title: Home-based rehabilitation of severely malnourished children using indigenous high-density diet.
abstract: OBJECTIVE
  To evaluate the efficacy, cost-effectiveness and acceptability of a 'high-density diet made from indigenous ingredients.
  
  
  METHODS
  The retrospective study was carried out from September 2009 to May 2010 in District Sanghar, Sindh, Pakistan. A field office was established and staff was recruited and trained. A baseline survey was done to screen for malnourished children aged 6-23 months using mid-upper arm circumference, for which a cut-off value of 115mm was adopted. The screened children with a weight-for-height z score <-3 were registered and were supplied the high-density diet and micronutrients. Their mothers were counselled on infant and young child feeding practices.
  
  
  RESULTS
  The mean age of 123 children in the study was 15.5±8.5 months, and mean weight was 5.91±1.18kg. Overall, 85(69%) children attained the target weight in a mean duration of 5.08±3.2 months. Besides, 29(23.5%) children were gaining weight, but had not achieved the target by the end of the study. The mean rate of weight-gain of children who recovered was 3.30±3.59 g/kg/day. No significant adverse effects were noted. There was no documented refusal of the therapeutic supplement. The net cost of rehabilitating a child was $34.31.
  
  
  CONCLUSIONS
  The high-density diet was reasonably efficacious in improving the nutritional status of severely malnourished children.
authors.affiliation: Honorary Chairperson, Health, Education and Literacy Programme (HELP), Pakistan; Former Chairperson of the Department of Pediatrics, Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Durre Samin
authors.initials: DS
authors.lastname: Akram
authors.affiliation: Senior Programme Manager, HELP, Karachi, Pakistan.
authors.forename: Yasmeen
authors.initials: Y
authors.lastname: Suleman
authors.affiliation: Department of Pediatrics, Dow University of Health Sciences, Karachi, Pakistan.
authors.forename: Hafsa Mohammed
authors.initials: HM
authors.lastname: Hanif
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D005527:Food, Fortified; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000178:diet therapy*; D008297:Male; D010154:Pakistan; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D013851:Thinness / Q000178:diet therapy*; D015430:Weight Gain
keywords: Community-based therapeutic care, High-density diet, High-density food supplement, Malnutrition, Ready-to-use therapeutic food, Severe acute malnutrition.