Nutritional Rehabilitation Centre Research Articles

Impact of maternal education on the development of severe acute malnourished children

Background: Severe acute malnutrition (SAM) is a grave form of undernutrition that has been recognized as a medical and social disorder. Various factors contribute to the development of SAM, but the impact of maternal education on the nutritional status and development of the child is of paramount importance since focused interventions in this aspect can yield promising results. Aims and Objectives: The aims and objectives of the study are to assess the impact of maternal education on the development of children with SAM. Materials and Methods: A total of 125 SAM children in the age group 12–30 months were enrolled in this prospective observational study from among those admitted to the nutritional rehabilitation center of a tertiary care center in central India. The developmental status of SAM children was assessed using the Developmental Assessment Scale of Indian Infants. The association of maternal education with the development of SAM children was analyzed. Results: Overall developmental delay was observed in 44.8% of SAM children, whereas motor and mental development delay was noted in 45.6% and 44% of SAM children. The maternal education level was significantly associated with the overall development of the SAM child. (P=0.043 for motor development, P=0.017 for mental development, P=0.023 for motor developmental delay). Conclusion: Maternal education plays a key role in improving the developmental status of SAM children, who are more prone to developmental delays across various domains. Efforts toward enhancing maternal education, especially knowledge regarding child nutrition and development, can reduce the incidence and improve the management of SAM in children.

IJCM_97A: Clinico-epidemiological profile and outcome of Severe Acute Malnutrition children admitted to the nutritional rehabilitation centre of a tertiary care hospital in Kalaburagi, Karnataka: a retrospective study

Background: Severe acute malnutrition is the major cause for under- five morbidity and mortality. According to NFHS 5 (2019-20), 7.7% of malnourished children under 5 years in India were severely wasted and in Karnataka it is 8.4 %. There is paucity of data on risk factors and clinical outcomes related to SAM children in North Karnataka, hence the present study was conducted. Objectives: 1. To assess the clinico-epidemiological profile of SAM children. 2. To determine the risk factors of SAM children admitted in NRC. 3. To study outcomes of SAM children admitted in NRC. Methodology: Study setting: Nutritional Rehabilitation Centre of Gulbarga Institute of Medical Sciences, a Tertiary care hospital in Kalaburagi. Study design: A retrospective record- based cross-sectional study Study population: All children under 5 years of age admitted with SAM in the NRC at GIMS, Kalaburagi. Study duration: December 2022- November 2023 Sample size: As per data from Medical Records Department, total number of SAM children admitted in NRC is 180 between December 2022 to November 2023. DATA COLLECTION METHOD: In all the admitted patients, a detailed history including socio demographic, clinical presentation, birth order, immunization and duration of stay in NRC, physical examination findings and investigations were collected from available records. Anthropometric measurements like weight, length /height, MUAC and weight for height were collected and analysed using WHO growth charts. The outcomes included whether the children completed duration of stay at NRC were cured with weight gain, no weight gain or succumbed to malnutrition. Inclusion criteria: All children under 5 years who were admitted and fulfilled the criteria of SAM by WHO. Exclusion Criteria: 1. Case sheets of admitted SAM children with incomplete data. STATISTICAL ANALYSIS: Data were entered in Microsoft excel sheet and analyzed using SPSS version 20. Results: Among 150 SAM children analysed,77 (51.7%) males and 73(48.3%) females had weight for height below - 3SD. Conclusion: Hospital-based management of SAM children in NRC with adherence to updated WHO standard guidelines has helped in reducing mortality and morbidity among undernourished children.

A study on maternal factors associated with knowledge, attitude and practices regarding feeding practices among mothers attending NRC

Background: Child under nutrition is the leading cause in more than one third of infant and child death globally especially in developing countries. Various social and environmental factors affect child nutrition and result in under nutrition. Maternal knowledge, their attitude, and practices all can have an effect in changing the child’s nutritional pattern. It is thus essential that mothers have proper knowledge on dietary practices in prevention of malnutrition, which, in turn, can help them to have good attitude toward the dietary practices so that they can change their behaviour and harmful practices. Methods: Information obtained from the mothers of children admitted to nutrition rehabilitation centre (NRC) during the period from January 2020 to June 2021 using the questionnaire with direct interview method. Used a predesigned questionnaire on respective mothers. Results: 42.8% of mothers had an overall good knowledge. 91.96% of mothers had a positive attitude and good practices towards feeding practices of children admitted to NRC. Conclusions: Education occupation and socio-economic class does not influence the knowledge attitude and practices of mothers regarding feeding practices whereas number of ANC visits has a significant effect.

