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PubMed1991

Tuberculosis, poverty, and "compliance": lessons from rural Haiti.

Tuberculosis (TB) is the leading cause of death among rural Haitian adults, and TB control in Haiti is widely acknowledged to be a failure. The causes of both the endemicity of TB and the failure of attempts to address it are briefly reviewed before data from a study conducted in rural, central Haiti are presented. Members of one group of patients with active TB were given free medical care; members of a second group were given free care as well as financial aid, incentives to attend a monthly clinic, and aggressive home follow-up by trained village health workers. Comparing the two groups shows significant differences in mortality, sputum positivity after 6 months of treatment, persistent pulmonary symptoms after 1 year of treatment, average amount of weight gained, ability to return to work, and cure rate. The roles of human immunodeficiency virus and cultural factors are also examined. When adequate nutrition and access to free care were assured, drug-dependent and patient-dependent factors were shown to be of secondary importance in determining treatment outcome. Based on these data from a small, community-based TB-control project, the authors conclude that high cure rates can be achieved if the primacy of economic causes of TB is acknowledged and addressed.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Distribution along a stages-of-behavioral-change continuum for condom and contraceptive use among women accessed in different settings. Prevention of HIV in Women and Infants Demonstration Projects.

The numbers of women of childbearing age in the US with HIV and AIDS from heterosexual transmission continues to rise. Behavioral interventions remain the best means of preventing transmission of HIV. Program planners often implement interventions to promote behavioral change in a wide range of settings such as family planning or sexually transmitted disease clinics, drug treatment facilities, or medical facilities that serve high risk and HIV positive women. Women recruited in different types of settings, however, may differ with respect to their experience with, attitudes toward, and willingness to use condoms and contraception. Such differences should be considered when tailoring interventions to the populations being served. We examined the readiness to use condoms and contraception among 3784 women in four cities recruited in three different types of settings: community, facilities not targeted to HIV positive women and medical facilities for HIV positive populations. Readiness to use condoms or contraception was measured using The Transtheoretical Model of Change. Women reported being in different stages along the continuum of condom and contraceptive use in the three settings. A greater proportion of women in the HIV-facility, 45%, had used condoms consistently for the previous 6 months compared to women in the other two settings (12% and 11%). Similarly, variation across settings was seen for contemplation of consistent contraceptive use to prevent unintended pregnancies. The variability in the distribution of condom and contraceptive use across settings underscores the importance of assessing the readiness for the behavior change and designing interventions that meet the specific needs of the populations being served.

Adolescent↗

PubMed1995

A randomized evaluation of consumer versus nonconsumer training of state mental health service providers.

Preliminary evidence suggests that mental health consumers can successfully serve as peer companions, case management aides, case managers, job coaches, and drop-in center staff. However, few empirical investigations have addressed the use of consumers to train mental health professionals. This project employed a randomized design to test the effects of using consumers as trainers for mental health service providers. Fifty-seven state mental health professionals participated in a two-day training designed to acquaint trainees with the attitudes and knowledge necessary for delivering assertive case management services. Participants were randomly assigned to one of two conditions: one in which they received the second day of training from a consumer and the other involving training by a nonconsumer. Analyses revealed that post-training attitudes were significantly more positive for those participants trained by the consumer. Subjective evaluations also reflected positive reactions to the use of consumers as trainers. Implications for further use of mental health consumers as trainers are explored.

Adult↗

PubMed2004

Is trust a predictor of having a dental home?

BACKGROUND: Developing a better understanding of sociodemographic variables that predict having a dental home may aid in reducing the disparities in oral health among minorities in the United States. METHODS: The authors used data from a telephone survey of 1,005 randomly selected low-income residents (403 men, 602 women) aged 18 or older in two Florida counties--Miami-Dade and Duval--to examine the sociodemographic characteristics of people who reported having a regular dentist. RESULTS: Bivariate analyses showed that respondents' levels of trust in physicians and dentists were strongly associated with having a dental home. After adjusting for other variables in a multiple logistic regression model, the authors found that respondents with a moderate level of trust in physicians and dentists were 52 percent less likely (odds ratio, or OR, = 0.48; 95 percent confidence interval, or CI, 0.26 to 0.89) and those with low trust were 54 percent less likely (OR = 0.46; 95 percent CI, 0.28 to 0.75) than those with high trust to have a regular dentist. Race/ethnicity, sex, age, education level and employment status remained significant correlates of having a regular dentist in the multivariate model. CONCLUSIONS: The results of this study suggest that efforts to reduce disparities in access to dental care and establish dental homes should include programs to increase patients' trust in dental professionals. CLINICAL IMPLICATIONS: While policy-makers consider ways to improve access to dental care, dental professionals should work at the community level to increase the level of trust of the community in the dental health provider.

