GROWTH, MORBIDITY, AND MORTALITY OF CHILDREN IN DHAKA AFTER TREATMENTFOR SEVERE MALNUTRITION - A PROSPECTIVE-STUDY

Over 1300 severely malnourished children (<60% of US National Center f or Health Statistics weight-for-height, with edema, or both) are admit ted each year to the Children's Nutrition Unit in Dhaka. Fatality duri ng treatment is low and recovery is rapid. Our aim was to determine wh ether this initial success is sustained when children return home. A p revious attempt to address this question was frustrated by the difficu lty in tracing children after discharge because most are from slum set tlements and families move frequently. This prospective study with for tnightly monitoring was therefore undertaken. The main outcomes of int erest were anthropometric status, relapse, morbidity. and mortality. C hildren (n = 437) who had been treated for severe malnutrition when ag ed 12-59 mo and had reached the discharge criterion of 80% of weight-f or-height, were followed for the next 12 mo. During follow-up, 7.5% we re lost without trace, 0.6% relapsed, and 2.3% died. Morbidity was hig h, with a mean of seven episodes of diarrhea during the year. Outpatie nt visits for diarrhea occurred for 67% of children, and 58% had pneum onia (10% had pneumonia three times). After 12 mo, mean weight-for-hei ght was 91% (-0.92 z score) but mean height-for-age remained at 84% (- 4.14 z score). Weight gain, but not height gain, tended to be lower in children who experienced more diarrhea. Fever and cough were not asso ciated with either weight or height gain. The high prevalence of illne ss highlights the need for continued accessible health care and for in terventions to reduce disease acquisition.