Hospital management of severely malnourished children: comparison of locally adapted protocol with WHO protocol.

OBJECTIVES To compare the effectiveness of locally adapted Institute of Child and Mother Health (ICMH) protocol with the WHO protocol for the management of severely malnourished children in Bangladesh. DESIGN Quasi-experimental non-randomized clinical trial. SETTING Hospital based. PARTICIPANTS Severely malnourished children (2-59 mo) with weight for height<70% (n=60). INTERVENTION Children treated with either WHO protocol (Group I, n=30) or ICMH protocol (Group II, n=30). OUTCOME VARIABLES Clinical improvement, weight gain, time taken to achieve target weight gain, and mortality among the study subjects. RESULTS Mean (SD) weight related to gain in Group I and Group II was 11.2 (4.1) and 11.1 (3.9) g/kg/day, respectively. The weight gain was not related to the age group or type of malnutrition. The time taken for edema to subside (7.3 d vs 8 d) and for improvement of appetite (6.5 d to 7.3 d vs 6.7 d to 8.4 d) was similar between the groups. The target weight gain was achieved in 28.3 (11.5) days in Group I against 27.9 (6.2) days in Group II (P=0.88). The mortality rate was 6.7% in each group. CONCLUSION Treatment of severe malnutrition with locally adapted ICMH protocol using locally available foods is as efficacious as the WHO protocol.