Correlation between maternal and infant vitamin B12 levels in severe malnutrition in infants under 6months.

Malnutrition poses a significant global health challenge, affecting various age groups, with infants under 6months being particularly vulnerable. Vitamin B12, an essential micronutrient critical for neurological development, has been identified as a key player in the overall health of both mothers and infants. To find the correlation between serum vitamin B12 levels in infants, 1-6months of age with severe malnutrition and maternal levels at tertiary care hospitals in western Rajasthan. The cross-sectional study was conducted in the UNICEF Regional Center of Excellence-supported Nutrition Rehabilitation Center in Rajasthan, India, through simple random sampling. One hundred ten infants with their mothers were enrolled after consent and approval from the Institutional Ethics Committee. Severe malnutrition predominantly affected infants aged 1-2months, with 77% born small for gestational age and 66.4% belonging to the multiple birth order group. Serum vitamin B12 levels showed a significant positive correlation between mothers and infants (p < 0.001), while exclusive breastfeeding correlated positively with age-appropriate milestones (p = 0.033). The findings emphasize the importance of targeted interventions addressing maternal and infant nutrition, with a focus on ensuring adequate vitamin B12 levels.

Determinants of nutritional outcome among beneficiaries of Nutrition Rehabilitation Centre

Background: Under Mission Balam Sukham, children of 6 months to 5 years having severe acute malnutrition (SAM) along with complications are managed at Nutrition Rehabilitation Centre (NRC). They are admitted for 14 days with the provision of a nutritional diet and medicines. Objectives: To explore determinants of nutritional outcome of SAM children admitted at NRC Methods: A prospective cohort study was conducted comprising 63 children aged 6 months to 5 years having SAM along with complications admitted at NRC of New Civil Hospital, Surat (NCHS) for 10 months. Results: The majority of participants were boys (54%), 12-23 months of age (50.8%), and Grade III socioeconomic class (39.6%). The duration of stay ranged from 2-36 days. The average duration of stay was 12.78 + 6.49 days; 14.26 ± 5.99 days for boys and 11.10 + 6.73 for girls. 18.8% stayed at NRC for 14 days. The average weight gain was 5.46 g/kg/day. A significant improvement in weight was seen in boys (t=2.20, p&lt;0.05), working mothers (t=2.44, p&lt;0.01), exclusively breastfed children (t=3.62, p&lt;0.01) of 6-11 months, full-term children of 12-23 months (t=4.0, p&lt;0.05). The children of 12-23 months (t=2.90, p&lt;0.01) and boys (t=2.15, p&lt;0.05) showed significant improvement in underweight (WAZ). Wasting improved significantly in age below 36 months (p&lt;0.05). 20.6% could achieve the target weight. Conclusion: NRC is an effective life-saving modality for malnutrition but its outcome is associated with factors like boys, exclusive breastfeeding, and full-term.

Thyroid Hormone Status in Severely Malnourished Children between 6 Months to 5 Years Admitted to Nutritional Rehabilitation Centre of a Tertiary Care Hospital

