C Nicholas Cuneo1, Emily Dansereau2, Anand R Habib3, Mary Davies4, Samuel Ware5, Kenneth Kornetsky6. 1. Department of Global Health and Social Medicine, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: cncuneo@bwh.harvard.edu. 2. Institute for Health Metrics and Evaluation, The University of Washington, Seattle, WA. 3. Harvard Medical School, Boston, MA. 4. Columbia University College of Physicians and Surgeons, New York, NY; St. Joseph's Clinic, Thomassique, Haiti. 5. St. Joseph's Clinic, Thomassique, Haiti. 6. St. Joseph's Clinic, Thomassique, Haiti; Medical Missionaries, Manassas, VA.
Abstract
BACKGROUND: Haiti has the worst malnutrition rate in the Western hemisphere. In October 2010, a cholera epidemic erupted and spread rapidly throughout the country, straining Haiti's already fragile health infrastructure across all levels of care. This study reviews data from an outpatient therapeutic feeding program (OTP) for acute childhood malnutrition at a clinic in rural Haiti with a focus on the effect of the 2010 cholera epidemic on program operations. METHODS: A retrospective chart review was conducted for the complete set of patients who were enrolled in the OTP from its inception in March 2009 through January 2014. FINDINGS: A total of 187 charts were retrieved representing 176 unique patients, of whom 5 were currently enrolled in care. At admission, 96 (51.3%) met criteria for severe acute malnutrition, 88 (47.1%) met criteria for moderate acute malnutrition, and 3 (1.6%) did not meet criteria for acute malnutrition. Of the 182 completed charts, 119 (65.4%) reached their target weight (≥-1 weight-for-height z-score) by discharge (ie, were "cured"), 43 (23.6%) defaulted, 11 (6.0%) were discharged prematurely, 8 (4.4%) died, and 1 (0.5%) was hospitalized. A total of 11 patients (6.3%) who were initially admitted relapsed after discharge and were later readmitted. Data from 170 complete records (93.4%) were included in a multivariate logistic regression. Severe (vs moderate) acute malnutrition was negatively associated with likelihood of being cured when controlling for other patient- and care-related factors (OR = 0.261, P = .002). Average cholera burden was negatively correlated with likelihood of OTP treatment cure when controlling for patient- and care-related variables (OR = 0.859, P = .002) but was insignificant when controlling for year. CONCLUSIONS: Results from the study have been used to inform a restructuring of the clinic's acute malnutrition program toward a more community-centered model of management, the context and implications of which are discussed in relation to the existing literature.
BACKGROUND: Haiti has the worst malnutrition rate in the Western hemisphere. In October 2010, a cholera epidemic erupted and spread rapidly throughout the country, straining Haiti's already fragile health infrastructure across all levels of care. This study reviews data from an outpatient therapeutic feeding program (OTP) for acute childhood malnutrition at a clinic in rural Haiti with a focus on the effect of the 2010 cholera epidemic on program operations. METHODS: A retrospective chart review was conducted for the complete set of patients who were enrolled in the OTP from its inception in March 2009 through January 2014. FINDINGS: A total of 187 charts were retrieved representing 176 unique patients, of whom 5 were currently enrolled in care. At admission, 96 (51.3%) met criteria for severe acute malnutrition, 88 (47.1%) met criteria for moderate acute malnutrition, and 3 (1.6%) did not meet criteria for acute malnutrition. Of the 182 completed charts, 119 (65.4%) reached their target weight (≥-1 weight-for-height z-score) by discharge (ie, were "cured"), 43 (23.6%) defaulted, 11 (6.0%) were discharged prematurely, 8 (4.4%) died, and 1 (0.5%) was hospitalized. A total of 11 patients (6.3%) who were initially admitted relapsed after discharge and were later readmitted. Data from 170 complete records (93.4%) were included in a multivariate logistic regression. Severe (vs moderate) acute malnutrition was negatively associated with likelihood of being cured when controlling for other patient- and care-related factors (OR = 0.261, P = .002). Average cholera burden was negatively correlated with likelihood of OTP treatment cure when controlling for patient- and care-related variables (OR = 0.859, P = .002) but was insignificant when controlling for year. CONCLUSIONS: Results from the study have been used to inform a restructuring of the clinic's acute malnutrition program toward a more community-centered model of management, the context and implications of which are discussed in relation to the existing literature.