Malnutrition Treatment Center Research Articles

Outcome of Severe Acute Malnutrition in Children Aged 6-59 Months Before and After the Institution of the Malnutrition Treatment Centre in the Regional Hospital Limbe, Southwest Region of Cameroon

Background: Malnutrition occurs when nutrient and energy intake do not meet, or exceed an individual’s requirements to maintain growth, immunity, and organ function. In 2020, among children 0-59 months worldwide, 21.3% (144 million) were stunted and 6.9% (47 million) were wasted. The Malnutrition Treatment Centre’s (MTC) establishment in the Regional Hospital Limbe in 2019 brought major changes in management such as free and continuous supply of therapeutic food and basic drugs, the expertise of a nutritionist and closer follow up of patients after discharge. The aim of this research was to evaluate the outcome of children with severe acute malnutrition aged 6-59 months treated at the MTC differed from those treated before the MTC’s creation. Methodology: An analytic cross sectional retrospective study was conducted from February to March 2022. The study period was from March 2016 to February 2019 (before the MTC) and March 2019 to February 2022 (after the MTC). A predesigned data extraction form was used to obtain sociodemographic data of the children and their parents, clinical findings on admission and hospital outcome. The data was entered into CDC Epi info 2.4 and analysed using SPSS. A p-value of <0.05 was considered statistically significant. Results: Out of 129 files included in the study, 35 were pre-MTC and 94 after its creation. The hospital prevalence of SAM increased from 4% to 7% after the MTC’s creation. The mean MUAC (mid-upper arm circumference) was 11.1 ± 0.98 cm. Marasmus was the most common form of SAM (90.7%). The most common admission symptoms were fever (74.4%), diarrhoea (47.2%) and vomiting (32.6%). The most common comorbidities were malaria (29.5%), gastrointestinal infection (20.9%), sepsis (18.6%) and pulmonary infection (14%). There was an increase in the recovery rate (from 71.4% to 76.6%) and the rate of weight gain (from 3.5 g/kg/day to 8.7 g/kg/day). There was also a reduction in the death rate (from 14.3% to 9.6%) and length of in-hospital admission (from 10.24 ±5.4 days to 7.3 ±3.6 days) Conclusion: The MTC led to an increase in the influx of patients with SAM at the RHL, marasmus was the most common form of SAM. There was an increase in the rate of weight gain, a decreased mortality rate and decreased length of hospital stay, thus revealing the pertinent relevance of the MTC in the management of SAM.

Growth monitoring and nutritional outcome of severe acute malnutrition children in the presence and absence of edema: a facility based retrospective study

Background: Severe acute malnutrition (SAM) is the leading cause of death in children. SAM affects approximately 20 million preschool children, mainly in Africa and South Asia. Children with severe acute malnutrition and severe edema (+++) have an increased risk of death compared with children with severe acute malnutrition and no edema. This study evaluated the nutritional outcome of SAM patients in the presence and absence of edema. Methods: This retrospective study was conducted in malnutrition treatment centre, JK Lon Hospital attached with Govt Medical College, Kota from January 2021 to December 2022 on children of age 6 months to 59 months, with clinical diagnosis of severe acute malnutrition. Ethics committee approval was not required as the study was a retrospective observational study. Patients were divided into three categories, viz. recovered, defaulted and non-responders. Results: A total of 270 patients were selected for this study on the basis of date made available through past records. Of the total patients studied, 32.2% (87) had bilateral edema while the rest (183) were non edematous. From edematous arm, 79.9% children recovered, 9.1% defaulted, and 11% were non-respondents. Conversely, of those without oedema 55.7% recovered, 7.0% defaulted, and 37.3% were non-respondents. Conclusions: Severe acute malnutrition is a preventable and treatable cause of childhood morbidity and mortality. The determinants of SAM include illiteracy, low socio-economic status, malnourished mother, low birth weight, ignorance about specific nutritional requirements of infants and young children, repeated infections, etc. In this study, we documented that the edematous children in the study area had a better likelihood of recovery as compared to those with severe wasting.

