Collins Steve, Sadler Kate
Valid International, Stockwell, London, UK.
Lancet. 2002 Dec 7;360(9348):1824-30. doi: 10.1016/S0140-6736(02)11770-3.
In emergency nutritional relief programmes, therapeutic feeding centres are the accepted intervention for the treatment of severely malnourished people. These centres often cannot treat all the people requiring care. Consequently, coverage of therapeutic feeding centre programmes can be low, reducing their effectiveness. We aimed to assess the effectiveness of outpatient treatment for severe malnutrition in an emergency relief programme.
We did a retrospective cohort study in an outpatient therapeutic feeding programme in Ethiopia from September, 2000, to January, 2001. We assessed clinical records for 170 children aged 6-120 months. The children had either marasmus, kwashiorkor, or marasmic kwashiorkor. Outcomes were mortality, default from programme, discharge from programme, rate of weight gain, and length of stay in programme.
144 (85%) patients recovered, seven (4%) died, 11 (6%) were transferred, and eight (5%) defaulted. Median time to discharge was 42 days (IQR 28-56), days to death 14 (7-26), and days to default 14 (7-28). Median rate of weight gain was 3.16 g kg(-1) x day(-1) (1.86-5.60). In patients who recovered, median rates of weight gain were 4.80 g kg(-1) day(-1) (2.95-8.07) for marasmic patients, 4.03 g x kg(-1) x day(-1) (2.68-4.29) for marasmic kwashiorkor patients, and 2.70 g x kg(-1) x day(-1) (0.00-4.76) for kwashiorkor patients.
Outpatient treatment exceeded internationally accepted minimum standards for recovery, default, and mortality rates. Time spent in the programme and rates of weight gain did not meet these standards. Outpatient care could provide a complementary treatment strategy to therapeutic feeding centres. Further research should compare the effectiveness of outpatient and centre-based treatment of severe malnutrition in emergency nutritional interventions.
在紧急营养救助项目中，治疗性喂养中心是治疗严重营养不良人群的公认干预措施。这些中心往往无法治疗所有需要护理的人。因此，治疗性喂养中心项目的覆盖范围可能较低，从而降低其有效性。我们旨在评估紧急救助项目中门诊治疗严重营养不良的有效性。
我们于2000年9月至2001年1月在埃塞俄比亚的一个门诊治疗性喂养项目中进行了一项回顾性队列研究。我们评估了170名年龄在6至120个月的儿童的临床记录。这些儿童患有消瘦症、夸希奥科病或混合型营养不良。结局指标包括死亡率、退出项目率、出院率、体重增加率和在项目中的停留时间。
144名（85%）患者康复，7名（4%）死亡，11名（6%）被转诊，8名（5%）退出项目。出院的中位时间为42天（四分位间距28 - 56天），死亡时间为14天（7 - 26天），退出项目时间为14天（7 - 28天）。体重增加的中位速率为3.16克·千克⁻¹·天⁻¹（1.86 - 5.60）。在康复的患者中，消瘦症患者体重增加的中位速率为4.80克·千克⁻¹·天⁻¹（2.95 - 8.07），混合型营养不良患者为4.03克·千克⁻¹·天⁻¹（2.68 - 4.29），夸希奥科病患者为2.70克·千克⁻¹·天⁻¹（0.00 - 4.76）。
门诊治疗在康复、退出项目和死亡率方面超过了国际公认的最低标准。在项目中花费的时间和体重增加率未达到这些标准。门诊护理可为治疗性喂养中心提供一种补充治疗策略。进一步的研究应比较紧急营养干预中门诊治疗和基于中心治疗严重营养不良的有效性。
