Treatment outcome in patients with severe acute malnutrition managed with protocolised care at malnutrition treatment corner in Rajasthan, India: a prospective observational study (quasi-experimental)

Rajendra P. Nagar, Teena Nagar, Brahm D. Gupta


Background: Malnutrition is rampant in paediatric age group. It is responsible for high morbidity, mortality and serious long term sequelae. In addition to critical care, a nutritional therapy followed by nutritional rehabilitation is a very important aspect for these children. Optimal management of these acutely ill children and a good outcome depends on an evidence based regimen of care.

Methods: Total 75 cases were enrolled in the study and nursed in malnutrition treatment corner and were fed in appropriate composition and quantity as per Indian academy of pediatrics guidelines (initial and rehabilitation phase; F75, F100 and staple food). All children were assessed daily for weight gain, improvement in clinical status, feeding problem, compliance with the treatment and improvement in the appetite.

Results: Out of 75 patients 63 (84%) patients were discharged. Dropout rate and mortality rate was 16% and 1.3% respectively. Majority patients were admitted for two weeks with mean duration of stay being 14.13 ± 9.1 days. Weight gain was good in 45, moderate in 22 and poor in 4 patients while 4 patients had weight loss during malnutrition treatment corner stay. Rate of weight gain was good in initial two weeks but as stay increased, rate of weight gain decreased in 3rd and 4th week with mean weight gain of 12.12±7.67 gm/kg/day. Twenty nine patients came for follow up after discharge and among them, 15(51.7%) patients had poor rate of weight gain, 9(31%) had moderate and 2 (6.89%) patients had good rate of weight gain whereas 3 patients had weight loss on follow up.

Conclusions: Severely malnourished children have a better weight gain and improvement in nutritional status while receiving protocolised care in malnutrition treatment corner, which results in faster recovery because it is well accepted and better tolerated. Hospital based management of these children in specialised feeding centre is very important for regaining lost weight.



Severe acute malnutrition, F75, F100, Staple food, protocolled care

Full Text:



The state of world children 2008. Child survival in Geneva- UNICEF flagship report. Available at URL: Accessed 22January 2008.

International Institute for Population Sciences (IIPS) and Macro International, 2007. National Family Health Survey (NFHS-3), 2005-06: India, Volume 1. Mumbai: IIPS.

Pelletier DL, Frongillo Jr EA, Schroeder DG, Habichet JP. The effect of malnutrition on child mortality. Bull World Health Organ. 1995;73:443-8.

Ahmed M, Ullah MM, Choudhary IA, Haqae ME, Salam MA. Mortality in severely malnourished children with diarrhoea and use of standardised management protocol. Lancet. 1999;353:1919-22.

Bhutta ZA, Ahemad T, Black RE, Cousens S, Dewey K, Giugliani El. Maternal and child under nutrition study group. What works? Intervention for maternal and child under nutrition and survival. Lancet. 2008;371:417-40.

Mamidi RS, Kulkarni B, Radhakrishana KV, Shatrugna V. Hospital based nutrition rehabilitation of severely undernourished children using energy dense local foods. Indian Pediatr 2010;47:687-93.

Savadogo L, Zoteba I, Donnen T, Hemart I, Sando BK, Dramix M. Management of severe malnutrition in urban NRC. Rev Epidemol Sante Publique. 2007;55:265-74.

Patel K, Gupta P, Shah D, Sethi K. Home-based rehabilitation of severely malnourished children in resource poor setting. Indian Pediatr. 2010;47:694-701.

Hossain MI, Nina S, Ahmed T, Golam MM, Kazi M, Nahar B, et al. Experience in Managing Severe Malnutrition in a Government Tertiary Treatment Facility in Bangladesh. J Health Popul Nutr. 2009;27:72-9.

Hossain MM, Hassan MQ, Rahman MH, Kabir ARML, Hannan AH, Rahman AKMF. Hospital management of severely malnourished children: comparision of locally adapted protocol with WHO protocol 2007. Indian Pediatr. 2010;46:213-7.

Gaboulaud V, Bouzoua N, Brasher C, Fedida G, Gergonne B, Brown V. Could nutritional rehabilitation at home complement or replace centre-based therapeutic feeding programmes for severe malnutrition? J Trop Pediatr. 2007;53:49-51.

Ashworth A, Chopra M, McCoy D, Sanders D, Jackson D, Karaolis N, et al. WHO guidelines for management of severe malnutrition in rural South African hospitals: Effect on case fatality and the influence of operational factors. Lancet. 2004;363:1110-5.