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AbstractObjectiveTo compare therapeutic feeding programme coverage for severely malnourished children achieved by a community-based therapeutic care (CTC) programme and a therapeutic feeding centre (TFC) programme operating in neighbouring districts in Malawi.DesignTwo surveys were implemented simultaneously one in each of the two programme areas. Each survey used a stratified design with strata defined using the centric systematic area sample method. Thirty 100?km2quadrats were sampled. The community or communities located closest to the centre of each quadrat were sampled using a case-finding approach. Cases were defined as children aged under 5 years with ??70% of the weight-for-height median or bilateral pitting oedema. Receipt of treatment was ascertained by the child's presence in a therapeutic feeding programme or by documentary evidence. Coverage in each quadrat was estimated in two ways, a period estimate that provides an estimation of coverage for the recent period preceding the survey and a point estimate that provides an estimation of coverage at the exact point in time of the survey.ResultsOverall the period coverage was 24.55% (95% confidence interval (CI)?=?17.8?31.4%) in the TFC programme and 73.64% (95% CI?=?66.0?81.3%) in the CTC programme. The point coverage was 20.04% (95% CI?=?13.8?26.3%) in the TFC programme and 59.95% (95% CI?=?51.4?68.5%) in the CTC programme.ConclusionsIn this context, CTC gave substantially higher programme coverage than a TFC programme. Given effective treatment, this enabled higher impact of CTC on severe malnutrition in this population. [ABSTRACT FROM AUTHOR]

Aim: To assess the clinical outcomes of a combined approach to the treatment of severe acute malnutrition in an area of high HIV prevalence using: (i) an initial inpatient phase, based on WHO guidelines and (ii) an outpatient recovery phase using ready-to-use therapeutic food. Methods: An operational prospective cohort study implemented in a referral hospital in Southern Malawi between May 2003 and 2004. Patient outcomes were compared with international standards and with audits carried out during the year preceding the study. Results: Inpatient mortality was 18% compared to 29% the previous year. Programme recovery rate was 58.1% compared to 45% the previous year. The overall programme mortality rate was 25.7%. Of the total known HIV seropositive children, 49.5% died. Conclusions: Inpatient mortality and cure rates improved compared to pre-study data but the overall mortality rate did not meet international standards. Additional interventions will be needed if these standards are to be achieved. [ABSTRACT FROM AUTHOR]