Adolescent↗

PubMed2006

Peer referral for HIV case-finding among men who have sex with men.

OBJECTIVE: To evaluate the effectiveness and cost-effectiveness of a health department-based peer referral program for identifying previously undiagnosed cases of HIV among men who have sex with men (MSM). DESIGN AND METHODS: Between 2002 and 2005, 283 MSM peer recruiters were enrolled in a public health program in King County, Washington, USA. Peer recruiters were enrolled from a sexually transmitted disease (STD) clinic, an HIV clinic, via media advertisements and through collaboration with community-based organizations (CBO). The peer recruiters underwent a brief training and were then paid US$ 20 for each peer they referred to be tested for HIV, STD and viral hepatitis. Peers were paid US$ 20 for being tested. The main outcome measure was the number of new cases of HIV identified and cost per case of HIV identified. RESULTS: Recruiters referred 498 peers for HIV, STD and hepatitis testing. Among 438 peers not previously diagnosed with HIV, 22 (5%) were HIV positive, of whom 18 received their HIV test results. Other infections were variably prevalent among tested peers: gonorrhea [23/307 (8%)], chlamydia [6/285 (2%)], syphilis [1/445 (0.2%)], hepatitis C [61/198 (31%)], surface antigen positive hepatitis B [8/314 (3%)]. Excluding the costs of testing for viral hepatitis and STDs other than HIV, the cost per new HIV case identified was US$ 4929. During the same period, the cost per new case of HIV detected through bathhouse-based HIV testing and through the county's largest CBO-based HIV testing program were US$ 8250 and US$ 11 481, respectively. CONCLUSIONS: Peer referral is an effective means of identifying new cases of HIV among MSM.

AIDS Serodiagnosis↗

PubMedDate not supplied

A unique community of family-oriented prostitutes in Nepal uninfected by HIV-1.

In the Mid Western and Far Western regions of Nepal live a unique group of prostitutes which maintains strong bonds resulting from 'untouchable' caste status and family tradition. Known as the Badis (pronounced 'bod ee'), it is estimated that well over 5000 Badi prostitutes are now actively engaged in the sex trade in Nepal. In 1991, a study of some of the social and cultural practices of this unique group was completed. In addition to the provision of counselling and information about STDs and AIDS, over 300 prostitutes were interviewed about their sex practices within the Badi community. Two hundred and twenty-eight Badi prostitutes consented to voluntary confidential testing for VDRL, and 250 consented to anonymous, unlinked serosurveillance for HIV-1. As previous studies have shown moderate to high rates of HIV-1 infection among prostitutes in general, and even higher rates of infection in low class prostitutes, some prevalence of VDRL as well as HIV-1 was expected. However, of the 228 Badi prostitutes tested, 154 (70%) were found to be VDRL positive, while none were found positive for HIV-1. At the same time, many of these prostitutes reported a history of constant and often untreated STDs. The implications for the future prevention of HIV infection in this group are obvious and striking. With immediate and effective STD treatment as well as counselling, the Badis represent one high risk group in which the global AIDS epidemic could be drastically reduced, or even averted.

Adolescent↗

PubMed1990

The impact and use of written leaflets as a counselling alternative in mass antenatal HIV screening.

Pre-test counselling has been seen as a pre-requisite for HIV screening. As HIV moves into the heterosexual community, the role of HIV screening in ante-natal care has increased. As vertical transmission is the major contributor to perinatal infection HIV screening of pregnant women has become a reality. The pregnant population comprises large numbers, the practical difficulties of routine pre-test counselling and the informational demand from pregnant women themselves has necessitated the provision of ante-natal leaflets about HIV infection and AIDS. A survey of 24 London hospitals revealed only three leaflets in use, two from one hospital and one from an AIDS Charity. A content evaluation of the leaflets revealed varying readability, elements of bias and presentation factors which may all affect the usefulness of such leaflets. An in depth qualitative group on the leaflet with highest readability revealed particular concerns and highlighted the fact that the leaflets could be seen as additions and addendums to counselling but were not sufficient in themselves.

