OUTCOME OF A REFEEDING PROGRAMME IN MALNOURISHED INDIGENOUS CHILDREN IN A MALAYSIAN DISTRICT HOSPITAL

Abstract

Introduction: Undernutrition is common among the children of indigenous Orang Asli in Malaysia. Refeeding program has been introduced to address this issue by improving their nutritional status therapeutically.

Objectives: The study aims to determine the outcome of refeeding program among undernourished Orang Asli children in Gua Musang, Kelantan.

Methodology: The study is a retrospective study involving undernourished Orang Asli children enrolled in a refeeding program in Gua Musang Hospital. Inclusion criteria are children of Orang Asli by ethnicity between the age of 6 months to 12 years, enrolled between 2012-2016 with weight-for-height Z score (WHZ) of < -1SD.  Factors associated with success of the program as defined by WHZ > -1SD upon discharge are measured as primary outcomes. Relapse, failure or ability to sustain WHZ > -1SD on follow up are obtained as secondary outcomes.

Results: 175 children were enrolled into the refeeding program. The median age at presentation was 24 months (IQR 19-90). At discharge, 29.1% achieved WHZ of -1SD while 54.9% had improved by at least 1SD above baseline admission WHZ. Older children are more likely to be discharged with higher WHZ. There are no reported cases of refeeding syndrome or mortality. Only 35 children returned for follow-up. None of them had weight reduction when compared to discharge weight. From MLR analysis, age was the only significant predictive factor and for increment of age by one month. 

Conclusion: The refeeding program is safe to improve WHZ to -1SD in about one third of children admitted for severe acute malnutrition, however more research needs to be conducted to address the high rate of defaulters.