Day-care management of children with severe malnutrition in an urban health clinic in Dhaka, Bangladesh

H. Ashraf, T. Ahmed, M. I. Hossain, N. H. Alam, R. Mahmud, S. M. Kamal, M. A. Salam, G. J. Fuchs

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Management of severely malnourished children with associated complications relies on hospital-based treatment. Implementation of a standardized protocol at the Dhaka Hospital, ICDDR,B reduced case fatality approximately 50%. We developed and prospectively evaluated a day-care clinic approach that provided antibiotics, micronutrients and feeding during the day with continued care by parents at home at night as an alternative to hospitalization. Severely malnourished children aged 6-23 months denied admission to hospital were enrolled at Radda Clinic, Dhaka and received protocolized management with antibiotics, micronutrients and milk-based diet from 8:00 am to 5:00 pm each day, while mothers were educated on continuation of care at home. They were transitioned to the day-care nutrition rehabilitation (NR) unit of Radda Clinic following resolution of acute illness, received NR diet (Khichuri, halwa and milk-based) daily until children attained 80% weight-for-length. From February 2001 to November 2003, 264 children were enrolled; 52% were boys and 78%, 21% and 1% had marasmus, marasmus-kwashiorkor and kwashiorkor, respectively. Only 13% had severe malnutrition alone while 35% had pneumonia, 35% had diarrhea and 17% had both pneumonia and diarrhea. The mean (SD) duration of acute and NR phases were 8 (4) and 14 (13) days, respectively. Children gained weight [mean (SD) g/kg day] more rapidly during acute 10 (7) than NR phase 6 (5). Successful management was possible in 82% (95% CI 77-86%) children, 12% discontinued treatment and 6% referred to hospitals. Only one child died during NR phase. Severely malnourished children can be successfully managed at existing day-care clinics using a protocolized approach.

Original languageEnglish
Pages (from-to)171-178
Number of pages8
JournalJournal of Tropical Pediatrics
Issue number3
StatePublished - Jun 2007

Bibliographical note

Funding Information:
The study was funded by the World Bank (Nutrition Centre of Excellence: NCOE) and Government of Bangladesh (GOB) Gates Match Fund. ICDDR,B acknowledges with gratitude the commitment of the donors to the Centre’s research efforts. The authors are grateful to Dr Dewan Shamsul Alam, Dr S. A. Shahed Hossain, Dr Iqbal Kabir and Dr Jena Hamadani for their excellent review of the manuscript.


  • Children
  • Day-care management
  • Severe malnutrition

ASJC Scopus subject areas

  • Medicine (all)


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