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Community-based controlled trial of dietary management of children with persistent diarrhea: sustained beneficial effect on ponderal and linear growth^1,2,3

¹ From the Projecto de Saúde de Bandim, Bissau, Guinea-Bissau; the Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen; the Center for International Health, University of Bergen, Norway; All India Institute of Medical Sciences, New Delhi; and Laboratorio Nacional de Saúde Publica, Bissau, Guinea-Bissau.

Background: Uncontrolled hospital-based studies in developing countries have reported promising results of dietary rehabilitation of children with persistent diarrhea.

Objective: The objective was to determine the immediate and long-term effects of a dietary supplement and micronutrients given to children with persistent diarrhea during the episode and for 1 wk during convalescence.

Design: The study was open, controlled, and community-based and was conducted in a periurban area in Guinea-Bissau. Children <3 y of age with persistent diarrhea were identified during weekly household visits. The children randomly assigned to the treatment and control groups were examined by a physician and all medical conditions were treated. The children in the treatment group were offered home-based dietary treatment consisting of locally available foods and micronutrient supplements.

Results: There were 141 episodes of persistent diarrhea during the study: 70 in the treatment group (in 58 children) and 71 in the control group (in 62 children). During the intervention period (median: 17 d), weight gain in the treatment group exceeded that of the control group by 61.5 g/wk (95% CI: 49.2, 73.8), whereas there was no significant difference in linear growth on the basis of knee-heel length. At a median follow-up period of 6.6 mo after the intervention was stopped, weight gain in the treatment group exceeded that of the control group by 12.5 g/wk (95% CI: 7.7, 17.3); knee-heel length was 7.5 mm/y (4.8, 10.2) greater and total length was 0.65 cm/y (0.11, 1.19) greater in the treatment group.

Conclusion: Therapeutic feeding and micronutrient supplementation had an immediate and sustained beneficial effect on growth in children with persistent diarrhea.

Key Words: Persistent diarrhea • dietary treatment • micronutrients • growth • children • community-based study • controlled study • Guinea-Bissau

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