Abstract
BackgroundIn Jharkhand, Malnutrition Treatment Centres (MTCs) have been established to provide care to children with severe acute malnutrition (SAM). The study examined the effects of facility- and community based care provided as part the MTC program on children with severe acute malnutrition.MethodA cohort of 150 children were enrolled and interviewed by trained investigators at admission, discharge, and after two months on the completion of the community-based phase of the MTC program. Trained investigators collected data on diet, morbidity, anthropometry, and utilization of health and nutrition services.ResultsWe found no deaths among children attending the MTC program. Recovery was poor, and the majority of children demonstrated poor weight gain, with severe wasting and underweight reported in 52 and 83% of the children respectively at the completion of the community-based phase of the MTC program. The average weight gain in the MTC facility (3.8 ± 5.9 g/kg body weight/d) and after discharge (0.6 ± 2.1 g/kg body weight/d) was below recommended standards. 67% of the children consumed food that met less than 50% of the recommended energy and protein requirement. Children experienced high number of illness episodes after discharge: 68% children had coughs and cold, 40% had fever and 35% had diarrhoea. Multiple morbidities were common: 50% of children had two or more episodes of illness. Caregiver’s exposure to MTC’s health and nutrition education sessions and meetings with frontline workers did not improve feeding practices at home. The take-home ration amount distributed to children through the supplementary food program was inadequate to achieve growth benefits.ConclusionsRecovery of children during and after the MTC program was suboptimal. This highlights the need for additional support to strengthen MTC program so that effective care to children can be provided.
Highlights
We found no deaths among children attending the Malnutrition Treatment Centre (MTC) program
The average weight gain in the MTC facility (3.8 ± 5.9 g/kg body weight/d) and after discharge (0.6 ± 2.1 g/kg body weight/d) was below recommended standards. 67% of the children consumed food that met less than 50% of the recommended energy and protein requirement
Recovery of children during and after the MTC program was suboptimal. This highlights the need for additional support to strengthen MTC program so that effective care to children can be provided
Summary
At any point of time, around 0.6 million children in the state are severely wasted [2] To address this challenge, Jharkhand’s State government has established 88 malnutrition treatment centres (MTCs) through the National Health Mission (NHM), where children with severe acute malnutrition (SAM)— severe wasting and/or mid-upper arm circumference (MUAC) < 115 mm and/or bilateral pitting oedema— receive medical and therapeutic care based on the WHO and Indian Academy of Pediatrics protocols [3,4,5]. After completing 4 days at the MTC, children are alternately fed F-100 and locally prepared semi-solid therapeutic food until the child is discharged from the centre. Children are transitioned to the community phase of the program, where they are followed up in the community by frontline workers; enrolled into the ICDS supplementary nutrition program; and returned for three follow-up visits to the MTC every 15 days during the 2 months following discharge
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