Journal of
Public Health and Epidemiology

  • Abbreviation: J. Public Health Epidemiol.
  • Language: English
  • ISSN: 2141-2316
  • DOI: 10.5897/JPHE
  • Start Year: 2009
  • Published Articles: 608

Full Length Research Paper

Long term mortality after community and facility based treatment of severe acute malnutrition: Analysis of data from Bangladesh, Kenya, Malawi and Niger

Paluku Bahwere1,3*, Angella Mtimuni3, Kate Sadler2,3, Theresa Banda3 and Steve Collins3
1Centre of Research in Epidemiology, Biostatistics and Clinical Research, Free University of Brussels, Brussels, Belgium 2Feinstein International Center, Tufts University, Medford, MA 02155, United State 3Valid International, 35 Leopold Street, Oxford, OX4 1TW, United Kingdom.
Email: [email protected]

  •  Accepted: 23 February 2012
  •  Published: 31 October 2012


The effectiveness of the community based therapeutic care (CTC) in treating severe acute malnutrition (SAM) has been demonstrated. However, there is still resistance from some policy makers and donors to invest into this cost-effective intervention. The mortality rate ratio (MRR) calculated by dividing the observed deaths after discharge by expected deaths was used to compare survival of 1,670 children discharged from the Dowa CTC from August 2002 to May 2005 and that of other cohorts reporting on long term survival of children after treatment of SAM retrieved from literature. A MMR of 1.1 (0.9 to 1.4) was observed for the Dowa CTC cohort while the MMR of 2.7 (1.3 to 4.9), 5.5 (3.9 to 7.6) and 20.0 (11.0 to 33.4) were observed for studies retrieved from the literature. Data showed that the survival of children who defaulted was worse than that of those who were discharged cured, and that of children treated at home after stabilisation or directly was better than those treated as inpatient until exit from the programme. The study outlines the need of using MMR when reporting on long term survival after SAM treatment and suggests that CTC should be included in the package of interventions with high potential for accelerating the progress towards reaching Millennium Developmental Goal four.


Key words: Severe acute malnutrition, children, long term, survival, mortality ratio.


Abbreviations: CTC, Community based therapeutic care; DHS, demographic and health surveys; HC, health centre; MICS, multiple indicators cluster survey; MMR, mortality rate ratio; MUAC, mid upper arm circumference; NCHS, national center for health statistics;SAM, severe acute malnutrition; SMR, standardized mortality ratio.