The Kingston Project. II. The effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: anthropometry

In 1985-86 in Jamaica a community-based health care project randomly allocated 81 3-36 month old malnourished children from the slums of metropolitan Kingston to either a group receiving home health care/clinic-based care and a 5-day course of a broad spectrum antibiotic metronidazole (20 mg/kg/day) for 6 months or a group receiving these same interventions and a high energy supplement (HES) (790 kcal) containing 20.6 gm protein for 3 months to test the effect of these interventions on anthropometric measures of growth. The researchers also wanted to determine whether metronidazole would overcome malabsorption of nutrients due to small bowel bacterial overgrowth. Children of both groups benefited considerably from the interventions. For example significant improvements in weight occurred almost immediately followed by improvements in length resulting in a significant improvement in the body mass index (BMI) (p = .0001). Children receiving both HES and metronidazole made significantly greater gains than those who only received HES (weight p = .02; length p = .0002; and BMI p = .0001). A significantly greater proportion of children did not respond to treatment and had to be hospitalized for infections especially respiratory infections in the HES only group than did those in the HES and metronidazole group (19% vs. 8%; p < .05). None of the children receiving metronidazole died. Reduced morbidity absence of case fatalities and anthropometric improvements support the belief that home visits by community health aides in combination with clinic-based health services providing HES and antibiotic treatment to moderately malnourished children can indeed rehabilitate them.