Wednesday, July 31, 2013

Combatting malnutrition with hospital treatment and take-home therapeutic food

18-month-old Saroeurn Kunthea (in the arms of her grandmother Som Chanthy)
recovered from severe acute malnutrition following the full treatment regimen.
©UNICEF Cambodia/2013/Pericles Carvalho
Combatting malnutrition with hospital treatment and take-home therapeutic food
Getting children back on track for healthy development

SVAY RIENG, Cambodia, 22 July 2013 – Eighteen-month-old Saroeurn Kunthea who lives in Trok village, south-east Cambodia is fortunate to be alive. At nine months of age, weighing only 4 kilograms, her grandmother, Puth Sopheap, sought urgent help at Svay Rieng Referral Hospital. “She was in very bad condition” says paediatric nurse Mrs. Som Chanthy who saw Kunthea when she was admitted. “She was lethargic, her eyes were sunken, she had a fever, a swollen abdomen and diarrhoea.” Measured, weighed and examined, Kunthea was diagnosed with severe acute malnutrition. Like 76 per cent of children under the age of 2 in Cambodia, Kunthea’s condition was the result of an inadequate diet. Though her mother breastfed her before and after going to work at a garment factory in town, her only solid food each day was watery rice.

Admitted to the hospital for a week, Kunthea was given medication, rehydration fluids and therapeutic milk-based liquid food to provide the right amount of protein, energy and vitamins. Her grandmother, who stayed with her, attended food demonstrations at the hospital and learned how to make multi-ingredient meals for a growing infant. “They taught me how to make Bobor Khab Krub Kroeung, a thick soup with rice, green vegetables, eggs and pumpkin,” said Sopheap. “When the child was sick, I didn’t know what to do. I just gave her boiled water to drink but after our stay [in hospital] I learned that to prevent malnutrition, I have to make [nutritious] food.”

Take home rations therapeutic food

Baby Kunthea went home after a week but her treatment did not end with her discharge from hospital. Her grandmother was given take-home rations of ready-to-use therapeutic food. Known as ‘RUTF’, the specially-formulated energy and vitamin bars can be eaten in biscuit form or mixed with boiled water and made into porridge. Sopheap was also instructed to bring Kunthea back to the hospital for three after-care visits at one week, three weeks and five weeks after her discharge. This schedule follows Cambodia’s National Guidelines for the Management of Acute Malnutrition which aims to ensure that children completely recover.

During each of the return visits Kunthea was weighed and measured and provided with an appropriate take-home ration of RUTF to last until the next visit. An allowance of 28,000 Riel (US$7) for every visit -16,000 Riel (US$4) for food and 12,000 Riel (US$3) for transport - helped to ease the financial burden on her family.

Financial assistance and take-home therapeutic food, provided with the support of UNICEF, in collaboration with the World Food Programme (WFP) and World Health Organization (WHO), with funding from the Norwegian, Lithuanian and Danish Committees for UNICEF, and the Spanish Government through the MDG Joint Programme for Children, Food Security and Nutrition, have helped to encourage families to complete the full treatment schedule. Nearly all children admitted to hospital now complete their treatment and make a full recovery from severe malnutrition which can have a permanent impact on their physical and cognitive development. More than one quarter of Cambodian children under 5-years-old are underweight and four out of every 10 are short for their age. 

Sopheap is pleased that she followed the full treatment regimen and has seen a marked change in her granddaughter who now weighs 8 kilograms. “Before, she was very small. After the final visit she was very different, very active. Kunthea can now walk. She’s strong. She plays and smiles.” So happy was Sopheap with the outcome that she is now a ‘model mother’ in the community, teaching other women how to make the nutritious multi-ingredient soup to help prevent their children becoming malnourished.

5-year-old Chim Sophea enjoys the take-home ration of ready-to-use therapeutic food.
The special-formulated energy bar can be eaten like a biscuit.
©UNICEF Cambodia/2013/Pericles Carvalho
Four months after Sopheap completed her treatment, another child was being admitted to Svay Rieng Referral Hospital with the same condition.

In nearby Chhouk Sor village, 5-year- old Chim Sophea recalls how she felt when she had severe acute malnutrition in May 2013. “I had fever,” she says softly, “I was tired.”

Her mother Chhay Ly explained further, “When she got sick, she was weak and didn’t talk to anyone. She had difficulty breathing and was inactive. She wasn’t interested in playing and she did not eat well.” A neighbour advised Ly to take Sophea - who then weighed 11.7 kilograms - to Svay Rieng Referral Hospital where the child was also found to be anaemic. Once again, Nurse Som Chanthy was there to admit Sophea.

“When she first came to hospital she was tired and breathing fast. She was thin, had fever and was very weak. After an examination she had to have a blood transfusion, was given fluids and provided with therapeutic food.” In hospital Sophea grew to like a variety of nutritious foods. “[At the hospital] I learned to make meals with rice, vegetables, pumpkin, fish and eggs. Sophea only used to want the soup water from the family meal, but now she likes eating vegetables and meat,” said her mother.

Importance of three follow-up hospital visits

Upon discharge from the hospital, Nurse Chanthy impressed on Sophea’s mother the importance of the three follow-up visits to monitor the child and receive take-home rations of therapeutic food. “To encourage patients to return I explain the reasons for the visits. I also telephone the family or the Village Chief to remind them and also talk to their neighbours.”

Sophea enjoyed eating the specially-formulated energy and vitamin bars and her transformation became more apparent with each appointment. “A change in the first visit was that she could walk alone. Two weeks later she was running around the hospital to play with the other children. Her final visit is this week,” said Nurse Chanthy.

Though the cost of the journey to hospital exceeded the US$3 travel allowance, Sophea’s mother was determined to complete the follow-up treatment.  “I saw her getting better when she started to eat more and play more,” said Ly, “even though it cost me 15,000 Riel [US$4.25] each way to go to the hospital I knew it was important to go because I didn’t want her to get sick again. I wanted her to get well and be able to study well in school. I am very happy to see her much better.” Sophea now weighs a healthy 15.5 kilograms and her diet is much improved. Asked about her favourite food, she has a ready answer, “I like duck eggs!”

By Denise Shepherd-Johnson


  1. I'm so happy to see all the children are cured from malnutrition. My name is Sao Lykheang, a post graduated student at Nation Institute of Public Health of Cambodia, Master of Science in Nutrition. Currently, I and my team are doing an assignment about efficiency of RUTF to the SAM children. One of my member, who is working at referral hospital, said that BP100( a taken home nutrient food) is hard to accepted by the SAM children because of its taste. She worries that the SAM children will not be cured completely if they do not consume the BP100 as they were requested.

  2. Dear Sao, many thanks for reading and posting your comment. We are well aware of the issue around the compliance of BP100 and UNICEF Cambodia is working on the development of a new product more suitable for Cambodian children. For your question on the efficiency of the guideline of SAM treatment, please find our latest peer-reviewed article:

    MS: 1744772118141906
    Title: Beyond the guidelines for the treatment of severely malnourished children with complications—assessment from Cambodia
    Authors: Prak Sophonneary, Dahl Miriam, Conkle Joel, Un Sam, Laillou Arnaud,
    Journal: BMC Nutrition

    BMC Nutrition.2015, 1:10
    DOI: 10.1186/s40795-015-0004-z