A comparison of the cost-effectiveness of alternative approaches to the treatment of severly malnourished children
A longitudinal, prospective and controlled trial was undertaken to identify the most \ud cost-effective treatment for children with severe malnutrition. Children <60% \ud weight-for-height or with oedema aged 12-60 months, were sequentially allocated \ud to i) in-patient treatment ii) day-care treatment iii) domiciliary management after \ud one week of day-care. Institutional and parental costs incurred to reach 80% \ud weight-for-height are compared. The groups were comparable as regards age, \ud sex, nutritional status, presence of infection and socioeconomic status at \ud recruitment. A total of 437 children completed the study. Mortality during \ud treatment was low in all groups <5%). Although the domiciliary group took the \ud longest to achieve 80% weight-for-height they did so at the lowest overall cost. \ud Day-care treatment approached in-patient care as regards speed of recovery at less \ud than half the total cost, but it was an unpopular option and only 4% gave this as \ud their preference. Although parental costs were highest for the domiciliary group as \ud no food supplements were provided, this was the majority's preference (67%) \ud especially among the group who experienced it. \ud Children continued to be followed for one year after they reached 80% weight-for-height to determine longer-term progress. Data were collected fortnightly for \ud morbidity and monthly for anthropometry, mortality and relapse rates. All three \ud groups increased in weight-for-height during the year from 80% to 91 % on average \ud but no increase was observed in height-for age. There was a high prevalence of \ud infection with an average incidence of 7 diarrhoeal episodes, and 30% presented \ud with acute respiratory infection on more than 3 occasions. Without access to \ud medical care it is likely that many would have relapsed. Only 0.6% however \ud required readmission for severe malnutrition and 1.6% died. \ud It is concluded that domiciliary management after 1 week of medical care is a cost effective option for treating severe malnutrition.
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