Comparison of tempe and special milk in the nutritional rehabilitation of severely malnourished children using biochemical and clinical parameters

Abstract

PEM a highly prevalent condition in almost all developing countries, including Kenya is treated with high calorie, high protein feeds. At the KNH special milk is used for the rehabilitation of children with PEM. Special milk is prepared using dry skimmed milk, com oil, eggs, and sugar. In Indonesia, a traditional food called tempe has been used in the rehabilitation of children with PEM. Tempe is prepared by fermenting cereals or legumes or a mixture of both with the fungus Rhizophus oligosporus. In this study comparison of special milk with tempe in the nutritional rehabilitation of children with either kwashiorkor or marasmic kwashiorkor in the paediatric wards of KNH was done. The period of observation was ten days which mainly covered the acute resuscitation phase. The total protein, albumin, and Hb were determined on the first post admission day, day four, day seven and day ten. Daily observations were done to determine the duration of oedema, apathy, diarrhoea, and changes in weight. A total of 90 children with a diagnosis of kwashiorkor or marasmic kwashiorkor were recruited and randomly allocated to either tempe group or special milk group. Each group had 45 children. Overall the 52 children had kwashiorkor and 38 had marasmic kwashiorkor. Each of the treatment groups had equal representation of kwashiorkor and marasmic kwashiorkor. The mean age in the tempe group was 26.1 ± 12.9 months. The mean age in the special milk group was 22.7 ± 10.6 months.

For each group there was a significant increase in the serum protein levels during the study period (p = 0.000). The rate of increase in serum proteins in the special milk group was 1.3 g per

day while the rate in the tempe group was 0.9 g per day. On the other hand comparison between the two groups showed that there was no difference between the mean serum protein values during the period of the study (p= 0.073-0.831). There was a significant increase in the albumin levels as the days of feeding progressed. The change in albumin levels was not affected by the type of feed (p= 0.0134). There was no difference between the mean levels of serum albumin in children fed on tempe and those fed on special milk throughout the period of investigation (p= 0.562-0.855). The mean Hb levels at the beginning of the study were similar and there was no significant change during the period of study (p= 0.500). Only 32% of the children gained weight. Twenty percent of these were in the special milk group and 12% were in the tempe group. Analysis of variance for paired data of tempe and special milk showed that the increase in weight in the two groups was not significantly different as the days progressed (p= 0.331). On linear regression analysis the increase in weight in the tempe group was not significant (p=0.988), while the increase in weight in the special milk group was significant (p=0.001). The growth rate for the children in the tempe group was 12.27 g per kilogram body weight per day while it was 16.01g per kilogram body weight per day in the special milk group. The rest ofthe children in the two groups continued to lose weight until they were discharged from the study on the 10th day . . There was no significant difference in the mean duration of diarrhoea, apathy and oedema between the tempe group and the special milk group (p= 0.323, 0.493, and 0.907 respectively). Survival analysis of the data was done for diarrhoea, apathy, and oedema. The results showed

that the children in the tempe group had lower probabilities of surviving with clinical features of diarrhoea, apathy and oedema for all the time intervals. It was concluded that tempe could be as good as special milk in the nutritional rehabilitation of children with severe PEM.