LONG-STAY VERSUS SHORT-STAY HOSPITAL TREATMENT OF CHILDREN SUFFERING FROM SEVERE PROTEIN-ENERGY MALNUTRITION

Objective: To contrast early discharge versus attempted full nutrition al rehabilitation in hospital of children suffering from severe protei n-energy malnutrition (PEM). Design: Field experiment, two-way analysi s of variance with one between group (short- versus long-stay) and one repeated measures factor (admission, then 12, 18, 24, 30 and 36 month s post-admission). Covariates introduced. Setting: Primary health care , Kingston, Jamaica. Subjects: n = 81; mean age 11 months; 79 contribu te longitudinal data; 44 every measurement. Interventions: When concur rent illnesses had been treated and normal feeding reestablished (weig ht gain 5 g/kg.day(-1)), subjects were randomly allocated to short-sta y (SS) or long-stay (LS) group. LS retained in hospital for full nutri tional rehabilitation mean 40 days). SS discharged immediately (mean 1 8 days) for standard Health Service care at home for 6 months plus hig h-energy supplement (3.31 MJ with 20.6 g protein daily) for first 3 mo nths. After discharge LS received 6 months home care, but without supp lementation. Results: Significant advantages for LS group on NCHS weig ht and length for age at discharge, and at 12, 18, 24 and for length a lso 30 months (P < 0.05 to P < 0.001). Weight advantage peaked at 12 a nd 18 months, length later at 18 and 24 months. Conclusions: Contrary to earlier reports, full nutritional rehabilitation can be achieved in hospital for children suffering from PEM. Although in the long-term b oth groups move towards expected levels in their home community, a sig nificant advantage maintained for similar to 2 years is developmentall y advantageous during the critical time after weaning. Sponsorship: Fu lly funded by Ministry of Development Cooperation, the Netherlands, wi th cooperation of Ministry of Health, Kingston, Jamaica.