adapted protocols.


METHODS
Children (n = 2740) were randomly sampled from the 44,017 children aged 6-59 mo admitted to 199 Nutrition Rehabilitation Centers in the state of Madhya Pradesh (1 January to 31 December 2010).


RESULTS
On admission, 2.2% of children had edema, 23.4% had medical complications, 56% were girls, 79% were in the age group 6-23 mo, and 64% belonged to scheduled tribe or scheduled caste families. Fifty-six children (2.0%) with severe congenital or pathological conditions were transferred to the district hospital. Of the 2684 program exits, 10 children (0.4%) died, 860 (32.0%) did not complete treatment (defaulted), and 1814 (67.6%) were discharged after a mean (±SD) stay of 75.8 ± 9.4 d. The mean weight gain among discharged children was 2.7 ± 1.9 g · kg body wt(-1) · d(-1); on discharge, 1179 (65%) of the children had recovered (weight gain ≥15% of initial weight).


CONCLUSIONS
The survival rates in the IM-SAM program were very high. However, the moderate recovery rates documented seem to indicate that the protocols currently in use need to be improved. This trial was registered at clinicaltrials.gov as NCT01917734.
Government of Madhya Pradesh, Atal Bal State Nutrition Mission and Integrated Child Development Services Program and National Rural Health Mission, Bhopal, India (MA and DDA); Gandhi Medical College, Bhopal, Madhya Pradesh, India (SB); Bundelkhand Medical College, Sagar, Madhya Pradesh, India (AKR); Gwalior Medical College, Gwalior, Madhya Pradesh, India (A Gaur); and UNICEF, Delhi, India (VMA, VA, A Garg, NB, and KS).
Víctor M
VM
Aguayo
Vandana
V
Agarwal
Manohar
M
Agnani
Dwarka
D
Das Agrawal
Sheela
S
Bhambhal
Ashok K
AK
Rawat
Ajay
A
Gaur
Aashima
A
Garg
Nina
N
Badgaiyan
Karanveer
K
Singh
D000208:Acute Disease; D000886:Anthropometry; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000628:therapy*; D015999:Multivariate Analysis; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D016896:Treatment Outcome; D015430:Weight Gain