Government of Madhya Pradesh, Atal Bal State Nutrition Mission and Integrated Child Development Services Program and National Rural Health Mission, Bhopal, India (MA and DDA); Gandhi Medical College, Bhopal, Madhya Pradesh, India (SB); Bundelkhand Medical College, Sagar, Madhya Pradesh, India (AKR); Gwalior Medical College, Gwalior, Madhya Pradesh, India (A Gaur); and UNICEF, Delhi, India (VMA, VA, A Garg, NB, and KS).
Am J Clin Nutr. 2013 Nov;98(5):1335-42. doi: 10.3945/ajcn.112.054080. Epub 2013 Sep 25.
At any point in time, an average 8 million Indian children suffer from severe acute malnutrition (SAM).
This article assesses the effectiveness of an integrated model for the management of SAM (IM-SAM) in India comprising facility- and community-based care and using locally adapted protocols.
Children (n = 2740) were randomly sampled from the 44,017 children aged 6-59 mo admitted to 199 Nutrition Rehabilitation Centers in the state of Madhya Pradesh (1 January to 31 December 2010).
On admission, 2.2% of children had edema, 23.4% had medical complications, 56% were girls, 79% were in the age group 6-23 mo, and 64% belonged to scheduled tribe or scheduled caste families. Fifty-six children (2.0%) with severe congenital or pathological conditions were transferred to the district hospital. Of the 2684 program exits, 10 children (0.4%) died, 860 (32.0%) did not complete treatment (defaulted), and 1814 (67.6%) were discharged after a mean (±SD) stay of 75.8 ± 9.4 d. The mean weight gain among discharged children was 2.7 ± 1.9 g · kg body wt(-1) · d(-1); on discharge, 1179 (65%) of the children had recovered (weight gain ≥15% of initial weight).
The survival rates in the IM-SAM program were very high. However, the moderate recovery rates documented seem to indicate that the protocols currently in use need to be improved. This trial was registered at clinicaltrials.gov as NCT01917734.
在任何时候，印度都有平均 800 万儿童患有严重急性营养不良（SAM）。
本文评估了印度一种综合管理严重急性营养不良模式（IM-SAM）的效果，该模式包括机构和社区护理，并使用了本土化的方案。
从马哈拉施特拉邦（2010 年 1 月 1 日至 12 月 31 日）199 个营养康复中心收治的 44017 名 6-59 月龄儿童中随机抽取了 2740 名儿童作为样本。
入院时，2.2%的儿童有水肿，23.4%有医疗并发症，56%为女孩，79%年龄在 6-23 月龄，64%来自在册种姓或在册部落家庭。56 名（2.0%）患有严重先天性或病理性疾病的儿童被转至地区医院。在 2684 名出院者中，有 10 名（0.4%）儿童死亡，860 名（32.0%）儿童未完成治疗（失访），1814 名（67.6%）儿童在平均（±标准差）75.8±9.4d 的住院治疗后出院。出院儿童的平均体重增加量为 2.7±1.9g·kg 体重·d(-1)；出院时，1179 名（65%）儿童康复（体重增加≥初始体重的 15%）。
IM-SAM 项目的生存率非常高。然而，记录的中等恢复率似乎表明，目前使用的方案需要改进。本试验在 clinicaltrials.gov 上注册为 NCT01917734。