Introduction: Severe malnutrition poses a significant risk to the thyroid gland's function and hormonal balance, which can lead to numerous physiological and developmental complications. Understanding the relationship between severe malnutrition and thyroid hormone status is crucial for the effective management of these children.&#x0D; Aim and Objective: To investigate the prevalence and patterns of thyroid hormone abnormalities in severely malnourished patients with subgroup analysis in Marasmus, Kwashiorkor, and edematous malnourished patients.&#x0D; Methodology: We conducted a cross-sectional study involving 116 children diagnosed with severe acute malnutrition (SAM). The study protocol was approved by the Institution Ethics Committee. Well-informed written consent in the local language was taken from parents. SAM was diagnosed and managed according to WHO criteria (1). Comprehensive laboratory investigations were conducted to assess serum levels of thyroid-stimulating hormone (TSH), free thyroxine (T4), and triiodothyronine (T3). Statistical analysis was performed to examine the associations between these variables and SAM.&#x0D; Results: Most of the 116 subjects included in the study were male (53.4%) and had a lower socioeconomic status (43.9%). The age distribution of the children aged below 5 years revealed that 46.5% were between 12 and 36 months old. In the present study, Marasmus was 55.2%, Kwashiorkor was 12.1%, and edematous malnutrition was 32.7%. Among 116 participants, 94.8% were discharged, while 5.2% were expired during treatment. The mean levels of fT3, fT4, and TSH were 1.88±1.06 pg/ml, 0.99±0.84 ng/dl, and 3.22±0.87 µIU/ml, respectively. Most SAM patients had low fT3, fT4, and TSH levels relative to the normal range.&#x0D; Conclusion: Monitoring of thyroid hormone status in SAM patients is mandatory for this vulnerable population.

Outcome of Malnourished Children Admitted in the Nutritional Rehabilitation Home.

Globally, the burden of malnutrition, especially undernutrition, as well as the consequences of malnutrition is of the rise which is especially of significant concern for underdeveloped countries. Countries like Nepal are also facing a similar problem of malnutrition. In Madhesh province, among the under 5 children the incidence of chronic malnutrition is 29.3%. Our aim is to assess the malnourishment in the children of Madhesh province in Nepal. This cross-sectional quantitative study was carried out among 409 malnourished children who were admitted from July 17, 2018 to July 16, 2022 at NRH in Gajendra Narayan Singh Hospital. Collected data were fed into Microsoft-excel and analyzed using SPSS software, version-2016. As data were normally distributed, frequency, percentage, mean and standard deviation were calculated for descriptive analysis. To find out the association of categorical variables, the Chi-square test or Fisher's Exact test was used where appropriate. P-value <0.05 was significant. Out of 409 malnourished cases, 145 cases were SAM (SD<-3) and 264 cases were MAM (-2 to -3SD) at the time of admission. The mean increment in the weight was 1.14±0.44 kg. The average length of stay was 19.82±8.73 days. There is a significant difference (p<0.001) in the length of stay among the SAM and MAM cases of our study and a difference in the increment of weight in comparison to mean weight gain (1.14±0.44 kg) with respect to the length of stay of the malnourished child who stayed for more than 28 days and less. There is significant weight gain in malnourished children after management at the Nutritional Rehabilitation Center.

Critical period for better nutrition among severely acute malnourished children up to two years of age: a hospital-based case-control study, Gujarat, Western India

Background: Nutrition in the first two years of life is important for growth and development among children. To tackle undernutrition during this period, timely initiation of breastfeeding and quality of complementary feeding practices are essential. So, this study was planned to determine feeding practices associated with severe acute malnutrition children. Methods: This was hospital-based case-control study with 1:1 ratio of cases (77) and controls (77). Cases and controls were matched for age and sex. Cases were selected from Nutritional Rehabilitation Centre and controls from Immunization clinic. Mothers were interviewed about feeding practices, immunization status and illness of their child. Weight and height of children were also measured. Results: Children who received pre-lacteal feeding were associated with SAM. Most of cases (62.3%) and controls (70.1%) had received breastfeeding within 1 hour of birth. Among children of &lt;7 months age, 71.4% cases breast-fed &lt;8 times in 24 hours. Among children of 7 months to 2 years, SAM was associated with children who were not received complementary feeding (CF) at correct age, not received semi-solid/solid diet, CF not added with ghee/oil and feeding frequency &lt;5 times in day. Among cases 18.2% and only 1.3% controls had &gt;3 ARI episodes in last 6 months. Conclusions: Among identified independent risk factors (p&lt;0.05), type of CF, not adding ghee/oil in CF and feeding frequency (BF+CF) &lt;5 times were associated with SAM among 7 months to 2 years. Hospitalization history and &gt;3 ARI episodes in last 6 months were also associated with SAM.

