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  • Title: [Management of malnourished children. Cases from the Protestant Hospital of Dabou].
    Author: Mutombo T.
    Journal: Med Trop (Mars); 1992; 52(4):407-14. PubMed ID: 1337366.
    Abstract:
    Malnutrition due to lack of nutritional resources unfortunately remains an endemic which ravages Third World countries. Not only is malnutrition a result of continuous droughts and wars, but it is a reflection of the difficult economic circumstances which persist in these countries. Malnutrition should be specifically treated in each region with the least costly locally available means. The experience of the Protestant Hospital of Dabou proves that this manner of care is possible in the midst of a rural area with very limited resources. Hospital surveillance, nutritional education and a stay in the nutritional rehabilitation center offers these malnourished children a new chance to begin in life again. Unfortunately for some, the acquired benefits disappear once they have left the establishment and the child returns to the same least favorable socio-economic environment for his development. In rural Dabou, Ivory Coast, a retrospective study was conducted of 141 children aged 6 months to 7 years admitted for malnutrition to the pediatric department of the Dabou Protestant Hospital between October 10, 1990, and April 14, 1991, to examine nutrition rehabilitation of the malnourished children and to propose a strategy using locally available means. The age group most represented was the 7-18 month old group. 26 children had anemia and 23 required a blood transfusion. Depending on the anthropometric indicator, 19.31-77.6% of the children were diagnosed with severe malnutrition (arm circumference for height and arm circumference, respectively). Nutritional rehabilitation consisted of five food regimens and nutrition education. It always began with an embolus of milky water delivered nasogastrically. Oral rehydration solution was sometimes mixed with the milky water. The children systematically received medical treatment: antibiotics, antifungal drugs, metronidazole, antiparasitic drugs, antimalarial drug, and adjuvant treatment (polyvitamins, minerals, kwashiorkor solution [potassium chloride plus magnesium], and one dose of vitamin A). Health workers weighed the children every day, conducted a tuberculin test, and tested for hematocrit. Weight gain was 56 g/day for marasmus patients, 46 g/day for underweight patients, and 15 g/day for marasmic kwashiorkor patients. Kwashiorkor patients lost 25 g/day. 70 patients were admitted to the Nutritional Rehabilitation Center of the hospital. 38% of the 50 who could be followed recovered and reached their ideal weight. 33.3% of the children were the first born child in the family. Recovery appeared to be directly proportional to the mean daily expenses of the family. More than 50% of children of families who spent more than 80 CFA/person/day recovered while few children whose families spent less than 60 CFA/person/day recovered.
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