Chapter 3. Six Month Outcomes of Malnourished Children Enrolled in the Nutritional Therapeutic Program in a Peri-Urban, Low-Income Settlement in the Western Cape, South Africa


Suzanne Kerswill, MBChB, Etienne Nel, PhD, FCPaed and Thandi Wessels, FCPaed
Department of Paediatrics, University of Stellenbosch,
Department of Health – Metro East, Cape Town, South Africa

Part of the book: Environmental Health: Poverty, Race and Child Health in the Time of COVID-19


The success of Community-based Therapeutic Care (CTC) in reducing mortality from severe acute malnutrition is well documented, although the sustainability of short-term successes is unknown. Modelled on CTC principles, the Nutrition Therapeutic Program (NTP) has been well established in the Western Cape in South Africa, but outcomes of this six-month program have yet to be measured. In this chapter we aim to determine outcomes of malnourished children after six months on the NTP, looking at weight gain, defaulting rates, and mortality, and to compare these outcomes to international sphere standards. A retrospective descriptive cohort study was conducted in a peri-urban, low-income settlement in the Western Cape. 270 patients meeting criteria for malnutrition between the age of six months and five years were recruited from three community clinics between January 2017 – December 2018. Outcomes revealed a mortality rate of 0.7%, which was below the international Sphere target of <3%. Other outcomes did not meet sphere targets, with a defaulting rate of 53% (target ><15%), success rate of 27% (target >75%), and average daily weight gain at six months of 0.76g/kg/day (target >3g/kg/day). We concluded that sphere targets may not be appropriate success metrics in this context, as the increased length of the program may be responsible for the higher defaulting rates, whilst recourse to in-hospital treatment means lower mortality rates are achievable. We feel that clear, achievable, and tailored local targets should be set to motivate healthcare practitioners to address the problem of childhood malnutrition in South Africa.


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