Nutritional Rehabilitation Centre Research Articles

Study to determine gender variation in severe acute malnutrition at nutrition rehabilitation centre

Background: The objective of this study is to know the gender variation in number of admissions, severity of malnutrition at the time of admission, gaining of weight and adherence to follow up in children admitted to nutrition rehabilitation center and during follow up.Methods: This is a retrospective study involving the review of existing programme records. Children who were admitted to nutrition rehabilitation centre, district hospital, Chamarajanagar, Karnataka, India, between January 2017 to December 2017 with severe acute malnutrition were involved in the study. The programme included 2 weeks of in-patient care, and four follow-up visits to the NRC subsequently as follows; 1st visit at 7 days, 2nd at 14 days, 3rd at 1 month and 4th at 2 months after discharge.Results: Among 57 children who admitted to NRC females were 30 (52.6%) and males 27 47.4%). 25 among 57 children (43.9%) could sustain weight gain of >5grams/kg/day as per one of the discharge criteria. 13 (52%) were females and 12 (48%) were males. 32(56%) among 57 admitted children to NRC, could achieve <-1SD during entire programmed. 15(46.8%) were females and 17 (53.1%) were males.Conclusions: There was no gender variation in either number of admission or severity of malnutrition at the time of admission or weight gain during NRC programme.

RETROSPECTIVE STUDY OF SEVERE ACUTE MALNOURISHED CHILDREN IN NUTRITION REHABILITATION CENTER OF MADHYA PRADESH, INDIA: MANAGEMENT AND OUTCOME

Introduction: Nutrition rehabilitation centers (NRCs) are established for optimal management of severe acute malnourished (SAM) children. Results of different NRCs vary in terms of outcome. Objective: The objective of the study was to know the morbidity and outcome pattern of SAM children. Materials and Methods: SAM children aged 0–59 months admitted during 2 years period in NRC of district hospital (secondary care center) of central India were enrolled in the study. Data of these children such as age, sex, weight on admission and discharge, complications, treatment, and outcome were studied. Results: A total of 993 children were admitted during 2 years April 2016–March 2018. Male children were 530 (53.37%) and female were 463 (46.62%). 93 (11.17%) children had mid-upper arm circumference 24 months of age. A total of 799 (80.46%) had associated medical complications and 521 (52.46%) children were admitted in the ward for stabilization and treatment of medical illness. 182 (18.32%) children were send back to corresponding NRC after stabilization while 50 (5.03%) were referred to a tertiary care center. From a total of 761 children in NRC, 594 (78.05%) improved, 60 (6.04%) were did not respond, 118 (15.5%) were defaulter, and 6 (0.6%) children died during treatment. The average duration of stay was 10.16 days and average weight gain was 10.01 g/kg/day. Conclusion: Besides, the target of reducing the prevalence of SAM, NRC is very important center for reducing under-five morbidity and mortality. To achieve the target to end up malnutrition, more NRCs should be started with the increasing capacity of existing NRCs with consideration of community-based model.

Evaluation of the outcome indicators of a Nutritional Rehabilitation Center in Eastern India

Background: Under the National Rural Health Mission all over India, in March 2011, the concept of facility-based dietary management in tertiary care hospital, which is named as Nutritional Rehabilitation Center (NRC), was started with the establishment of NRCs at district level. Objective: Our aim was to evaluate the outcome indicators of facility-based management of severe acute malnutrition (SAM) children admitted in the NRC, to identify the gaps in the NRC management of SAM, and to propose recommendations to bridge the gaps. Materials and Methods: This study is a hospital-based snap short study which was conducted in NRC, Sardar Vallabhbhai Patel Postgraduate Institute of Paediatrics, Sishu Bhawan, S.C.B Medical College, Cuttack, from 2014 to 2017. Patients >1 month and

Performance of Nutrition Rehabilitation Centers: A Case Study from Chhattisgarh, India.

