Rashid M A, Rahman M E, Kamruzzaman M, Islam M S, Moniruzzaman M M, Sabiha K, Albani S A, Mondol A R
Dr Muhammed Anisur Rashid, Junior Consultant Paeditrics, Upazilla Health Complex, Hathazari, Chattogram, Bangladesh; E-mail:
Mymensingh Med J. 2019 Oct;28(4):887-893.
Severe malnutrition is an important cause of death in children. According to new WHO-growth chart 2006, the proportion of children with severe wasting is 3.1% thus the total number being 4, 65000 (BDHS 2014). Overall risk of death among children with severe acute malnutrition (SAM) is 9 times more than well nourished children. The death rate among hospitalized children of SAM was as high as 15%. Once properly treated, severely malnourished children would grow up leading a normal life. Severe malnutrition in children can be successfully treated by using WHO guidelines that have been shown to be feasible and sustainable even in small district hospital with limited resources. A randomized controlled trial was conducted at department of Pediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2014 to September 2015. The trial enrolled 92 SAM patients (46 cases + 46 controls) aged 06 months to 59 months of either sex who meet the inclusion criteria consecutively. Enrolled children were randomized by lottery method into two groups, Group I and Group II. Patients in Group I was treated with F-75 and F-100 recipes and managed in two phases, initial stabilization phase with F-75 recipes then subsequently rehabilitation phase by F-100 recipes. Patients in Group II was treated with prepackaged F-75 & F-100 formulae and feeding was given in two phases i.e. initial stabilization phase and subsequently rehabilitation phase according to national guidelines for the management of severe malnourished children. Then play therapy was given for half an hour daily with red colored toy in Ashic play centre Dhaka Medical College Hospital for patients of both groups. The time (days) taken to return of appetite (mean±SD) was 5.1±1.16 and 4.8±1.34 in Group I and Group II respectively, disappearance of edema (mean±SD) 4.8±1.53 in and 4.9±1.05 for Group I Group II respectively, to gain target weight (mean±SD) 13.8±2.20 days and 13.5±1.74 days in Group I and Group II respectively, rate of weight gain (mean±SD) 17.70±7.07gm/kg/day for Group I and 16.20±4.63gm/kg/day for Group II. The side effects, diarrhea was equal in both group, vomiting was more in Group II, combined diarrhea and vomiting was more in Group I but the differences were not statistically significant. The treatment cost (mean±SD) was higher in Group II (97.2±78.24 BDT/child/day) than in Group I (58.5±54.36 BDT/child/day). Return of appetite and disappearance of oedema and target weight gain were similar in both groups but treatment cost was higher in Group II than Group I, which was statistically significant.
重度营养不良是儿童死亡的一个重要原因。根据世界卫生组织2006年新的生长图表，重度消瘦儿童的比例为3.1%，总数为46.5万（2014年孟加拉国人口与健康调查）。重度急性营养不良（SAM）儿童的总体死亡风险是营养良好儿童的9倍。住院的SAM儿童死亡率高达15%。一旦得到妥善治疗，重度营养不良的儿童长大后将过上正常生活。使用世界卫生组织的指南可以成功治疗儿童重度营养不良，这些指南已被证明即使在资源有限的小型地区医院也是可行和可持续的。2014年7月至2015年9月，在孟加拉国达卡达卡医学院医院儿科进行了一项随机对照试验。该试验连续纳入了92名年龄在6个月至59个月之间、符合纳入标准的SAM患者（46例+46例对照），男女不限。入选的儿童通过抽签法随机分为两组，第一组和第二组。第一组患者采用F-75和F-100配方进行治疗，并分两个阶段进行管理，初始稳定阶段采用F-75配方，随后康复阶段采用F-100配方。第二组患者采用预包装的F-75和F-100配方奶粉，并根据重度营养不良儿童管理的国家指南分两个阶段进行喂养，即初始稳定阶段和随后的康复阶段。然后，两组患者每天在达卡医学院医院阿希克游戏中心使用红色玩具进行半小时的游戏治疗。第一组和第二组食欲恢复所需时间（平均值±标准差）分别为5.1±1.16天和4.8±1.34天，水肿消失时间（平均值±标准差）第一组为4.8±1.53天，第二组为4.9±1.05天，达到目标体重所需时间（平均值±标准差）第一组为13.8±2.20天，第二组为13.5±1.74天，体重增加率（平均值±标准差）第一组为17.70±7.07克/千克/天，第二组为16.20±4.63克/千克/天。副作用方面，两组腹泻情况相同，第二组呕吐较多，第一组腹泻和呕吐合并情况较多，但差异无统计学意义。第二组的治疗费用（平均值±标准差）（97.2±78.24孟加拉塔卡/儿童/天）高于第一组（58.5±54.36孟加拉塔卡/儿童/天）。两组食欲恢复、水肿消失和目标体重增加情况相似，但第二组治疗费用高于第一组，差异具有统计学意义。
