Treating Childhood Malnutrition in Rural Haiti: Program Outcomes and Obstacles

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 therapeuti...

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Autores principales:	C. Nicholas Cuneo, Emily Dansereau, Anand R. Habib, Mary Davies, Samuel Ware, Kenneth Kornetsky
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2017
Materias:	Haiti malnutrition outpatient treatment RUTF cholera outcomes rural Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/2a5c7ceecb7c4b21acc258546bc5ce5c
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spelling	oai:doaj.org-article:2a5c7ceecb7c4b21acc258546bc5ce5c2021-12-02T01:08:19ZTreating Childhood Malnutrition in Rural Haiti: Program Outcomes and Obstacles2214-999610.1016/j.aogh.2017.05.003https://doaj.org/article/2a5c7ceecb7c4b21acc258546bc5ce5c2017-06-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/195https://doaj.org/toc/2214-9996Background: 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.C. Nicholas CuneoEmily DansereauAnand R. HabibMary DaviesSamuel WareKenneth KornetskyUbiquity PressarticleHaitimalnutritionoutpatienttreatmentRUTFcholeraoutcomesruralInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 83, Iss 2, Pp 300-310 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Haiti malnutrition outpatient treatment RUTF cholera outcomes rural Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Haiti malnutrition outpatient treatment RUTF cholera outcomes rural Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 C. Nicholas Cuneo Emily Dansereau Anand R. Habib Mary Davies Samuel Ware Kenneth Kornetsky Treating Childhood Malnutrition in Rural Haiti: Program Outcomes and Obstacles
description	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.
format	article
author	C. Nicholas Cuneo Emily Dansereau Anand R. Habib Mary Davies Samuel Ware Kenneth Kornetsky
author_facet	C. Nicholas Cuneo Emily Dansereau Anand R. Habib Mary Davies Samuel Ware Kenneth Kornetsky
author_sort	C. Nicholas Cuneo
title	Treating Childhood Malnutrition in Rural Haiti: Program Outcomes and Obstacles
title_short	Treating Childhood Malnutrition in Rural Haiti: Program Outcomes and Obstacles
title_full	Treating Childhood Malnutrition in Rural Haiti: Program Outcomes and Obstacles
title_fullStr	Treating Childhood Malnutrition in Rural Haiti: Program Outcomes and Obstacles
title_full_unstemmed	Treating Childhood Malnutrition in Rural Haiti: Program Outcomes and Obstacles
title_sort	treating childhood malnutrition in rural haiti: program outcomes and obstacles
publisher	Ubiquity Press
publishDate	2017
url	https://doaj.org/article/2a5c7ceecb7c4b21acc258546bc5ce5c
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Treating Childhood Malnutrition in Rural Haiti: Program Outcomes and Obstacles

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