Malnutrition Treatment Center Research Articles

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.

Complimentary feeding practices in severe acute malnutrition children admitted in malnutrition treatment centre of RNT medical college

Background: To assess the complimentary feeding practice in Severe Acute Malnutrition (SAM) children aged between 6months to 5years.Methods: 110 SAM children admitted in Malnutrition Treatment Centre (MTC) of MBGH Hospital, Udaipur over a period of 3 months were taken in the study. Structured questionnaire including child’s personal data, socioeconomic status of the family, breast feeding and complementary feeding status were used. Clinical and anthropometric assessment of children was done.Results: Out of the 110 children included in the study, 58 (52.7%) were males and 52 (47.2%) were females. Mean age of children included was 16.8 ± 10.73 months. Maximum children were in the age group of 6-12months 60 (54.5%), followed by 13-24 months of age 38 (34.5%), followed by >2-5years of age 12 (10.9%). Thirty-four (30.9%) children were on exclusive breast feeding, with 30 (27.3%) in age group of 6-12 months and 4 (3.6%) in 12- 24 months. Breast feeding with complimentary feeding was practiced in 30 (27.3%) children of 6-12 months of age and 22 (20%) children of 13-24 months. Out of the 76 children on additional feed with or without breast feeds, 70 (92.1%) consumed milk- either goat milk, cow milk or buffalo milk.Conclusions: Anthropometric assessment revealed that maximum number of SAM children also had chronic malnutrition. Diet of SAM children mainly included milk and cereals. They did not obtain a balanced diet to meet their nutritional requirement.

Serum Albumin Levels In Edematous Severe Acute Malnutrition Children Aged 6 Months to 5 Years.

Objective: To Study the serum albumin levels in edematous severe acute malnutrition children aged 6months to 5 years.Methods: An observational hospital based prospective study was conducted at Malnutrition Treatment Center (MTC), Bal Chikitsalya, RNT Medical College, Udaipur (Raj.) India from July 2015 to Dec 2015. We enrolled total 50 children aged 6 Months to 5 Years having nutritional edema with medical complications. Acute complications were treated and nutritional rehabilitation was done by WHO protocols.Results: A total of 50 children were studied. Mean age of children was 16.5411.05 months, 52.0% were males and 48.0% were females. Majority of children had moderate edema(52.0%) followed by 34.0%of severe edema whereas only 14.0% of SAM children had mild edema. Mean serum albumin levels were 2.7 50.74 gm/dl. Serum albumin levels were, In mild grade edema(1+), 3.270.60 gm/dl, in moderate grade edema(+2) 2.85 0.74gm/dl and in severe grade edema(3+) 2.38 0.63 gm/dl.. Serum albumin levels were statistically significantly associated with grade of edema (p value=0.01).Conclusion: This study concluded that edematous severe acute malnutrition children had hypoalbuminemia and this hypoalbuminemia statistically significant with grade of edema.

Pattern of Co-morbidities in Children with Severe Acute Malnutrition admitted in MTC of a teaching hospital of Westeren Rajasthan, India

1 Incharge of Malnutrition Treatment Center, Department of Paeditrics, S. P. Medical College, Bikaner, Rajasthan, INDIA 2* Assistant Professor, Department of Biochemistry, S. P. Medical College, Bikaner, Rajasthan, INDIA 3 Professor and Head of Dept, Department of Paeditrics, S. P. Medical College, Bikaner, Rajasthan, INDIA *Corresponding Author Dr Anita Verma Assistant Professor, Department of Biochemistry, S. P. Medical College, Bikaner, Rajasthan, INDIA Phone (or Mobile) No.: +919460995741 Email: anita.verma.meena@gmail.com Abstract Objective: To study the pattern of co-morbidities in children having Severe Acute Malnutrition in MTC attached to a teaching hospital. Methods: In a span of five years all the children (1082), admitted in MTC of PBM Hospital,S.P.Medical College Bikaner, were studied for presence of one or more comorbid conditions along with severe acute malnutrition. Results: Out of the 1082 children who were admitted to Malnutrition Treatment Center (MTC), acute respiratory infection is the most common (55.17%) co-morbidity in children with Severe Acute Malnutrition and followed by Anaemia (43.17%). Out of 1082 children having SAM 63.58% children were having one comorbidity, 26.89% were having two co-morbidity and 9.42% were having more than two co-morbidty. 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.