Background:High prevalence of malnutrition across India poses a significant obstacle to achieving desirable child health outcomes. For addressing childhood malnutrition, the government of Chhattisgarh during 2010–2014 established Nutrition Rehabilitation Centers (NRCs) in selected health units for the timely, adequate, and appropriate feeding of children, and for improving skills of mothers and caregivers on age-appropriate caring, counseling, and growth monitoring. This study examined the functioning of NRCs in three districts; assessed perception of mothers and carers of children admitted in the NRC; and assessed the perspectives of service providers.Methods:Four out of 46 NRCs were purposively chosen. Monthly performance reports of 2012–2014 were reviewed. Fifty mothers/carers of under-five children were interviewed; and ten in-depth interviews were conducted with the service providers. Descriptive statistics, co-relational, and regression models were used for data analysis; qualitative data were analyzed thematically.Results:Vacancy of staff ranged from 7.4% to 70%. The mean age of children during admission was 23.8 ± 6.2 months. The mean percentage weight gain was 11.6%, whereas the mean duration of stay in the NRC was 10.7 ± 3.5 days. Weight gain was directly related to the weight during admission. Follow-up visit and follow-up card issuing, counseling to mothers, special diet preparation, timely receipt of incentives, and training on diet preparation needed immediate attention.Conclusions:Regular review and supportive supervision could play a crucial role in improving the quality of services. The awareness level and expectation of mothers could be improved through NRC-based education and outreach services.

A study of facility based management at nutrition rehabilitation centres in Telangana state

A study of facility based management at nutrition rehabilitation centres in Telangana state

Outcome of nutritional intervention measures at a nutrition rehabilitation centre in Krishna district, Andhra Pradesh

Background: Nutrition rehabilitation centre (NRC) is a unit in a district health facility, where children with severe acute malnutrition are admitted and provided with nutritional and therapeutic care.Methods: Analysis of nutritional data of all the children admitted to NRC at Krishna district from January 2017 to July 2018. Statistical analysis was done using SPSS.Results: A total of 200 children were included in the study. The overall mean weight at admission was found to be 8.30 kg with a standard deviation of 2.35 kg and the mean weight at the time of discharge is 9.57 kg with a standard deviation of 2.61 kg. There is a statistically significant difference in weight and mid arm circumference at admission and discharge. Mean duration of hospital stay is around 18.67±5.4 days. Target weight is achieved in 71% of the study group.Conclusions: Present study reflects that NRCs have been playing a key role to cope up with the problem of severe acute malnutrition as demonstrated by a high rate of weight gain at discharge as well as during follow ups.

Path to severe acute malnutrition in children below 2 years of age: Findings of qualitative research in Uttar Pradesh, North India

IntroductionMalnutrition in infancy contributes to high mortality and morbidity. In India, government has established nutrition rehabilitation centres for managing children with severe acute malnutrition. The study was conducted with aim to understand how community perceived malnutrition and how child's size at birth, infant and young child feeding related behaviours and child's illness were associated with decline in the child's growth or health. MethodsQualitative research employing focused ethnographic methodologies was used. From February–December 2016, cases studies and in-depth interviews were conducted with 12 mothers of malnourished children <24 months of age (cases), purposively recruited from nutrition rehabilitation centre of 3 districts in Uttar Pradesh, North India. Twenty-four mothers of gender and age matched well-nourished controls from village of cases were also interviewed. Focus group discussion was done with community health workers from villages of cases. Data were coded and after analysis and data triangulation, emerging concepts were grouped into core themes linked with malnutrition. ResultsGrounded on experience of participants, emerging themes were that importance of exclusive breastfeeding was neither understood nor emphasized, there was no concept of complementary feeding, family food lacked diversity, malnutrition was not recognised as a health hazard, and there was lack of autonomy of females in reproductive and general health issues. ConclusionGiven these paths to malnutrition in infancy, there is an urgent need to create community awareness about malnutrition as a disease as well as about optimal breastfeeding and complementary feeding practices in infancy by using innovative behaviour change communication strategies.

