Home-Based Treatment of Acute Malnutrition in Cambodian Urban Poor Communities

BACKGROUND: The prevalence of malnutrition in Cambodia is among the highest in Southeast Asia. Until recently, there has been a consensus that the treatment and rehabilitation of acutely severely malnourished children should take place in hospitals; however, limited local health resources often place constraints upon the inpatient management of these children. OBJECTIVE: This study reviews the outcomes of a community nutrition program designed to rehabilitate children under the age of 5 years with moderate or severe acute malnutrition living in a poor urban community in Phnom Penh, Cambodia. METHODS: Clinical records of the program participants during the period from January 1999 to November 2006 were reviewed. Attainment of recovery weight-for-height z-scores, the length of time taken to achieve this recovery, rates of weight gain, mortality rate, and rate of default were determined from the data. RESULTS: One hundred fifty-nine children aged 4 years or younger with a mean admission weight-for-height z-score of -3.3 were treated. The mean outcome weight-for-height z-score was -1.5. Eighty-seven children (55%) reached a weight-for-height z-score > or = -1 over a mean period of 14 weeks of rehabilitation. The average rate of weight gain was 4 g/kg/day. The case fatality rate was 5.6%. CONCLUSIONS: This program is an example of effective, community-based rehabilitation of children with moderate or severe acute malnutrition in an urban, Southeast Asian, non-humanitarian-relief context, through a combination of nutritional education, regular home visiting, and food support.