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Effects of Community-based Follow-up Care in Managing Severely Underweight Children

Hossain, Md Iqbal*; Nahar, Baitun; Hamadani, Jena D.*; Ahmed, Tahmeed*; Brown, Kenneth H.

Journal of Pediatric Gastroenterology and Nutrition: September 2011 - Volume 53 - Issue 3 - p 310–319
doi: 10.1097/MPG.0b013e31821dca49
Original Articles: Hepatology and Nutrition

Objective: The aim of the present study was to assess the effects of community-based follow-up care, food supplementation, and/or psychosocial stimulation on the recovery of severely underweight children.

Patients and Methods: A total of 507 severely underweight children (weight-for-age z score <−3) ages 6 to 24 months hospitalized at the International Center for Diarrheal Disease Research, Bangladesh, were randomly assigned to 1 of the following regimens for 3 months once they recovered from diarrhea: fortnightly follow-up care at the International Center for Diarrheal Disease Research, Bangladesh Hospital, including growth monitoring, health education, and micronutrient supplementation (group H-C, n = 102); fortnightly follow-up at community clinics, using the same treatment regimen as group H-C (group C-C, n = 99); community-based follow-up as per group C-C plus cereal-based supplementary food (SF) (group C-SF, n = 101); follow-up as per group C-C plus psychosocial stimulation (PS) (group C-PS, n = 102); or follow-up as per group C-C plus both SF and PS (group C-SF + PS, n = 103).

Results: There were no significant differences in baseline characteristics by treatment group. Attendance at scheduled follow-up visits was greater in groups C-SF, C-SF + PS, and C-PS than in C-C and H-C; P < 0.05. Rates of weight gain were greater in groups C-SF + PS, C-SF, and C-PS (0.88–1.01 kg) compared with groups C-C and H-C (0.63–0.76 kg), P < 0.05. Three-factor analysis of covariance of the effects of treatment components indicated that weight gain and change in weight-for-age z score and weight-for-length z score were greater in groups that received SF (P < 0.05) and linear growth was greater among children managed in the community (P = 0.002).

Conclusions: Positioning follow-up services in the community increases follow-up visits and promotes greater linear growth; providing SF, with or without PS, increases clinic attendance and enhances nutritional recovery. Community-based service delivery, especially including SF, permits better rehabilitation of greater numbers of severely underweight children.

*International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B)

Institute of Mother and Child Health, Uppsala University, Sweden

Department of Nutrition and Program in International and Community Nutrition, University of California, Davis.

Address correspondence and reprint requests to Md Iqbal Hossain, MBBS, DCH, PhD, Centre for Nutrition and Food Security, Dhaka Hospital, ICDDR,B, Mohakhali, Dhaka 1212, Bangladesh (e-mail:

Received 17 August, 2010

Accepted 20 February, 2011

The study was funded by Sida-SAREC, Sweden, the Program in International and Community Nutrition, UC Davis, the Fogarty International Center (NIH Research Grant No. D43 TW01267), and ICDDR,B and its donors which provide unrestricted support to the Center for its operations and research. Current donors providing unrestricted support include Australian Agency for International Development, Government of the People's Republic of Bangladesh, Canadian International Development Agency, Embassy of the Kingdom of the Netherlands, Swedish International Development Cooperation Agency (Sida), Swiss Agency for Development and Cooperation, and Department for International Development, United Kingdom. registration no. NCT01157741.

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN