A longitudinal assessment of the diet and growth of malnourished children participating in nutrition rehabilitation centres in Accra, Ghana

Objective: To examine the adoption of feeding recommendations among caregivers of children recuperating from malnutrition and assess the determinants of growth of children attending a nutrition rehabilitation centre (NRC) in Accra, Ghana. Design: Longitudinal study in which attendance and maternal programme participation were recorded daily and children's anthropometry and dietary intake were measured at four time points (admission, interim, exit, post-exit) at the NRC and participants' homes. Setting: NRCs at four polyclinics and participants' homes in Accra, Ghana. Subjects: One hundred and eight caregivers and their 116 children referred to an NRC between November 1999 and July 2000. Results: Most caregivers attended the NRC sporadically (effective length of stay was 1.4 ± 0.1 months). Use of NRC-promoted foods in the home after discharge was low due to inaccessibility of the food items, lack of preparation knowledge or money, child preferences and the common practice of purchasing ready-to-eat foods. Although there were significant increases in children's weight-for-age (P = 0.048) and weight-for-height (P= 0.002) Z-scores between enrolment and discharge, most children discontinued programme participation before adequate recuperation. Conclusions: The NRC education did not address the use of street foods for child feeding and was unsuccessful in changing in-home feeding behaviour. The prominence of street foods in children's diets warrants re-evaluation of the NRC's educational approaches to enhance their responsiveness to caregivers' needs and effectiveness for the continued recuperation of malnourished children at home. NRC feeding strategies need improvement to ensure adequate provision of energy and nutrients to support catch-up growth in children.