Counseling↗

PubMed1996

Precision, accuracy, and managed care implications of a hand-held whole blood analyzer in the prehospital setting.

Hand-held portable clinical analyzers permit the rapid measurement of whole blood electrolytes, glucose, blood urea nitrogen (BUN) and hematocrit. Knowledge of these values in the field might aid radio telemetry emergency department physicians in the field treatment and triage of patients. The purpose of this study was determine if the analyzer could function in the hostile prehospital environment. In phase 1, analyses of control electrolyte (n = 30) and hematocrit (n = 28) solutions were performed in a moving ambulance by paramedics to determine precision performance. The F-statistic was used to compare variances against reference values and no significant differences were found. In phase 2, prospective split-sample testing of 57 whole blood samples drawn in the field were analyzed on 2 machines by paramedics in a moving ambulance, and then again within 10 minutes of arrival at the receiving hospital emergency department. Regression analysis between ambulance and emergency department venues revealed high correlation (r) values: sodium (Na)+ (0.93), potassium (K)+ (0.99), chloride (Cl)- (0.89), BUN (0.99), glucose (0.99), hematocrit (0.95), and hemoglobin (0.92). A hand-held whole blood analyzer can be reliably used in the field to obtain blood chemistry and hematocrit values. There was excellent correlation between field and hospital emergency department values. Clinical pathologists extend their oversight and consider encouraging emergency physicians to obtain field blood chemistry values in research studies aimed at improving medical treatment and patient triage in the prehospital setting. We speculate that these results might be important to managed care groups because knowledge of blood chemistry values in the field might provide physicians with objective, criteria-based data on which to triage patients to the emergency department, to an ambulatory care setting, or to a community health center with attendant cost savings.

Ambulances↗

PubMedDate not supplied

Physician assistant training for Native Alaskan community health aides: the MEDEX Northwest experience.

BACKGROUND-From 1980 through 1990, 16 Native Alaskan Community Health Aides and 21 non-Native Alaskans began physician assistant training at MEDEX Northwest at the University of Washington. This study was done to assess the outcome of training Native Alaskan health workers as physician assistants, specifically whether Native Alaskan graduates are working in settings that serve Alaska Natives. METHODS-The backgrounds, educational experiences and deployment locations of Native and non-Native Alaskans accepted for training were compared using MEDEX Northwest student records. The 1991 graduate survey was used to compare differences in practice setting, specialty and salary between Native and non-Native graduates working in Alaska in 1991. RESULTS-All of the non-Natives and 81% of the Natives completed the program. Of those completing the program, 100% of the Natives returned to Alaska where 91% found work as primary care physician assistants in clinics serving predominantly Native communities. By comparison 78% of the non-Native graduates returned to Alaska to work as physician assistants, 60% of them in primary care and 15% of them in predominantly Native communities. There were no significant differences in salary or benefits between Native and non-Native graduates. CONCLUSIONS-Physician assistant training for entry level health workers is a viable strategy for increasing the number of under-represented minorities in the health professions. The Native graduates of MEDEX Northwest are returning to communities where they serve Native people both as health care providers and as professional role models.

Alaska↗

PubMed2006

Uptake of workplace HIV counselling and testing: a cluster-randomised trial in Zimbabwe.

BACKGROUND: HIV counselling and testing is a key component of both HIV care and HIV prevention, but uptake is currently low. We investigated the impact of rapid HIV testing at the workplace on uptake of voluntary counselling and testing (VCT). METHODS AND FINDINGS: The study was a cluster-randomised trial of two VCT strategies, with business occupational health clinics as the unit of randomisation. VCT was directly offered to all employees, followed by 2 y of open access to VCT and basic HIV care. Businesses were randomised to either on-site rapid HIV testing at their occupational clinic (11 businesses) or to vouchers for off-site VCT at a chain of free-standing centres also using rapid tests (11 businesses). Baseline anonymised HIV serology was requested from all employees. HIV prevalence was 19.8% and 18.4%, respectively, at businesses randomised to on-site and off-site VCT. In total, 1,957 of 3,950 employees at clinics randomised to on-site testing had VCT (mean uptake by site 51.1%) compared to 586 of 3,532 employees taking vouchers at clinics randomised to off-site testing (mean uptake by site 19.2%). The risk ratio for on-site VCT compared to voucher uptake was 2.8 (95% confidence interval 1.8 to 3.8) after adjustment for potential confounders. Only 125 employees (mean uptake by site 4.3%) reported using their voucher, so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 (95% confidence interval 8.2 to 16.8). CONCLUSIONS: High-impact VCT strategies are urgently needed to maximise HIV prevention and access to care in Africa. VCT at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care. Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT.

