Hi Cecile,

Thanks for positing this interesting and informative paper. In your introduction you note that "high weight gain rates have never been observed in the community setting" (range 1-5 g/kg / day).

While I note that 2 of the references come from asian contexts, I have observed high weight gains in field programmes (10-15g / kg / day) on standard RUTF doses (Bangladesh). Being healthily sceptical I checked the equipment, protocols, staff competence and child measurements first hand. 

I saw data from Ethiopia that also had weight gains of > 8g/ kg / day (data originated from very competent NGO staff taking measurements).

While this is only anecdotal, the potential for high weight gains in the community setting should perhaps not be dismissed. At the time I put the high weight gains down to a very strong adherence to the RUTF protocols made possible through the respect for the instructions of the health staff and the highly decentralised service delivery (through satellite health centres) enabling close follow up.

I wonder if there are other practitioners with similar experiences?

Cheers

Paul

Hi Paul,

You may know the article below, which does show that weight gain is lower in community than in inpatient settings but with still rather high in home based treatment. I quote from the results section:

The mean weight gain was respectively 20.8, 10.1 and 9.7 g/kg/day for the TFC, TFC plus home-based and home-based group alone.

Gaboulaud V1, Dan-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 Feb;53(1):49-51.

Abstract

To measure the success rate of three different strategies used in Médecins Sans Frontières large-scale therapeutic nutritional rehabilitation programme in Niger, we analysed three cohorts of severely malnourished patients in terms of daily weight gain, length of stay, recovery, case fatality and defaulting. A total of 1937 children aged 6-59 months were followed prospectively from 15 August 2002 to 21 October 2003. For the three cohorts, 660 children were maintained in the therapeutic feeding centre (TFC) during the entire treatment, 937 children were initially treated at the TFC and completed treatment at home and 340 children were exclusively treated at home. For all cohorts, average time in the programme and average weight gain met the international standards (30-40 days, >8 g/kg/day). Default rates were 28.1, 16.8 and 5.6% for TFC only, TFC plus home-based and home-based alone strategies, respectively. The overall case fatality rate for the entire programme was 6.8%. Case fatality rates were 18.9% for TFC only and 1.7% for home-based alone. No deaths were recorded in children transferred to rehabilitation at home. This study suggests that satisfactory results for the treatment of severe malnutrition can be achieved using a combination of home and hospital-based strategies.