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Post discharge morbidities and mortalities among children with severe acute malnutrition who did not undergo nutrition rehabilitation

Prasenjit Mondal, M. Munirul Islam, Md. Iqbal Hossain, Sayeeda Huq, K. M. Shahunja, Md. Nur Haque Alam, Tahmeed Ahmed

Background: This prospective study evaluated the post discharge morbidities among children with severe acute malnutrition (SAM), including diarrhea and/or other acute illnesses, who did not agree to undergo the nutrition rehabilitation (NR) phase of management of SAM at Dhaka Hospital of icddr,b, Bangladesh. The probable causes of not undergoing NR were family and other unavoidable commitments. Methods: We prospectively followed up 90 children aged 6–59 months of both sexes suffering from SAM with associated morbidities who presented at the Dhaka Hospital of icddr,b during the period of May to August 2014 and did not undergo NR following acute phase management. Three follow-up schedules were planned at two week intervals. For the second follow-up, caregivers brought their children to the follow-up unit, while the others were carried out over the phone. Results: During the first follow-up, 37 of 70 (53%) reported different morbidities. Only 7 children came for the second follow-up and all of them required hospitalization for different morbidities. On third follow-up, 23 of 58 (40%) children reported morbidity. The odds of morbidities were 7.7 times higher (95% CI: 2.33– 26.58, p<0.0001) among the children who came from a poor family (monthly income < USD 127). Conclusions: Children with SAM and diarrhea bypassing the NR frequently suffered from different types of morbidities. Nutrition rehabilitation is an important component of the management of SAM. As such, nutrition programs should consider the inclusion of the community-based management of acute malnutrition for the complete management of SAM in young children.