Treatment of children with malnutrition and diarrhoea

Abstract

Researchers at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in Dhaka examined the effects of a standardized protocol against a nonstandardized treatment. The research focused on the management of severely malnourished children with diarrhea. The results showed a 9% mortality in the test group (standardized treatment) whereas mortality in the control group (nonstandardized treatment) was 17%. In addition, only 40% of children in the test group received intravenous infusions, compared with 70% of the controls. In this study, the nature and amount of intravenous therapy suggests that the deaths were due primarily to malnourishment. In line with this and in recognition of the fatal consequences of infection on severe protein-energy malnutrition, WHO has produced a manual on the management of this deficiency. Three conventional phases of treatment are presented in this manual, which are in accordance with the conclusions of the ICDDR,B study: to avoid intravenous therapy and the use of low-sodium rehydration solution. Priorities in the first phase are rehydration, treatment of infection, and provision of important trace elements. In the second phase, the daily requirements do not exceed 80-100 kcal/kg of energy and 1 g protein/kg. The final phase is initiated when appetite has been restored, and high-energy feeds with reasonable amounts of protein can be safely given. The comprehensive distribution of this manual in developing countries is recommended, together with proper training for doctors and nurses.