Clinical spectrum of severe acute malnutrition among children admitted to nutritional rehabilitation centre of a tertiary care hospital with special reference to incidence of bilateral pitting pedal oedema in children with severe acute malnutrition

Background: Malnutrition is a major cause of morbidity and mortality in under five children globally, according to global nutrition report 2016, forty five percent of deaths in under five children are linked to malnutrition. The objective of this study was to study the clinical spectrum in children with Severe Acute Malnutrition (SAM) admitted to nutritional rehabilitation center of a tertiary care hospital.Methods: Children between the age group of 6 months to 5 years admitted in the nutritional rehabilitation centre during the period of 1 year (from April 2016 to March 2017) meeting our inclusion criteria were included in the study. We retrospectively reviewed the medical records of these children. Clinical spectrum of SAM was compared with comparison group.Results: A total of 100 cases were included in the study. Ninety five percent of children met the criteria of weight for height less than 3SD, 45% of children met the criteria of Mid Upper arm Circumference (MUAC) less than 11.5 cms and 5% of children met the criteria of bilateral pitting pedal oedema. Mean age of presentation of children in the present study was 15.8 months among which 45% were males and 55% were females. Major symptoms of the study group were fever, cough, hurried breathing, loss of appetite and loose stools with 79%, 45%, 27%, 26% and 23% as respective frequencies. Pneumonia (43%) was the major comorbidity among children admitted with severe acute malnutrition. Diarrhoea (21%), meningitis (8%), urinary tract infection (6%) were the other co-morbidities present in the study group.Conclusions: Pneumonia and diarrhoea are the major co-morbidities present in children with SAM. Majority of children fulfil the criteria of weight for height ≤3SD for diagnosis of SAM. There is a low incidence of oedematous malnutrition in the present study.

A study on assessment of nutrition and health status of the children one year after discharge from the Nutritional Rehabilitation Centre in South India

Background: Nutrition rehabilitation centers (NRCs) were started to control severe malnutrition and follow-up of children with severe acute malnutrition is essential because mortality rate of 10-30% has been reported after discharge from hospital.Methods: A community based cross sectional study with the objectives to assess the current health status of the children discharged from the NRC and to assess the healthy practices learned by mothers during their stay at NRC. We included children those discharged from May to October 2013. The children were approached house to house visit and assessed for their health status with a pretested semi structured questionnaire. Mothers of the children were also interviewed for the knowledge and practices of the dietary and child care.Results: Among 67 children, 8 (11.9%) children could not be traced and 7 (10.4%) were reported dead, 52 were included 27 were boys and 25 were girls with a mean age of 35 months. The current nutritional status was 71.2% were not in very low weight, 17.3% were moderately underweight, and 11.5% were still severely underweight. Children who had more number of follow-ups had a better nutritional status which was significant (p&lt;0.0001). 94% of the mothers had knowledge about correct feeding practices and food preparations; 86.5% were aware of good hygiene; 75% aware of the danger signs. Only 59.5% of the mothers could recollect the structured play therapy.Conclusions: Community based followup of the children following discharge from NRC and appropriate feedback to the mothers is very much essential for sustained results.

How healthy are children one year after discharge from nutritional rehabilitation centres?

Nutritional rehabilitation centres (NRCs) have been established to ensure the nutritional recovery of severely malnourished children. The long-term nutritional outcomes in children discharged from NRCs have not been described. In this retrospective cohort study, the nutritional status of 514 children was assessed one year after discharge. Household and maternal data, as well as data regarding variables related to the children's stay at the NRC, were collected. A total of 33.4% had moderate malnutrition and 11.7% had severe malnutrition. The mean weight for height Z-score at admission, discharge and one year after discharge were -3.61, -1.90 and -2.34, respectively. Thus, long-term monitoring and follow-up of children discharged from NRCs till they achieve normal nutritional status is mandatory.