AIDS Serodiagnosis↗

PubMed2002

Prospective, multicenter surveillance study of Candida glabrata: fluconazole and itraconazole susceptibility profiles in bloodstream, invasive, and colonizing strains and differences between isolates from three urban teaching hospitals in New York City (Candida Susceptibility Trends Study, 1998 to 1999).

Since the 1990s, the substantial increase in the rate of Candida glabrata infections has become a serious problem. As most C. glabrata infections arise from the host's endogenous microflora, the present prospective, multicenter analysis included all clinical isolates associated with colonization and with systemic and hematogenous candidiasis. Among 347 C. glabrata isolates, the overall rates of resistance to fluconazole (MIC > or = 64 micro g/ml) and itraconazole (MIC > or = 1 micro g/ml) were 10.7 and 15.2%, respectively, although for half (n = 148) of the itraconazole-susceptible isolates the MICs (0.25 to 0.5 micro g/ml) were in the susceptible-dependent upon dose range. Fluconazole resistance was more common among C. glabrata isolates obtained from centers caring for patients with cancer (MICs at which 90% of isolates are inhibited [MIC(90)s] = 32 micro g/ml) or AIDS (MIC(90)s > 64 micro g/ml) than among C. glabrata isolates from a community-based university medical center (MIC(90)s = 16 micro g/ml) (P = 0.001). Thirty-three bloodstream isolates and those obtained from other body sites had similar in vitro susceptibility profiles. The fluconazole MIC(90)s (< or =16 micro g/ml) for C. glabrata yeast isolates from the gastrointestinal tract were lower than those (> or =64 micro g/ml) for C. glabrata isolates from respiratory and urinary tract samples (P = 0.01). A similar discrepancy for itraconazole was not significant (P > 0.5). We did not observe differences in fluconazole or itraconazole susceptibility profiles among C. glabrata isolates associated with either hematogenous dissemination or colonization. The significant discrepancy in antifungal susceptibility among C. glabrata organisms isolated from hospitals in the same geographic region emphasizes the significance of periodic susceptibility surveillance programs for individual institutions, especially those providing care to patients at risk.

Antifungal Agents↗

PubMed2004

Comprehensive pediatric human immunodeficiency virus care and treatment in Constanta, Romania: implementation of a program of highly active antiretroviral therapy in a resource-poor setting.

BACKGROUND: Relatively few human immunodeficiency virus (HIV)-infected children worldwide have access to care and treatment. The Romanian-American Children's Center, a collaborative project of a U.S. health care institution and the Romanian government, has established a comprehensive program of highly active antiretroviral therapy for children in Constanta, Romania. OBJECTIVES: To describe the design and outcomes of a program of pediatric HIV/acquired immunodeficiency syndrome (AIDS) care and treatment in a resource-poor setting. SETTING: Outpatient center providing comprehensive primary and HIV/AIDS specialty care and treatment to all known HIV-infected children living in Constanta County, Romania. OUTCOMES: As of August 2003, a total of 452 children were receiving highly active antiretroviral therapy. Therapy has been well-tolerated, with approximately 90% of children continuing to receive treatment after a median duration of follow-up of 67 weeks. Normal weight and height growth velocities have been observed among treated children. Marked decreases have been observed in rates of hospitalization and mortality. The mean change in CD4+ lymphocyte count for 173 children who have both a baseline count and at least 1 follow-up count is +284 cells/microL (P < 0.0001). CONCLUSIONS: Highly active antiretroviral therapy can be administered safely and effectively to children in a resource-poor setting, with outcomes comparable with those observed in U.S. pediatric antiretroviral clinical trials.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Knowledge of men and women about reproductive tract infections and AIDS in a rural area of north India: impact of a community-based intervention.