Epidemiological Proileof Children with Malnutrition at Child Malnutrition Treatment Center (CMTC)in Saurashtra Region

Introduction: Adequate Nutrition is important for optimum growth, immunity, neurological and cognitive development of the child. Malnutrition leads to illness and mortality among under 5 children. Nearly 40% under 5 children are malnourished in Gujarat despite many nutritional programmes. Objectives: To assess the epidemiological factors of malnourished children at Child Malnutrition Treatment Centre (CMTC) and to ind outthe association between epidemiological factors and nutritional status of study participants. Method: A cross-sectional study was conducted on Children admitted at CMTC at Narayan Nagar Urban Health Center, the only one and newly established CMTC in Rajkot city in year 2015. Study duration was 14 months. Interview of mothers of 120 children was conducted to know epidemiological factors of malnourished children. Weight on admission was noted from register. Pre-formed, semi-structured proforma used. Results: Out of 120 children, 5.8%, 55.8%, 34.2% and 4.2% were from <1, 1-3, 3-5 and >5 year age groups respectively. Nearly 40% children belonged to Socioeconomic Class IV. The proportion of Low Birth Weight children was 40%. Current feeding practice was appropriate in 10.8% children according to IMNCI guideline. Upper Respiratory Tract Infection occurred in 76.7% children with average 4.5 episodes. High birth order of children is statistically signi icant with severity of malnutrition. Birth weight and feeding practices of children were not associated with grade of malnutrition. Conclusion: Need based education of mothers for preventing low birth weight, exclusive breastfeeding, complementary feeding, quantity and type of routine diet etc. should be given.

An observational analysis of profile and outcome of children with malnutrition admitted at malnutrition treatment centre

ABSTRACT Introduction: Nutritional status is an important health indicator and children bear maximum burden of it. Poor nutrition during first thousand days of a child’s life can lead to stunted growth. Comorbid condition adversely affects treatment outcome of malnutrition. This study is aimed to describe the profile and treatment outcome of malnourished children. Materials and Methods: This record-based retrospective, analytical observational study was conducted from October to December 2020. Data of severe acute malnourished children who were admitted in malnutrition treatment centre during August 2017 to September 2020, collected. Totally, 264 eligible children were enrolled in the study. The data were collected through medical records of patients. Data were entered in excel spreadsheet and analysed. Results: Most of the children belonged to 6-24 months of age, almost equal proportion of male and female, and more than three-fourth of children were from rural area. The mean length of stay in hospital was 15.19 ± 6.64 days and average weight gain of children was 7.6 ± 6.7 gm/kg/day. There was significant increase in Z-score (Weight/Height) and MUAC at the time of discharge (P value <0.05). There was no significant association of treatment outcome with the presence of comorbidities (P value >0.05). Conclusion: Most vulnerable age group for malnutrition was 6 months to 2 years. Majority of children with malnutrition improve with standard treatment protocol of malnutrition. We can improve the ability of community health workers to significantly reduce child malnutrition at the primary care level and in the community by equipping them with the required knowledge, tools, and assistance.

A Retrospective cohort study on Utilization of RashtriyaBalSwasthyaKaryakram (RBSK) Services among children screened at an Urban Health Centre (UHC) of Ahmedabad Municipal Corporation (AMC)

Introduction: Rashtriya Bal Swasthya Karyakram (RBSK) is a systemic approach of 4‘D’s (Defect, Diseases, Deficiency, Developmental delay) for early identification and linkage with care, support and treatment. Objectives: (1) Document utilization of RBSK services within a year of referral, (2) Assess reasons for non-utilization of services and (3) Assess out of pocket expenditure (OOPE) among users and non-users of the program. Method: Retrospective Cohort Study was conducted at an Urban Health Centre (UHC) taking two cohorts of children referred for 4‘D’s during April 2018-March 2020 under RBSK. A total of 102 cases were sampled. Probability Proportionate to size (PPS) method was used to ensure proportionate representation of each of 4‘D’s in the sample. Required number of participants in each category were selected randomly. Results: Out of 102 sampled cases, 97 were covered. Utilization of services was 50.5%; major reasons for non-utilization were preference for private providers and reluctance to stay at Comprehensive Malnutrition Treatment Centre (CMTC). Mean OOPE in users was Rs. 21545, significantly less (p <.05) than Rs. 70198 in non-users. Conclusion: After referral by RBSK team, only half utilized the services. Among users, OOPE was less for total cost incurred and also for direct cost incurred like consultation charges, medicines, consumables etc. Counselling those parents whose children are detected with any of 4Ds, to visit Child Malnutrition Treatment Center (CMTC)/ District Early Intervention Center (DEIC) remains a challenge.

Facility Based Management of Child Malnutrition- Lesson Learnt from a North Gujarat Study

Introduction: Malnutrition is a key health problem in India and Gujarat. Mission BalamSukham was launched to overcome malnutrition. Facility-based management of malnutrition is one of two components of this program. Objectives: 1. To evaluate Strengths, Weaknesses, Opportunities and Challenges (or Threats) of Child Malnutrition Treatment Centre (CMTC) and Nutrition Rehabilitation Centre (NRC). 2. To project into areas that needs improvement to overcome the centres’ weaknesses and challenges. Method: In-depth interviews were taken for health workers and beneficiaries of NRC and CMTC of Patan district till saturation of responses. Transcripts were made and themes were analysed based on the SWOC matrix. Results: Major issues identified by the study were absence of continuous financial support to operationalize CMTCs selected under Gatishil Gujarat program, Absence of Paediatrician, lack of awareness regarding child nutrition over night stay at centre and quality of training. Conclusion: Some internal weaknesses and strengths were acknowledged. Only facility-based management of SAM children did not make a difference in community. Training of ASHA and Anganwadi worker about nutritional counselling, screening and monitoring of SAM child is needed to strengthen the community-based management of SAM children.

ASSOCIATION OF CELIAC DISEASES WITH SEVERE ACUTE MALNUTRITION CHILDREN, AT TERTIARY CARE CENTRE: - A PROSPECTIVE STUDY

Introduction: Celiac disease (CD) may be an underlying cause of malnutrition. 
 Aim: The objective of this study was to find out the seroprevalence of CD in children suffering from severe acute malnutrition (SAM) in age group of 1–5 years.
 Materials and Methods: This was a prospective, observational, hospital-based study carried out at Malnutrition Treatment Centre attached with the ananta institute of medical science & research center Rajsamand, Rajasthan, from February 2019 to January 2020. A total of 220 children with SAM were enrolled and screened for CD on the basis of celiac serology (tissue transglutaminase [tTg]-immunoglobulin A/G [IgA/IgG]).
 Results: Celiac serology was positivity in 60 (27.28%) cases; out of total 60 seropositive cases, 28 (46.66%) cases were seropositive for both tTg-IgA and IgG, while only tTg-IgA and only tTg-IgG were positive in 18 (30%) and 14 (23.33%) cases, respectively. Mean serotiter of serum tTg-IgA and IgG in seropositive cases was 134.01±198.74 and 49.05±25.74 unit/ml.
 Conclusions: High seroprevalence of CD in SAM should be taken as alert as CD may be an underlying cause and responsible for malnutrition. These children should be screened by celiac serology (tTg-IgA/IgG) to rule out CD.
 Key words: Celiac disease, Seroprevalence, Severe acute malnutrition

Home Based Food Supplemented With RUTF (Ready To Use Therapeutic Food) Versus Only Home Based Food for Post Discharge Rehabilitation Phase Weight Gain in Children with Severe Acute Malnutrition

Background: Weight gain in patients of Severe Acute Malnutrition(SAM) after discharge from child malnutrition treatment centre (CMTC) is generally not satisfactory(

Performance and costing of nutrition intervention measures on admitted children in malnutrition treatment center: a case study from Jharkhand, India

Background: Children with severe acute malnutrition (SAM) having medical complications require immediate care at malnutrition treatment centers (MTC). Thus, it becomes important to assess the effect and treatment cost of such children in these facilities. Hence, the present study was done with these aims in two MTCs in Jharkhand, India.Methods: A retrospective record review was done of the children admitted to these two MTCs between 1st April 2017 and 31st March 2018. A predesigned proforma was used to collect child related information. The data collected was entered in Microsoft excel sheet and analysed.Results: Majority of the admitted children (90.6%) were in 6-23 months age group. 358 (51.5%) children were females. Only, 194 (27.9%) children admitted were SAM had any medical complication. 690 (99.3%) children were discharged of whom 499 (72.3%) were discharged after achieving the target weight. The average weight gain during their stay was 8.1±2.4 g/kg/day and average length of stay was 16.7±3.2 days. Post discharge follow up rates were found to be low and only 130 (18.8%) children completed all three follow ups. Average cost per SAM child treated was Rs. 18,599 (US$ 272) and per SAM child cured was Rs. 25,904 (US$ 379).Conclusions: MTCs are effective in managing medically complicated SAM children. However, improvements are necessary to ensure that more such children should be treated at facility level, complimented with a community based programme for managing uncomplicated SAM children to improve coverage and ensure continuum of care.

Demographic, Prevalence and Clinical Profile of Severe Malnourished Infants Admitted to the Malnutrition Treatment Centre of Bikaner Hospital, Rajasthan

Demographic, Prevalence and Clinical Profile of Severe Malnourished Infants Admitted to the Malnutrition Treatment Centre of Bikaner Hospital, Rajasthan

Study Of Nutritional Intervention Among Malnourished Children At Malnutrition Treatment Center (Mtc), Jharkhand

Study Of Nutritional Intervention Among Malnourished Children At Malnutrition Treatment Center (Mtc), Jharkhand

Clinico-laboratory profile of Seropositive Celiac Diseases in Severe Acute Malnutrition

Introduction: Celiac Disease shares clinical features with malnutrition and may be responsible for malnutrition. The objective of this study was to study clinico-laboratory profile of seropositive Celiac Diseases in Severe Acute Malnutrition. Material & Methods: The present study was a prospective, hospital based, observational study conducted at Malnutrition Treatment Centre (MTC) of tertiary care Pediatric hospital associated with government medical college of southern Rajasthan. The study was conducted over the period of one year from Dec. 2017 to Nov. 2018. Total 110 children with Severe Acute Malnutrition enrolled and screened for Celiac Disease on the basis of celiac serology (tTg-IgA/IgG). Clinico-laboratory findings of celiac seropositive and seronegative patients were recorded and analysed statistically. Results: Celiacsero-positivity was observed in 30 cases (27.28%). Out of these seropositive cases 14 cases (46.66%) were seropositive for both tTg-IgA and IgG, while 9 cases (30%) were positive for only tTg-IgA and rest 7 cases (23.33%) were positive for only tTg-IgG. Most of the seropositive patients (12, 40%) were in age group of 4-5 years of age group. In seropositive cases recurrent blood in stool (54.45%) and recurrent diarrhoea (52.94%) were common clinical features at the time of admission. S. Vit. B12 & Folic Acid were low in all the patients but more seropositive patients showed low levels of S. Folic acid (P value <0.05). Conclusions: Recurrent diarrhoea and blood in stool were common presenting feature on admission in celiac seropositive patients suffering from severe acute malnutrition. Vit. B12 and Folic acid deficiency were also observed as a common finding in seropositive patients.

Seroprevalence of celiac diseases in children suffering from severe acute malnutrition in age group of 1–5 years

Introduction: Celiac disease (CD) may be an underlying cause of malnutrition. Aim: The objective of this study was to find out the seroprevalence of CD in children suffering from severe acute malnutrition (SAM) in age group of 1–5 years. Materials and Methods: This was a prospective, observational, hospital-based study carried out at Malnutrition Treatment Centre attached with tertiary care pediatric hospital associated with the medical college of southern Rajasthan, from December 2017 to November 2018. A total of 110 children with SAM were enrolled and screened for CD on the basis of celiac serology (tissuetransglutaminase [tTg]-immunoglobulin A/G [IgA/IgG]). Results: Celiac serology was positivity in 30 (27.28%) cases; out of total 30 seropositive cases, 14 (46.66%) cases were seropositive for both tTg-IgA and IgG, while only tTg-IgA and only tTg-IgG were positive in 9 (30%) and 7 (23.33%) cases, respectively. Mean serotiter of serum tTg-IgA and IgG in seropositive cases was 134.01±198.74 and 49.05±25.74 unit/ml. Conclusions: High seroprevalence of CD in SAM should be taken as alert as CD may be an underlying cause and responsible for malnutrition. These children should be screened by celiac serology (tTg-IgA/IgG) to rule out CD.

PATTERN OF CO-MORBIDITIES IN CHILDREN WITH SEVERE ACUTE MALNUTRITION ADMITTED IN MTC AT M.G. HOSPITAL BHILWARA, RAJASTHAN

Background: A round the globe nearly 20 million children below the age of five, having Severe Acute Malnutrition (SAM) and contributing to one million deaths every year in this age group. To study the pattern of co-morbidities in children having Severe Acute Malnutrition in MTC attached to a teaching hospital.&#x0D; Methods: This prospective study was carried out in the MTC attached to Department of Pediatrics, M.G. Hospital Bhilwara, Rajasthan. All children between One to sixty months of age with severe acute malnutrition (SAM) admitted in the Malnutrition Treatment Centre were included. WHO criteria were followed for diagnosis and need for admissions in children suffering from severe acute malnutrition.&#x0D; Results: Out of 200 children having SAM 55.00% children were having one co-morbidity, 27.00% were having two co-morbidity and 10.00% were having more than two co-morbidty.&#x0D; Conclusions: It is imperative to suspect and anticipate co-morbid condition in these children. High index of suspicion for these co-morbidities is the key to reduce mortality and better outcome in children having acute severe malnutrition.&#x0D; Keywords: sever acute malnutrition (SAM), malnutrition treatment corner (MTC), co-morbidity

Treatment cure rate and its predictors among children with severe acute malnutrition in northwest Ethiopia: A retrospective record review.

BackgroundMore than 29 million that is an estimated 5%, under-five children suffer from severe acute malnutrition (SAM) globally, with a nine times higher risk of mortality than that of well-nourished children. However, little is known regarding outcomes and predictors of SAM in Ethiopia. Therefore, this study aims to determine treatment cure rate and its predictors among children aged 6–59 months with SAM admitted to a stabilization center.MethodologyA retrospective record review was employed in SAM children at the University of Gondar Comprehensive Specialized Hospital (UOGCSH) from 2014 to 2016. SAM defined as weight for height below -3 z scores of the median World Health Organization (WHO) growth standards or presence of bilateral edema or mid upper arm circumference < 115mm for a child ≥6months age. All SAM patients with medical complication(s) or failure to pass appetite test are admitted to the malnutrition treatment center for inpatient follow-up. Data were extracted from a randomly selected records after getting ethical clearance. Data were cleaned, coded and entered to Epi-info version-7, and analyzed using STATA/se version-14. Descriptive statistics and analytic analyses schemes including bivariable and multivariable Cox proportional hazards model were conducted.ResultAmong a total of 416 records recruited for this study, 288 (69.2%) SAM children were cured at the end of the follow up, with a median cure time of 11 days. Kwash-dermatosis (AHR (Adjusted Hazard Ratio): 1.48(95% CI: 1.01, 2.16)), anemia (AHR: 1.36(95% CI: 1.07, 1.74)), tuberculosis (AHR: 1.6(95% CI: 1.04, 2.43)) and altered body temperature at admission (AHR: 1.58(95% CI: 1.04, 2.4) were independent predictors of time to cure.ConclusionThe cure rate in SAM children was low relative to sphere standard guideline. Prognosis of SAM largely depends on the presence of other comorbidities at admission. Available intervention modalities need to address coexisting morbidities to achieve better outcomes in SAM children.

Progress of children with severe acute malnutrition in the malnutrition treatment centre rehabilitation program: evidence from a prospective study in Jharkhand, India

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.

Quantification of edema in edematous severe acute malnutrition children aged 6 months to 5 years

Background: Malnutrition is rampant in India, and edematous severe acute malnutrition (SAM) is associated with high morbidity and mortality. Clinical grading of edema in these children is known, but still, no quantification has been described. Objective: The objective of this study was to quantify the edema in children with edematous SAM (E-SAM). Materials and Methods: This prospective study was conducted over a period of 1 year in 2016 at a malnutrition treatment center of tertiary hospital attached to a medical college. 50 children were selected with E-SAM between 6 months and 5 years of age. The sick children, needing intensive care unit care and having edema other than nutritional cause, were excluded from the study. These children were examined daily for any change in the status of edema by comparing the change in the weight, which was taken using electronic weighing scale. The weight at which child has no edema and no fall in weight for 2 consecutive days was defined as dry weight of the child. All the children were evaluated regarding the onset of loss of edema, days taken for complete disappearance of edema, weight loss per day, mean loss of weight, etc. Results: Of 50 children with E-SAM, 28 were male and 22 were females. Mean age of children was 16.5±11.04 months. The admitted children had +2 edema (26%), followed by +3 edema (17%), while only 7 (14%) children had +1 edema. The mean age of moderate-to-severe edematous children was 13 months. These children started losing edema by day 3 (3.22±0.9) and the mean number of days for complete disappearance of edema was 10.02±2.8 days. The mean percent weight loss was 1% per day and did not vary with different grades of edema (p&gt;0.5). The percentage loss of total weight was maximum for children with +3 edema being 13%, followed by 10% in +2, and 5% in +1 edema which was statistically significant (p=0.004). Conclusions: E-SAM children have grade +1, +2, and +3 edema which are equivalent to 5%, 10%, and &gt;10% over to their actual weight, respectively, and younger children are more susceptible to moderate-to-severe edema.

Experience of anganwadi workers running VCNC under ‘Misssion Balam Sukham’ in a tribal area of Gujarat, India

Background: State Government has started a programme “Mission Balam Sukham” to combat the malnutrition with 3 tier approach including Village Child Nutrition Center (VCNC), Child Malnutrition Treatment Center (CMTC) and Nutrition Rehabilitation Center (NRC). Present study was conducted with the objectives to compare the availability of articles present at anganwadies and VCNCs and to know the experience of anganwadi workers running VCNC. Methods: Ten VCNCs from Naswadi block were selected by systemic random sampling and compared with 10 anganwadies as control group from nearby block Sankheda to check the availability of necessary articles. Ten anganwadi workers who ran the VCNCs for 1 month were interviewed about their experience of running VCNC. Results: There were not major differences in availability of articles like weight machine, MUAC tap, IMNCI (Integrated management of neonatal and childhood illnesses) chart, utensils for cooking, soap and water supply, common medicines and food articles between control anganwadies and VCNCs. Some of the articles like referral slips and thermometer were lacking at control anganwadies as well as VCNCs. Anganwadi workers (AWW) did not get enough medicines and functioning weighing scales and proper training before starting the VCNCs. Conclusions: VCNC needs to supply proper medicine stocks, functional weighing scale and other necessary articles to make the programme successful. AWWs also need the proper training to identify and treat the malnutrition at anganwadi centres.

Complicated severe acute malnutrition: anthropometric status from Southern Rajasthan, India

Background: Childhood under-nutrition is an important public health and development challenge in India. Undernourished children have significantly higher risk of mortality and morbidity. Objective of present study was to identify the anthropometric status of complicated Severe acute malnutrition (SAM) in Southern Rajasthan, India.Methods: It was a retrospective study conducted in children admitted at Malnutrition Treatment Centre attached to a tertiary hospital. Basic socio-demographic and anthropometric records of all children between 6 months to 5 years of age were analysed.Results: Out of the total 1554 SAM children admitted in last two years, 855 (55.01%) were males and 699 (44.98%) were females. Mean weight was 6.17±1.59 kg, mean height was 71.65±8.6 cm and Mid upper arm circumference (MUAC) was 10.99±1.53 cm. Among these, 1375 (88.48%) children fulfilled weight for height (WFH) criteria, 919 (59.13%) fulfilled MUAC criteria and 246 (15.83%) had edema. On WFH Zscore analysis, 53% had &lt;-3SD and &lt;-4SD, 19.88% had &lt;-5SD, 9.97% had &lt;-6SD, 3.47% had &lt;-7SD and 1.67% had &lt;-8SD. Also, we observed that lower values of MUAC ranging from &lt;11.5cm to &lt;9cm. MUAC of 11.5-10cm was in 43.43% of children and 15% had MUAC &lt;10cm. Among the children of all age group, we observe that males of 6-24 months of age are more significantly affected as compared to females.Conclusions: The study highlights the fact that extreme grades of malnutrition exist in our area ranging upto Z-score of -8SD and beyond, and is not limited to -3SD and -4SD. Also, males are the more affected of the two sexes in our rural and tribal area setting.

An experience of facility based management at one of the malnutrition treatment centre in district Baran of Rajasthan, India

Background: To assess performance of one of the Malnutrition Treatment Centre (MTC) in district Baran of Rajasthan. India. Methods: An observational prospective study was conducted at MTC where 132 Severe Acute Malnutrition (SAM) children were recruited. Their socio-demographic details and anthropometric measurements were recorded. These SAM children were followed till the period of 4 follow-up visits to measure their weight. MTC performance indicators were assessed. Results: Majority of SAM children belong to age group less than 2 years, gender female, caste OBC (Other Backward Class), SC (Scheduled Caste) and ST (Scheduled Tribe). ASHAs (Accredited Social Health Activists) are playing key role in referring them to MTC. Death rate was 0%, cure (recovery) rate 42.4%, defaulter rate 25.8%, mean length of stay (days) at MTC was 8.04 and mean weight gain was 5.926 g/kg/day. Performance indicators are significantly affected by length of stay at MTC. Follow-up rate was poor with no significant weight gain observed after discharge. Conclusions: MTCs are effective in saving lives of SAM children but not in maintaining long term control on malnutrition.