Role of inpatient stay Assessment of the above is easier as an inpt- –access to mother/ carer, child, observers, specimen collection and transport, tests and results
Role of hospitalisation for CM Advantages –Assessment –Nutritional rehab, multidisciplinary team –Discharge and follow up plans (Schwartz 2000) Disadvantages –Separation from home, family –Stressful environment –Staffing pressures –Nosocomial infection (Oates 2001)
Role of hospitalisation for CM (2) Influences Constraints on health system-> decisions re competing priorities –Primary prevention vs Secondary prevention vs Tertiary care (Black 1999, Brewster 2008) Access to community based services, incl skill of staff; distance; perceived level of compliance (Lee 2003)
Role of hospitalisation for CM (3) Outcome? Limited evidence ASH study 2002 of hospitalision for FTT –effective in re-establishing weight gain –effective in identifying organic contributors to malnutrition, but 38% hospital acquired infection 53% readmitted within 6 months Children did not sustain catch-up growth (Russell et al, 2004)
When to hospitalise children for CM Little disagreement severe wasting dehydration and/or infection or other intercurrent illness when community-based interventions have failed where there are other serious risk factors (incl. psychosocial) for the child and family oassessment oidentification and treatment of organic factors onutritional rehabilitation (Russell 2004, Brewster 2008) oDischarge plan and follow up oPolicy development has been difficult but is progressing
When to hospitalise an individual child Some individual variation inevitable
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