A Study on Comparison between WHO Protocol and Locally Adapted Dietary Protocol in the Management of Nutritional Marasmus At Hospitals in Bangladesh

ABSTRACT

Objectives: To compare the efficacy of locally adapted DMCHdietary protocol with the WHO protocol for the management ofnutritional marasmus in Bangladesh.Materials & Methods: A Hospital based Randomizedcontrolled Trial (RCT) was conducted on Marasmic children(06-59 years) with weight for height/length ≤ 3SD of themedian WHO references (n=62). Children treated with eitherWHO protocol (group-1, n=31) or DMCH protocol (Group-2,n=31). Clinical improvement, rate of weight gain, time taken toachieve target weight gain, return of appetite, return of smileand total cost of treatment were evaluated in both groups.Results: In DMCH group the time taken to achieve targetweight was 13.43 days which was around one day less thanthat of WHO group (14.33 days) and rate of weight gain washigher by around 2.6 gm/kg/day. Child receiving DMCHregimen took on average 3.47 days to return to smile the timewas 4.47 in WHO group (P< 0.01). Most importantly dailytreatment cost was higher by around 17 taka per day in WHOgroup. Neither of the group experienced any serious adverseeffect or fatality.Conclusion: Peanut based DMCH dietary regimen can beused effectively in the treatment of nutritional marasmus(without oedema) in the facility.