Treatment of children suffering from severe malnutrition in an area of Santiago, Chile.

Despite marked progress in recent years, infant and young child malnutrition remains a serious health problem in Chile. To help define the nature of that problem better, researchers working in the Southeastern Metropolitan Area of Santiago conducted a survey of infants classified as having grade 2 protein-calorie malnutrition (PCM) and children under age 2 classified as having grade 3 PCM during the period March 31-October 1, 1980. The survey, based on a review of health facility records for all children in the area receiving care during the study period, found a total of 388 infants with grade 2 PCM and 102 subjects under 2 with grade 3 PCM. The study also found that the subjects who received comprehensive professional outpatient care at the area's Infant Nutrition Center fared significantly better than those cared for at outpatient health centers. The authors therefore recommend that the treatment of such children should be referred to or coordinated with centers that are diagnostically and therapeutically more sophisticated than the outpatient health centers. In this vein, it appears that the style of treatment provided by the Infant Nutrition Center could be developed more broadly throughout Chile and could be effectively employed in other countries with similar situations. It also appears, however, that malnourished children cannot be treated effectively as outpatients because they have very unsatisfactory home environments. One alternative approach is such cases is to admit the child as an inpatient to a special nutritional recovery center. Hospitalization, which typically occurs when the child is suffering from 1 or more pathologic conditions besides malnutrition, constitutes another alternative. However, the present survey found that the nutritional status of hospitalized study children did not improve, on the average, and some subjects experienced a marked nutritional deterioration. Another important point is that over 1/4 of the malnourished study children had low birthweights or had been premature. This underscores the importance of avoiding low birthweights as much as possible, and then giving low birthweight infants adequate care and treatment. In addition, clear standards should be established for the feeding of low birthweight children and for determining their nutritional status.