A study of clinical profile and outcome of SAM children admitted in nutritional rehabilitation centre, Patna Medical College and Hospital, Patna, Bihar, India

Background: Severe Acute malnutrition (SAM) with severe wasting remains a major killer of children. In Bihar 48% of children are stunted, 21 % are wasted and 7% are severely wasted. Even during the first six months of life, 31% are wasted. Under nutrition generally decreases with the increasing mother’s schooling, better nutritional status of the mother. Stunting and under nutrition are higher in rural areas than in urban areas.Methods: It is a hospital based observational study done between June 2017 to December 2017. A total of 55 SAM patients with medical complications in the age group of 6 months to 60 months admitted in Nutritional Rehabilitation center (NRC), Department of Pediatrics, Patna Medical College, Patna were included in the study. Socio-Economic profile, effectiveness of NRC in treating SAM children, and effect of timely initiation of complementary feed on nutritional status of children were assessed.Results: A total of 55 children were admitted in the NRC of PMCH, Patna during the period of June 2017 to Dec 2017. 56.4% were males and 43.6% were females. 36% o were in the age group of 12months to 24months. 78% belonged to below poverty line. Major medical complications were anemia (53%), LRTI (33%) and acute gastroenteritis (29%). Immunisation was complete in only 45%. In only 53% babies Complimentary feeding was initiated after 6 months of age. 67% of the mothers of SAM children were illiterate. 95% children were discharged after gaining proper weight. Defaulter rate was 4% and death rate was 2%. 78% of the admitted children showed good weight gain i.e.&gt;10 gm/kg/day, whereas in 15% children weight gain was in the range of 5-10 gm/kg/day.Conclusions: Many factors such as literacy, income, age of marriage and sanitation facility indirectly or directly influence the nutritional status of children. NRCs provide life-saving care for children with SAM as demonstrated by the high recovery rate (95%).

Effect of vitamin D supplementation in children with severe acute malnutrition in a nutritional rehabilitation centre: a randomized controlled trial

Background: According to World Health Organization (2013) approximately 35% of the under-fivemortalities are due to nutrition related factors & 4.4% of deaths are due to severe wasting. It has been found that Vitamin D levels are low in children with malnourished and very sick children. Even the prevalence of vitamin D deficiency is very high in Indian subcontinent. In WHO recommendations for the management of severe acute malnutrition there is no role of vitamin D supplementation. Objective: To study the effect of vitamin D supplementation on severe acute malnourished children admitted in nutritional rehabilitation Centre. Design: Single blinded Randomized controlled, parallel group trial. Setting: Nutritional Rehabilitation Centre (NRC) of a tertiary care hospital. Participants: 70 severe acute malnourished children aged 6 months to 59 months admitted in the NRC were randomized by computer generated random table. Intervention: 6 lakhs IU vitamin D was given intramuscularly on day one of therapy after an informed consent to the study group and other group was given only management of SAM. Main Outcome measure: outcome indicators of NRC i.e. cure rate, death rate, non-responders, relapse rate. Results: There was no significant difference in the outcome indicators of NRC i.e cured, death, non-response and relapse rate (p=0.32) and average weight gain (p= 0.38) and length of stay (p=0.42) between the two groups at discharge but wasting (p=0.02 on first, p=0.008 on third and p=0.04 on fourth follow ups respectively) improved significantly on follow ups. Conclusions: vitamin D supplementation does not have any significant improvement in the outcome indicators at discharge but significantly improves wasting on follow up.

Clinical Profile and outcome of Severe Acute Malnutrition (SAM) Children admitted in Nutrition Rehabilitation Centre, City Hospital, Berhampur, Odisha

Clinical Profile and outcome of Severe Acute Malnutrition (SAM) Children admitted in Nutrition Rehabilitation Centre, City Hospital, Berhampur, Odisha

A study of effectiveness of nutritional interventions on children with severe acute malnutrition admitted in nutrition rehabilitation centers of Bhopal, Madhya Pradesh

