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Efficacy of modified WHO feeding protocol for management of severe malnutrition in children: a pilot study from a teaching hospital in New Delhi, India.

AIM
To assess the efficacy of modified World Health Organization (WHO) feeding protocol for severe malnutrition.


SETTING
Prospective observational study conducted in the nutritional rehabilitation center of a tertiary care teaching hospital of New Delhi, India over four months period from August to November 2007.


METHODS
25 children with severe malnutrition (age 6 months to 5 years) were recruited. All children were treated according to Indian Academy of Pediatrics modified WHO guidelines. Daily weight gain and improvement in the clinical status was assessed. Children were followed up at day 15, day 30 and day 45 after discharge or when a new problem emerged.


RESULTS
Weight-for-age z score (WAZ) at admission was -4.82+/-0.96, weight-for-height z score (WHZ) was -5.0+/-0.7, height-for-age z-score (HAZ) was -2.55+/-1.65. All children had diarrhea on admission, two had pneumonia in addition, and one each had otitis, sepsis and hepatitis in addition to diarrhea. The mean duration of admission was 8.32+/-2.87 days. At discharge the mean WAZ was -4.15+/-0.92 and mean WHZ, -3.91+/-0.61 (p value highly significant). Follow up at day 15, 30 and 45 showed significant improvement in WAZ and WHZ.


CONCLUSIONS
Following modified WHO guidelines is feasible, efficacious and cost effective in resource-limited settings. Early discharge of patients is possible with no complications or mortality.