عنوان ترانسليتريتد: Prise en charge ambulatoire des enfants modérément et sévèrement mal nourris dans la zone de santé rurale de Kapolowe au Shaba (Zaïre).

المؤلفون: Tellier V; Urité de nutrition, Institut de médecine tropicale, 155 Nationalestraat, B-2000 Anvers, Belgique., Luboya N, De Graeve G, Beghin I

المصدر: Sante (Montrouge, France) [Sante] 1996 Jul-Aug; Vol. 6 (4), pp. 213-9.

نوع المنشور: English Abstract; Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: John Libbey Eurotext Country of Publication: France NLM ID: 9212437 Publication Model: Print Cited Medium: Print ISSN: 1157-5999 (Print) Linking ISSN: 11575999 NLM ISO Abbreviation: Sante Subsets: MEDLINE

مواضيع طبية MeSH: Ambulatory Care*/economics , Rural Health*, Nutrition Disorders/*therapy, Attitude to Health ; Body Height ; Breast Feeding ; Democratic Republic of the Congo ; Dietary Proteins/administration & dosage ; Follow-Up Studies ; Health Care Costs ; Home Nursing ; Humans ; Infant ; Infant Care ; Infant Food ; Mother-Child Relations ; Patient Dropouts ; Patient Education as Topic ; Professional-Family Relations ; Soybean Proteins/administration & dosage ; Survival Rate ; Weight Gain

مستخلص: In Kapalowe rural health district, hospitalisation of malnourished children is restricted to complicated cases; once the complication is under control or eliminated, the child's treatment is continued at home, based on a 13 weeks contract, between parents and health centre. The parents commit themselves to feed their child four times a day (two porridge and two family dish portions), to consult once a week at the health centre and to welcome a weekly home visit. The objective of this visit is to support the parents, to detect possible problems and to reach the roots for this particular child. During the contract period, cost of medical treatment and recommended soya flour, is borne by the parents through a lump sum contribution. In this article, data concerning the first 95 children home rehabilitated (1989-1991) in Kapalowe are analysed. Characteristics of these children are classical regarding malnutrition; for example, age distribution is similar to that of weaning and of defunction of children at the hospital during the same year. Approximately half of them are still breastfed at the beginning of the contract. Most of them are correctly immunized and have been seen at the health centre at least two times in the last six months. Seventy-four children finished the contract; there were 17 abandons and 4 deaths. Weight gain is inferior to that observed in specialized feeding centres which do benefit from external resources, which is not the case here. It was not possible to show a significant catch up for the height for age indicator after the three months contract. These anthropometrical results are less important than the global and subjective improvement in the child's general health status observed at the end of the contract. None of the children reached the target weight after 13 weeks but important changes were observed in their behaviour, in their resistance to infection and in the attitude of their parents. The parents generally followed the instructions quite well. The middle of the contract seems to be a key period when either significative changes happen or when the attention is released. Treatment instructions have been amended to avoid monotony and overload, and to stimulate staff creativity and self-satisfaction. Payment was not a problem for the parents as malnutrition is not linked to extreme poverty. Mother's attitude and confidence and child initial weight for height status are two important contract success determinants. Abandons are more frequent when the mother is pessimistic and in case of kwashiorkor. Despite this, most of these children had gained more than one kilo before the contract was interrupted. Some didn't fulfill the W/H inclusion criteria (-2 standard deviations) and should probably not have been under contract. The four deaths were linked to insufficient treatment instructions for usually banal diseases that have another meaning in case of malnutrition, such as diarrhoea, fever, etc. An evaluation performed three months after the end of the contract in 26 children show 13 further improvements, 8 statu quo, 4 relapses and 2 new deaths. Conclusions are that home nutritional rehabilitation is possible where a health district is fully operational, that anthropometric data are useful to monitor rehabilitation but not to be pursued only as sole and ultimate objectives, and that adequate follow up after the first intensive stage is essential. The paper also shows how such a research result can have direct consequences on the organization of health activities.

عنوان ترانسليتريتد: Faut-il fermer les centres de récupération nutritionnelle ambulatoire à Niamey (Niger)? Analyse de situation, propositions et évaluation d'une intervention.

المؤلفون: Barennes H

المصدر: Sante (Montrouge, France) [Sante] 1996 Jul-Aug; Vol. 6 (4), pp. 220-8.

نوع المنشور: English Abstract; Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: John Libbey Eurotext Country of Publication: France NLM ID: 9212437 Publication Model: Print Cited Medium: Print ISSN: 1157-5999 (Print) Linking ISSN: 11575999 NLM ISO Abbreviation: Sante Subsets: MEDLINE

مواضيع طبية MeSH: Ambulatory Care* , Infant Nutritional Physiological Phenomena*, Nutrition Disorders/*therapy, Attitude of Health Personnel ; Child, Preschool ; Costs and Cost Analysis ; Educational Status ; Family ; Follow-Up Studies ; Health Knowledge, Attitudes, Practice ; Humans ; Infant ; Infant Food ; Infant Mortality ; Length of Stay ; Mother-Child Relations ; Niger/epidemiology ; Nutrition Disorders/epidemiology ; Nutritional Status ; Patient Compliance ; Patient Transfer ; Prevalence ; Retrospective Studies ; Social Support ; Treatment Outcome ; Urban Health ; Weight Gain

مستخلص: In Niger, malnutrition underlies the high child mortality (319/1,000). The prevalence of acute malnutrition (weight/height below minus 2 z score) is more than 16% in the 0 to 5 year old range. The situation in the urban areas in slightly better than average (child mortality of 210.3/1,000). Thus the situation is very serious. The efficacy of intensive nutritional rehabilitation centers and ambulatory nutritional rehabilitation centers is controversial. The practices and knowledge of the staff of the ambulatory centers in Niamey was studied by weekly session meetings. The shortcomings could be explained by the absence of individual care, the additional work for the mothers, the mothers' illiteracy, the costs, the domestic problems and problems of cultural support, passivity of screening for malnutrition associated with the very low and irregular nutritional value of the meals supplied to the children. However, these centers exist, and they have staffs. The sessions were therefore used to develop and implement alternative strategies, and the role of the ambulatory units was discussed. The program was evaluated according to mothers' compliance, children's nutritional status, length of stay, rate of transfer to the hospital scored by retrospective analysis of the data for 397 children followed between July and October for each 1993, 1994 and 1995. The nutritional status on admission was similar for each of the three years (weight/height - 2.6 z score). The number of children with weight gain increased from 35 to 127 (P < 0.005). The rate of loss to follow-up decreased from 67% to 32% (P < 0.005). In 1993 the mothers were expected to attend daily. In 1995, after 5 to 10 days of training, follow-up was once weekly. The length of care decreased from 64.3 to 46.9 days for a similar weight gain (3.5 g/kg/day). Transfer to the hospital decreased from 10.7% in 1993 to 5.7% in 1995 (P < 0.0001), whereas this score remained high in the Niamey health centers without and ambulatory unit (24.7 in 1995). Thus the efficacy of these units can be improved although long-term outcome has yet to be demonstrated. It is also necessary to improve screening of malnourished children attending daily out-patients clinics.