Background: The prevalence of under-nutrition among under-five children is high and varies widely. Children with severe acute malnutrition require immediate attention along with proper nutritional rehabilitation not only to decrease mortality but also to achieve full potential after recovery. Nutrition rehabilitation centres (NRCs) were started to control severe malnutrition and decrease the prevalence of severe malnourished children to less than 1% among children aged 1–5 years.Methods: The present study was conducted from July 2016 to June 2017; 500 children admitted to five different NRCs in Bhopal district of Madhya Pradesh were observed during their stay at NRCs and children were followed up during a period of 6 months after discharge from NRCs. Mothers of the children were interviewed on various health issues of children and feeding practices at the NRCs using a predesigned and pretested interview schedule.Results: The study group consisted of 252 boys and 248 girls; 51.20% were between 13 and 36 months of age. All 500 children were analysed for anthropometric indicators. A statistically significant difference was obtained between the weight of children at admission, discharge and follow up (ANOVA=106.2, p&lt;0.001); difference of mid upper arm circumference (MUAC) at admission, discharge and follow up was also statistically significant (ANOVA=24.02, p&lt;0.001). The average weight gain during the stay at the centers was 8.95±3.59 g/kg/day. The mothers of the children lacked adequate information on health issues and composition and preparation of nutrient rich diets for their children.Conclusions: The NRCs were effective in improving the condition of admitted children, but the effects were not well sustained following discharge due to lack of adequate parental awareness and action.

Study of thyroid profile in malnourished children (6 months - 5 years) admitted in the nutritional rehabilitation centre and paediatric ward NSCB Medical College Jabalpur, India

Background: Globally, PEM continues to be a major health problem in developing countries and the most important risk factor for illnesses and death especially among young children. The research was conducted to study the effect of thyroid profile in malnourished children (6 month-5 years) admitted in tertiary care center in Central India.Methods: A cross sectional hospital based observational study was carried out in tertiary care hospital NSCB MCH Jabalpur. 80 malnourished children were included in the study. The cases were categorized into moderate and severe malnutrition as per WHO classification. Detailed clinical assessment of nutritional status followed by anthropometric measurement (weight for height) was recorded in predesigned proforma. Triiodothyronine (T3), Thyroxine (T4), thyroid stimulating hormone (TSH), serum total protein and serum albumin were estimated. The parameters were compared among SAM and MAM groups using appropriate tool.Results: Mean serum protein, serum albumin, T3, T4 were significantly low in SAM group, when compared to the MAM group (p &lt;0.001). while level of TSH was not found significant among SAM and MAM groups.Conclusions: Malnutrition is associated with decrease level of thyroid hormone levels and were positively correlated with serum total protein and albumin levels. The decrease level of thyroid hormone may have a contributory role in retarded growth and development.

Clinical Profile of Children with Severe acute Malnutrition Admitted to the Nutritional Rehabilitation Centre of a Tertiary Care Teaching Hospital of Assam

Clinical Profile of Children with Severe acute Malnutrition Admitted to the Nutritional Rehabilitation Centre of a Tertiary Care Teaching Hospital of Assam

CLINICAL PROFILE OF SEVERE ACUTE MALNUTRITION AMONG CHILDREN UNDER FIVE YEARS OF AGE LIVING IN BUNDELKHAND REGION OF UTTAR PRADESH

Introduction: Malnutrition is a general term and often refers to undernutrition resulting from inadequate consumption, poor absorption, or excessive loss of nutrients, but the term also encompasses overnutrition. Objective: The objective is to study the clinical profile of children with severe acute malnutrition (SAM) and also to assess the effectiveness of Nutrition Rehabilitation Center in providing therapeutic care for children with SAM. Materials and Methods: This prospective study was conducted at the department of pediatrics of a tertiary care center at Jhansi for a period of 12 months among 152 children with SAM. A detailed history and physical examination finding were recorded in pretested pro forma at the time of admission using the standard methodology and anthropometric measurement expressed in standard deviation from the median of the reference population (WHO). Results: Majority of the patients (96, 63.15%) belonged to age group of 6

