Background and aims Moderate acute malnutrition (MAM) [WLZ: < –2 to –3] is a major health problem in Bangladesh and other low-income countries. This study was conducted to assess the effect of community-based follow-up care, with/without food supplementation and/or psychosocial stimulation, as an alternative to current hospital-based follow-up care of children with MAM.
Methods 227 children with MAM aged 6–24 months were randomly assigned to one of five regimens:
fortnightly follow-up care (FFC) at the icddr, b’s outpatient-department, including growth monitoring, health education, and micro-nutrient supplementation (H-C, n=49);
FFC at community follow-up unit [established in the existing primary health care centers close to the residence of the child] but received the same regimen as H-C (C-C, n=53);
as per C-C plus cereal-based supplementary food (SF) (C-SF, n=49);
as per C-C plus psychosocial stimulation (PS) (C-PS, n=43); or
as per C-C plus both SF+PS (C-SF+PS, n=33).
Results Baseline characteristics were similar among the groups. Follow-up attendance and gain in weight and length were greater in groups C-SF, C-SF+PS, and C-PS than C-C, and these indicators were observed least in H-C. Children in the H-C group more often suffered from diarrhea and fever than others. Children who attended at least five of the total six scheduled follow-up visits gained more in weight, length than those who attended fewer.
Conclusions Community-based service delivery, especially including supplementary food with or without psychosocial stimulation, permits better rehabilitation of greater numbers of children with MAM compared to current hospital outpatients-based care.