This study of a community-level health-education intervention on reproductive tract infections/sexually transmitted diseases (RTIs/STDs) was conducted in three villages of Haryana in north India. The study was aimed at increasing awareness among men and women of reproductive age about the prevention and treatment of RTIs, modes of HIV/AIDS transmission, and methods of prevention. Health education was imparted through one-to-one interactions with men and women during home visits, at village-based clinics and health camps, and through health-education talks with men and women. Cumulative effects of the intervention were examined at the end of the survey by comparing the change in knowledge from the baseline. Records of clinic attendance were examined to assess the probable impact of the intervention on clinic attendance. Baseline and follow-up evaluations revealed that there was an improvement in the median total knowledge score of women from 0 to 6, whereas it remained at 5 for men both at baseline and follow-up. Knowledge about RTI/STIs increased among both men and women from the median score of 0 to 2 and from 0 to 3 respectively. The median knowledge score on HIV/AIDS declined among men from 4 to 2 but increased from 0 to 3 among women. Clinic attendance for RTI/STI cases, referred to the Naraingarh hospital, showed an eight-fold rise from an average of four cases per month in 1998-1999 to an average of 35 cases per month in 1999-2000. The findings of the study suggest that health-education strategy through home visits, RTI case management and counselling, and organizing a weekly clinic and occasional camps and health-education talks can increase the level of awareness about RTIs/STIs among both men and women and improve clinic attendance.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Efficacy of exercise counselling as an aid for smoking cessation: a randomized controlled trial.

AIM: To examine whether exercise counselling increases smoking abstinence and reduces tobacco withdrawal and gains in weight and body fat. DESIGN: A randomized controlled trial. SETTING: A community-based stop smoking clinic. PARTICIPANTS: Two hundred and ninety-nine male and female smokers. INTERVENTION: Participants were assigned randomly to a 7-week smoking cessation programme, including nicotine replacement therapy plus either (i) exercise counselling, or (ii) health education advice with equal contact time as for the exercise counselling condition. MEASUREMENTS: Six weeks of smoking abstinence was confirmed by expired carbon monoxide. FINDINGS: There was no significant difference in smoking abstinence between the exercise group (n = 154) and the controls (n = 145) at 6 weeks (39.6% versus 38.6%), nor was there any difference in gains in weight or body fat, although those in the exercise group increased their exercise levels. Exercise participants reported less tension, anxiety and stress than the controls during the first week of smoking abstinence (P = 0.03, 0.01 and 0.04, respectively), less irritability throughout 2 weeks of abstinence (P = 0.03), and less restlessness throughout 3 weeks of abstinence (P = 0.04). CONCLUSIONS: Adding brief exercise counselling to a smoking cessation programme did not increase smoking abstinence or reduce gains in weight or body fat significantly, although exercise levels were raised and there were some beneficial effects on psychological symptoms.

Adult↗

PubMed1993

An evaluation of an AIDS risk reduction education and skills training (ARREST) program.

PURPOSE: With the increasing rate of HIV infection among adolescents, there is an urgent need for interventions that will provide teenagers with information, the ability to make decisions, and the assertiveness and communication skills required for effective prevention and risk reduction. This study evaluated an AIDS Risk Reduction Education and Skills Training (ARREST) program designed for adolescents, ages 12-16 years. METHODS: Eighty-seven inner-city, African-American (36%) and Latino (55%) adolescents were recruited from community-based after-school programs, and randomly assigned to either the ARREST intervention or a wait-list control group. Adolescents assigned to the ARREST intervention participated in three 90-minute intervention sessions. ARREST was evaluated by comparing pre- and post-test scores on a battery of self-report measures and videotaped role-play simulations. RESULTS: Analyses revealed significant post-test differences between the ARREST and wait-list control groups, with teens in the ARREST group demonstrating significant changes in knowledge and negative attitudes about HIV/AIDS, perception of risk, and appropriate concern about contracting AIDS. Most importantly, adolescents in the ARREST group demonstrated a significant increase in behavioral skills for negotiating prevention and risk reduction, and resisting peer pressures to engage in risk-related sexual and drug-use behaviors. CONCLUSIONS: ARREST was effective in meeting its short-term objectives for changes in knowledge and behavioral skills, which are important prerequisites for behavior change. Replication with long-term follow-up assessment is needed, however, to determine this intervention's effectiveness at changing risk-related sexual and drug-use behaviors.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Clinical and administrative outcomes during publicly-funded inpatient stroke rehabilitation based on a case-mix group classification model.