A STUDY OF SERUM ELECTROLYTES IN SEVERE ACUTE MALNOURISHED CHILDREN WITH AND WITHOUT COMPLICATIONS

Objective: Children with severe acute malnutrition (SAM) are categorized into “complicated and uncomplicated cases” based on clinical criteria alone. Electrolyte imbalance is one of the prognostic factors in severe malnutrition. We aimed to study serum electrolytes in complicated and uncomplicated SAM children. Methods: This was a cross-sectional observational study conducted at the nutritional rehabilitation center of a tertiary care hospital attached to a medical college from May 2016 to April 2017. Children between the ages of 1 month and 5 years who met the World Health Organization criteria for SAM were included in the study. Serum electrolytes were estimated with an automated analyzer by ion selective electrode method. Results: Among 113 SAM children included, 71 had complications and 42 were without complications. The mean value of serum sodium was 134.58±5.45 meq/L, potassium was 4.29±0.75 meq/L, and chloride was 103.31±7.16 meq/L. Hyponatremia was seen in 43.4% and hypokalemia in 7.1% of children. There was no statistically significant difference in the mean values of serum electrolytes and frequency of hyponatremia and hypokalemia between groups. Conclusion: Dyselectrolytemia occurs in SAM children with and without complications. Serum electrolyte levels may need to be measured in all SAM cases to detect asymptomatic hyponatremia and hypokalemia. This will help in triaging those with asymptomatic hyponatremia and hypokalemia to inpatient care.

Evaluation of a Pilot Project to Combat Community Malnutrition in the Health District of Korhogo, Côte d’Ivoire

In Côte d'Ivoire, to combat community malnutrition, the country has opted for the Learning and Nutritional Rehabilitation Center (FARN). Before establishing these centers, a pilot phase was initiated in the Korhogo Health District. The objective of this study was to assess the impact of this intervention in the community. This was a retrospective and prospective cross-sectional study that targeted children aged 6 to 59 months and their mothers. The variables studied were the prevalence of acute malnutrition, the nutritional status of discharged children cared in the community, and the change in mothers' behavior. The results show a significant reduction in the prevalence of malnutrition among 6- to 59-month-old children from 9.7% to 6.2%, a cure rate of 89.1% for children discharged and a consolidation rate of a good nutritional status at 85.4% at 3 months in these same children. Among mothers benefiting from FARN, there was a change in behavior favorable to good nutritional practices compared to non-beneficiary mothers. In view of these results, FARNs prove to be an effective approach to fighting malnutrition in Côte d'Ivoire. Extending this approach to the entire national territory is therefore essential.

A prospective observational study to evaluate the efficacy of facility-based management in malnourished children at NRC, district Meerut.

Background:Scarcity of suitable food, lack of purchasing power of the family as well as traditional beliefs and taboos about what the baby should eat, often lead to a sufficient balanced diet, resulting in malnutrition. In children, malnutrition is synonymous with growth failure. Malnourished children are shorter and weigh less than they should be for their age and height.Materials and Methods:The present study was conducted from September 2017 to November 2017.112 malnourish children, aged 6-60 months who were admitted to NRC during the study period at district hospital Meerut were assessed. Checklist based on operational guidelines on facility based management was used. Data was analyzed in Microsoft Excel and Epi info.Result:In the studied population, there were 45 males and 67 females, out of which highest representation was from the age group of 13 to 24 months.67% of studied population belonged to schedule caste. The average weight gain during the stay at the center was 9.92±5.43g/kg/day. The average duration of stay at NRC was 12.01±1.61 days. Only 30% of mothers had appropriate knowledge regarding therapeutic diet and only 50% of the mothers know about the preparation of nutritious food from locally available foods.Conclusion:Targeted supplementary nutrition and therapeutic nutrition with specific micronutrients when provided to malnourish children for 14 days by Nutrition Rehabilitation Center can be helpful to improve their nutritional status. There is need to scale up community awareness and community participation for NRCs.