The Treatment of Persistent Diarrhoea and Malnutrition: Long‐term Effects of In‐patient Rehabilitation

This study aimed to characterize the clinical condition of Gambian children presenting with persistent diarrhea and severe protein energy malnutrition and to evaluate the effects of short-term in- patient treatment in terms of long-term outcome. 22 children (aged 6-36 months) with persistent diarrhea (4 or more loose stools/day for more than 2 weeks) and severe malnutrition (weight- for-height <75% of the National Center for Health Statistics median value) were assessed prior to in-patient treatment for 3 weeks with antibiotics and high nutrient-density milk. Initial assessment included biochemical and immunological status together with stool microbiology. Criteria for discharge--cessation of diarrhea for 5 consecutive days and steady weight gain--were met in all subjects within 4 weeks. Progress was assessed clinically and anthropometrically at weekly intervals and 6 and 12 months following discharge. Results showed a steady improvement in growth during the period of in-patient treatment. Continuing improvement in weight-for-age and mid-upper arm circumference was observed after 6 and 12 months and weight-for-height continued to improve up to 6 months but fell back by 12 months. This study has demonstrated that in the treatment of persistent diarrhea in the tropics relatively short periods of in-patient rehabilitation while leading to a resolution of diarrheal symptoms and weight gain in the short-term do not lead to complete recovery. Persistent diarrhea and malnutrition are likely to recur when the child returns to his village. It is necessary to establish in a prospective study the minimum period of supervised feeding required to ensure the ‘critical level’ of weight gain necessary for linear growth to return to normal. (authors)