Efficacy of outreach nutrition rehabilitation centres in reducing mortality and improving nutritional outcome of severely malnourished children in Guinea Bissau.

OBJECTIVE: There is still controversy about the efficacy and cost-effectiveness of outreach nutrition rehabilitation centres (NRCs) for severely malnourished children. We wanted to compare the mortality rates and nutritional status of severely malnourished children admitted to rural NRCs in Gabu region, Guinea Bissau, with other severely malnourished children who were not rehabilitated and stayed in their villages.
DESIGN: Retrospective cohort study over a 3-year period. Mortality rates and nutritional outcome compared for children who were admitted to rural NRCs and those who were not rehabilitated. Selection for admission to the NRCs was based on availability of places only.
SETTING: 19 health areas of the Gabu region, Guinea Bissau, West Africa.
SUBJECTS: 1038 severely malnourished children (< 60% weight-for-age using NCHS standards) aged 6 to 47 months. 354 were rehabilitated in NRCs and 684 received no rehabilitation.
RESULTS: Up to 36 months follow-up the relative risk of death in the rehabilitated group was 0.75 [95% confidence interval (c.i.) = 0.57-0.99], equivalent to a 25% reduction in mortality. The difference in mortality between the two groups was much higher during the first 3 months [P < 0.02, relative risk = 0.59 (95% c.i. = 0.39-0.91)]. Rehabilitated children had a higher mean weight gain in the first 3 months (1.63 compared to 0.56 weight-for-age standard deviation score, P < 0.001), and weight gain differences lasted up to 18 months (P < 0.01).
CONCLUSIONS: Low-cost, outreach NRCs are effective both in the short term and in the mid-term to improve the nutritional situation and reduce the mortality of severely malnourished children.