RESUMO
OBJECTIVES: To compare the effectiveness of locally adapted Institute of Child and Mother Health (ICMH) protocol with the WHO protocol for the management of severely malnourished children in Bangladesh. DESIGN: Quasi-experimental non-randomized clinical trial. SETTING: Hospital based. PARTICIPANTS: Severely malnourished children (2-59 mo) with weight for height<70% (n=60). INTERVENTION: Children treated with either WHO protocol (Group I, n=30) or ICMH protocol (Group II, n=30). OUTCOME VARIABLES: Clinical improvement, weight gain, time taken to achieve target weight gain, and mortality among the study subjects. RESULTS: Mean (SD) weight related to gain in Group I and Group II was 11.2 (4.1) and 11.1 (3.9) g/kg/day, respectively. The weight gain was not related to the age group or type of malnutrition. The time taken for edema to subside (7.3 d vs 8 d) and for improvement of appetite (6.5 d to 7.3 d vs 6.7 d to 8.4 d) was similar between the groups. The target weight gain was achieved in 28.3 (11.5) days in Group I against 27.9 (6.2) days in Group II (P=0.88). The mortality rate was 6.7% in each group. CONCLUSION: Treatment of severe malnutrition with locally adapted ICMH protocol using locally available foods is as efficacious as the WHO protocol.