OBJECTIVES: To determine efficiency and efficacy of publicly-funded inpatient stroke rehabilitation based on a Case-Mix Group Classification Model, and to analyse the usefulness of this decisional aid in the refinement of rehabilitation services delivery needed to optimize accessibility to inpatient rehabilitation services for individuals with stroke in a publicly-funded healthcare system. DESIGN: Individuals with stroke (n=422) who received inpatient rehabilitation through the Montreal Rehabilitation Hospital Network were included in this retrospective study. Clinical (total, motor and cognitive-Functional Independence Measure (FIM) scores, percentage of discharge to community) and administrative outcomes (onset to rehabilitation interval, length of inpatient rehabilitation stay, length of stay efficiency) were measured. RESULTS: Across Case-Mix Groups, mean onset to rehabilitation days varied between 16.2 (5.7) and 32.0 (19.4) days whereas the mean length of stay fluctuated between 27.5 (13) and 77.0 (27) days. Best total (41.6 (21.4)) and motor-FIM (38.9 (19.0)) gains were observed in most severely disabled cases (114) whereas the Case-Mix Group 103 presented the best cognitive-FIM gain (5.8 (4.0)). Optimal mean total, motor and cognitive-FIM efficiency rates, found in moderately disabled stroke patients, were 0.668 (0.434), 0.634 (0.377) and 0.15 (0.136), respectively. Majority of patients returned home following rehabilitation in all Case-Mix Groups (63.6% to 96.4%) except for groups 112 and 108. CONCLUSION: Moderate to good length of stay efficiencies are observed among all Case-Mix Group following stroke rehabilitation. In fact, individuals with moderate disability present the best rate of recovery. Variations in length of stay efficiency suggest that the use of a Case-Mix Group Classification Model in stroke rehabilitation could represent an innovative approach, especially for program evaluation in publicly-funded and universal-access rehabilitation hospitals.

Aged↗

PubMed2000

Evaluation of a drama-in-education programme to increase AIDS awareness in South African high schools: a randomized community intervention trial.

A community intervention trial was undertaken in KwaZulu Natal, South Africa to evaluate the effectiveness of a high school drama-in-education programme. Seven pairs of secondary schools were randomized to receive either written information about HIV/AIDS or the drama programme. Questionnaire surveys of knowledge, attitude and behaviour were compared before and 6 months after the interventions. One thousand and eighty students participated in the first survey and 699 in the second. Improvements in knowledge (P=0.0002) and attitudes (P < 0.00001) about HIV/AIDS were demonstrated in pupils at schools receiving the drama programme when compared to pupils receiving written information alone. These changes were independent of age, gender, school or previous sexual experience. In schools receiving the drama programme, sexually active pupils reported an increase in condom use (P < 0.01). It is important to provide resources to sustain such programmes and to obtain stronger evidence of effect on behaviour by measuring changes in HIV incidence.

Acquired Immunodeficiency Syndrome↗

PubMed1993

The Kingston Project. II. The effects of high energy supplement and metronidazole on malnourished children rehabilitated in the community: anthropometry.

Malnourished children (mean age 1.2 years) referred from public health clinics to a paediatric metabolic ward in Kingston, Jamaica, were enrolled for treatment in a community-based health care project and were randomly allocated to one of two groups. The first group was treated at home with metronidazole and then for 6 months using the standard health care provided from local clinics by community health aides. The second group was given the same drug and home treatment, but in addition received a high energy supplement of 3.31 MJ daily for 3 months. We have previously shown a significant advantage in both weight and height gain for a group given the same supplement in contrast with standard health care controls (Heikens et al., 1989, Eur. J. Clin. Nutr. 43, 145-160), and in this study test the addition of a drug treatment aimed at reducing malabsorbtion due to a possible microbial overgrowth of the small bowel in malnourished children. This paper reports anthropometric findings showing significant benefits from both the drug and nutritional treatments. Greatest gains were by the group given both treatments, but the group given the antibiotic treatment, without energy supplementation, also made better growth recovery than did controls. Only 8% of the children treated with metronidazole failed to respond to community-based intervention and were admitted to hospital, compared with 19% for the other groups (P < 0.05). These findings support targetted high-energy supplementation for the rehabilitation of moderately malnourished children receiving health clinic care, and suggest further that such programs should include antibiotic treatment directed at SBBO.

Analysis of Variance↗