Evaluation of hospitalisation for indigenous children with malnutrition living in central Australia

The definitive version is available at www.blackwell-synergy.comObjective: To evaluate the effectiveness of hospital admissions for indigenous children with malnutrition in a rural/remote Australian centre. Design: Retrospective review of the medical records. Setting: Rural secondary hospital. Subjects: Remote and rural indigenous children aged less than four years managed for malnutrition in Alice Springs Hospital (ASH). Main outcome measure: The primary outcome measure was weight gain during hospitalisation and posthospitalisation. Secondary outcome measures were yield of investigations, diagnoses made, treatments given, social interventions, readmission rate and nosocomial infection. Results: Median age of the 55 children was 15.1 months. Median weight change was 1.5 g day−1prior to hospitalisation, 36.7 g day−1during and 9 g day−1two months following hospitalisation (P < 0.05). Investigations performed had high yields (80% of children had a treatable organic contributor to malnutrition). Nosocomial infection occurred in 21 (38%) children. Readmission occurred at an average of 1.9 times per child (range 0–5), 34 (37%) occurred within three months and 48 (52%) within six months. Conclusion: In rural Indigenous children with malnutrition, hospitalisation was effective in re-establishing growth and defining organic contributors to malnutrition. However, the high readmission rate and nosocomial infection mandates that alternative models to nutritional rehabilitation, in addition to a broad psychosocial and public health approach to prevention and management of malnutrition, is required. What this paper adds: Malnutrition is very common among Indigenous children living in rural and remote communities. Hospitalisation in rural hospitals is often used to break the cycle of malnutrition and infection, but this intervention has never been evaluated. Hospitalisation was effective in re-establishing growth and defining organic contributors to malnutrition. This, however, occurred at the expense of the high readmission rate and nosocomial infection. The present study suggests that alternative models to nutritional rehabilitation in addition to a broad psychosocial and public health approach to prevention and management of malnutrition is required.Beth J. Russell, Andrew V. White, Jonathan Newbury, Carmel Hattch, Jennie Thurley and Anne B. Chan