title: How effective is the integration of facility and community-based management of severe acute malnutrition in India?
abstract: METHODS
  All children admitted to two nutritional rehabilitation centres (NRCs) during 2011-2012 in Madhya Pradesh, India.
  
  
  OBJECTIVE
  To determine 1) adherence to in-patient care and follow-up visits, 2) attainment and maintenance of target weight gain, and 3) association with the children's demographic characteristics.
  
  
  METHODS
  A retrospective record review. The 74-day programme included 14 days of in-patient care, with subsequent home-based care and four follow-up visits to the NRC at 15-day intervals. The first three visits were part of the treatment, while the fourth was for assessment of sustained weight gain.
  
  
  RESULTS
  Of the 1027 children admitted, 900 (88%) completed in-patient care. Of these, 685 (76%) attended the first three follow-up visits, 482 (70%) of whom gained >15% of their admission weight. Of these, 409 (85%) completed four visits, 314 (77%) of whom were able to sustain their weight gain. Those unable to gain >15% weight by the third visit had a significantly lower proportion of sustained weight gain at the fourth visit. Children aged ⩾6 months had significantly higher odds (OR 4.5, 95%CI 3.1-6.2, P < 0.05) of completing in-patient care.
  
  
  CONCLUSIONS
  In-patient care combined with community-based follow-up was effective in adherence to follow-up visits; however, there is still room for improvement in attaining and sustaining the target weight.
authors.affiliation: Indian Institute of Public Health Delhi, Public Health Foundation of India, New Delhi, India.
authors.forename: B
authors.initials: B
authors.lastname: Kumar
authors.affiliation: Family Health International, Bhopal, India.
authors.forename: J
authors.initials: J
authors.lastname: Shrivastava
authors.affiliation: International Union Against Tuberculosis and Lung Disease, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Satyanarayana
authors.affiliation: Medical Department, Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg.
authors.forename: A J
authors.initials: AJ
authors.lastname: Reid
authors.affiliation: Medical Department, Operational Research Unit, Operational Centre Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg.
authors.forename: E
authors.initials: E
authors.lastname: Ali
authors.affiliation: Indian Institute of Public Health Delhi, Public Health Foundation of India, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Zodpey
authors.affiliation: Government of Madhya Pradesh, Bhopal, India.
authors.forename: M
authors.initials: M
authors.lastname: Agnani
keywords: Madhya Pradesh; adherence to follow-up; nutrition rehabilitation centre; weight gain