Abstract
BackgroundGlobally, it is estimated that 50 million children under five are wasted. National nutrition survey-2018 has shown that 23.3 and 45.5% of children are wasted and stunted in Pakistan. Many studies have shown that hospital-based management of malnutrition is not practical due to high cost and iatrogenic infections and currently WHO recommends community-based management of malnutrition with provision of therapeutic food. There is limited evidence of community rehabilitation of malnourished children by using home fortified diet in Pakistan. This study explores use of energy dense, home fortified diet in achieving weight gain of malnourished children in Karachi.MethodsA descriptive, retrospective chart review of pediatric patients (aged 6 month–5 years) seen in Indus Hospital between January 2017 to June 2018 was conducted. A pre-designed data abstraction form was used to record detailed information about demographic characteristics, feeding, anthropometric, micronutrient, and nutritional details at enrollment and on follow-up.ResultsA total of 361 patients were included in the final analysis. The median age (IQR) of children was 15 (14) months. Forty eight percent (n = 172) children had diarrhea and 54% (n = 195) children had respiratory tract infection. The median length of stay in the program was 28 days. The median (IQR) for average weight gain was 4.8 (0–10.3) g/Kg/day, 64.6% (n = 226) children defaulted, 29% (n = 102) were cured and 3% (n = 10) died.ConclusionThis study showed adequate weight gain and recovery in malnourished children by using home fortified diet in real life situations without using therapeutic food or monetary support. Home fortified diets may serve as effective strategy in community-based rehabilitation of malnourished children.
Highlights
It is estimated that 50 million children under five are wasted
Participants A total of 490 children were screened for malnutrition
Of the 361 patients, malnutrition was identified in 97% children (n = 353) on basis of mid upper arm circumference (MUAC)
Summary
National nutrition survey-2018 has shown that 23.3 and 45.5% of children are wasted and stunted in Pakistan. There is limited evidence of community rehabilitation of malnourished children by using home fortified diet in Pakistan. It was estimated that in year 2019, one hundred and forty-four million children under five were wasted globally and South Asia was the epicenter of the global burden [1]. National nutrition survey-2018 of Pakistan reflects high burden of malnutrition in children under 5 years. Inpatient management did not prove to be practical due to several constraints which included high cost of management, iatrogenic infections and cost to families due to prolonged hospital stay [4] Due to these challenges, WHO revised treatment guidelines and recommended that only complicated malnourished children should be treated in hospitals while uncomplicated cases should be managed in community-based settings [3]. In order to ensure optimal diet for community management, in resourcerestrained countries UNICEF recommended either use of therapeutic diets like Ready to use therapeutic feed (RUTF) [5] and Corn Soya Blend (CSB) [6] or fortification of local diet with products like Micro Nutrient Powder (MNP) [7]
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