Efficacy and effectiveness of community-based treatment of severe malnutrition

This article, in the Food and Nutrition Bulletin of the United Nations University, questions whether community based rehabilitation for treatment of severe malnutrition is effective and whether it should be advised for routine health systems. The paper examined community-based rehabilitation programmes delivered by day-care nutrition centres, residential nutrition centres, primary health clinics, and home care with or without provision of food, for the period 1980–2005. It finds that 33 per cent of the programmes could be considered effective but none of the programmes operating within routine health systems without external (donor) assistance were effective.

The article concludes that with careful planning and resources, all four types of community-based programmes can be effective. It is unlikely that a single delivery system would suit all situations and the choice depends on local factors. The author recommends that high energy intakes, high protein intakes, and provision of micronutrients are essential for success. In cases where children have access to a functioning primary health care system and can be monitored, and caregivers can provide sufficient energy and protein dense food mixtures, the rehabilitation stage of treatment of severe malnutrition should take place in the community. [adapted from author]