A short-term intervention for the treatment of severe malnutrition in a post-conflict country: results of a survey in Guinea Bissau

Objectives: To determine (i) the extent of malnutrition and the risk factors for severe malnutrition in Guinea Bissau, a post-conflict country experiencing long-term consequences of civil war; and (ii) the feasibility and effectiveness of a short-term intervention characterized by outpatient treatment with locally produced food for the treatment of severe malnutrition during the rainy season. Design and setting: Social, clinical, nutritional information were collected for children reaching the paediatric outpatient clinic of the Hospital 'Comunita' di Sant'Egidio' in Bissau, Guinea Bissau, from 1 July to 12 August 2003. Severely malnourished children (weight-for-age <- 3SD) in poor health status were admitted for daily nutritional and pharmacological treatment until complete recovery. Social and health indicators were analysed to define risk factors of severe malnutrition. Results: In total, 2642 children were visited (age range: 1 month-17 years). Fever, cough and dermatological problems were the main reasons for access. Social data outlined poor housing conditions: 86.4% used water from unprotected wells, 97.3% did not have a bathroom at home, 78.2% lived in a mud house. Weight-for-age was <- 2SD in 23.0% of the children and <- 3SD in 10.3%; thirty-seven children (1.4%) were severely malnourished and admitted for day care. All recovered with a weight gain of 4.45 g/kg per d, none died or relapsed after 1 year. Severely malnourished children were mainly infants, part of large families and had illiterate mothers. Conclusion: Short-term interventions performed in post-conflict countries during seasons of high burden of disease and malnutrition are feasible and successful at low cost; day-care treatment of severe malnutrition with locally produced food is an option that can be tested in other settings.