Myocardial performance index in severe acute malnutrition children aged 6 month to 5 years

Background: Severe Acute Malnutrition (SAM) is one of the most common health problems. Children suffering from SAM frequently exhibit cardiovascular abnormalities leading to morbidity and mortality. We evaluated myocardial performance index (MPI) to measure both systolic and diastolic functions of the heart. Methods: Hospital based prospective study in which we enrolled 100 children with SAM aged 6 months to 5 years admitted in malnutrition treatment centre (MTC), Bal Chikitaslya, Udaipur, Rajasthan, India. All the children underwent a detailed clinical and echocardiographic evaluation. The different echocardiographic variables along with MPI were calculated . Results: Out of 100 children majority of study population was in <-3SD, Z-score and <-4 SD, Z-score (63%), although extremes like <-5 SD to <-7SD, Z-score were also noted in 35% of children. In echocardigraphic variables ventricular function as mean ejection fraction was normal (70.69±9.57). The mean MPI was 0.41±0.11 with p-value of <0.001. Conclusions: MPI in SAM children was abnormally high inspite of normal ejection fraction. This can be used in children with SAM as early marker of ventricular dysfunction even before ejection fraction starts declining.

Clinico-laboratory profile and outcome of edematous severe acute malnutrition in children aged 6 months to 5 years

Background: Malnutrition is still rampant in India. There are so many cases of edematous malnutrition present in Rajasthan. So we planned to study the Clinico-Laboratory profile And Outcome of Edematous Severe Acute Malnutrition in children aged 6 months to 5 years. Methods: An observational hospital based prospective study was conducted at Malnutrition Treatment Center (MTC), Bal Chikitsalya, RNT Medical College, Udaipur, Rajasthan, India from July 2015 to Dec 2015. We enrolled total 50 SAM children aged 6 Months to 5 years having nutritional edema with medical complications. All the enrolled cases were hospitalized, acute complications were treated and nutritional rehabilitation by WHO feeding protocol was done. Clinical, laboratory parameters and outcome of E-SAM were analyzed. Results: A total of 50 children were studied. Mean age of children was 16.54±11.05 months, 52.0% were male and 48.0% were female children, Majority of them were under <-3SD and <-4SD z-score (48.0%) followed by <-2SD and in <-1SD z-score (32.0%). Onset of edema reduction occurs on 3.22±0.91day, complete disappearance of edema occurs in 10.02±2.80 days, mean weight fall was 0.91±0.31% per day, mean length of stay in hospital was 14.93 ±4.10 days. Mean weight gain was 14.18±5.42 gm/kg/day and case fatality rate was nil. All these outcomes except weight gain were significantly associated with grade of edema (p value <.05). Conclusions: Majority of the patients they were in WHO z-score of <-3SD and <-4SD z-score but extremes are also occurring up to <-8SD z-score Pneumonia and tuberculosis are the affected co morbidities for outcome of E-SAM children. Disappearance of edema, and length of stay are little bit longer than usual WHO guideline recommendations and they had a significant association with grade of edema. Percentage of wt. fall also had association with grade of edema.

Cultural significance of primary teeth for caregivers in Northeast Brazil

This anthropological study critically evaluates Brazilian caregivers' symbolic production and significance of their malnourished offspring's primary teeth, as well as their own, and describes popular dental practices. From January to June 2004, ethnographic interviews of 27 poor, low-literacy mothers were conducted at a public Malnutrition Treatment Center in Fortaleza, Ceará State. Participant observation of clinical pathways and home environments supplemented the data. Content analysis was performed. Results confirm that primary teeth are imbued with cultural significance in Northeast Brazil. Mothers examine mouths, perceive signs of decay, associate primary with permanent tooth healthiness, identify ethnodental illnesses, seek assistance, and perform rituals with exfoliated teeth. The mother's motivation to care for primary teeth is sparked by her memories of past toothache and attempts to avoid stigma and discrimination. Social determinants, not mothers' beliefs or behaviors, are the most critical obstacles to effective dental care. Legitimizing lay knowledge and empowering caregivers and children can improve oral health in Northeast Brazil.

"Fraqueza de nascença": sentidos e significados culturais de impressões maternas na saúde infantil no Nordeste brasileiro

Pregnancy encompasses socio-cultural, historical, and affective dimensions that process various meanings in women's bodies. Each society constructs popular concepts, practices, and explanatory models that differ from the biomedical model and aim to protect the mother and fetus and foster a healthy pregnancy. This qualitative study, based on interpretative anthropology, unveils the experiences of 27 poor women and their repercussions on the malnutrition of their infants, treated at a Childhood Malnutrition Treatment Center in Fortaleza, Northeast Brazil. From January to June 2004, ethnographic and narrative interviews were conducted on so-called "birth weakness", in addition to participant observation of outpatient, nursing, and home childcare. The mothers believed that their own physical and emotional suffering and precarious nutritional status were "imprinted" on the fetus, resulting in the child's malnutrition. While the ethno-etiology of "weakness" points to factors outside the body that involuntarily affect the pregnant mother, the medical view tended to incriminate the mother herself. It is necessary to understand the mothers' narratives, sympathize with their suffering, and spawn a closer approach between the popular and biomedical concepts.