Classes of medications prescribed to malnourished children and their relationship with time to recovery.

There is conflicting evidence around prescription practices in the management of malnutrition; the study objective was to explore medication classifications prescribed and their relationship between time-to-recovery and specific demographic characteristics among children with malnutrition in Guatemala. Descriptive correlational study of data obtained in a retrospective record review. Children aged 0-5years with malnutrition treated in a Guatemalan Nutrition Rehabilitation Center between 2019 and 2020 (N=155). Variables assessed were medication classification of prescribed medications, age, gender, time-to-recovery, malnutrition severity, and COVID cohort. The most frequently used medication classifications were vitamins (95%), respiratory (75%), antipyretic (68%), antibiotic (61%), and gastrointestinal agents (54%). Antibiotic, respiratory, corticosteroid, antipyretic, and gastrointestinal agents were prescribed significantly more in cases with a time-to-recovery of 6weeks or greater. Medication classifications prescribed most often were related to common comorbidities of malnutrition and illnesses affecting children in Guatemala, such as respiratory and diarrheal diseases. The medication used in cases with a time-to-recovery of ≥6weeks suggest these cases may have had more comorbidities, which could explain the longer recovery times. Caution is suggested in routine prophylactic antibiotic use in public health settings, given the lack of association with improved recovery times, the potential for antibiotic drug resistance, and the negative effects on renal function among children.

Pulmonary Tuberculosis in Severely Malnourished Children Admitted to Nutrition Rehabilitation Centers: A Multicenter Study.

To identify prevalence of pulmonary tuberculosis (TB) in severely malnourished children admitted to nutritional rehabilitation centers. A multicenter cross-sectional study involving 41 nutrition rehabilitation centres (NRCs) across India was carried out to document prevalence of pulmonary tuberculosis in acute severe malnourished children admitted in NRCs. After training of the NRC staff to follow algorithm provided by national tuberculosis elimination program, children admitted to NRCs were screened for pulmonary tuberculosis. A total of 4356 children were enrolled across all the sites. Gastric aspirate for Cartridge based nucleic acid amplification test (CBNAAT), tuberculin skin test (TST) and X-ray film of chest were done in more than 99% of enrolled subjects. A total of 189 children (4.3%) had pulmonary tuberculosis. Eighty-seven (1.99%) were microbiologically confirmed by positive CBNAAT. On multivariate analysis, only significant association was with history of contact with TB patient in family. The present results suggest that a significant proportion (>4%) of children admitted in NRCs suffer from pulmonarytuberculosis. It is feasible to improve diagnosis of tuberculosis as a whole and microbiologically confirmed TB.

Understanding time-to-recovery among Guatemalan Children before and during COVID-19

PurposeTo understand malnutrition recovery at a Guatemalan Nutrition Rehabilitation Center (NRC) before and during the COVID-19 pandemic. Design and methodsA retrospective chart review was conducted on-site in November 2022. The NRC is located on the outskirts of Antigua, Guatemala. They manage the care of 15–20 children at a time, providing food, medicine, and health assessments. A total of 156 records were included (126 prior to the onset of COVID; 30 after the onset of COVID). Descriptive variables collected were age, gender, severity of malnutrition, height, weight, amoxicillin, multivitamins, nebulizer/bronchodilator, and zinc. Principal resultsThere was no significant difference in time-to-recovery between COVID cohorts. Mean time-to-recovery was 5.65 weeks, or 39.57 days (SD = 25.62, 95% CI [35.5, 43.7]) among all recovered cases (n = 149). The cohort admitted after the onset of COVID-19 (March 1, 2020) had a significantly higher weight gain and discharge weight. In the total sample, amoxicillin was the only significant predictor variable for recovery time; with children receiving it being more likely to recover in >6 weeks. The few differences between cohorts was possibly attributed to the sample after the onset of COVID-19. These records had minimal sociocultural data. Major conclusionsConducting a family needs assessment on admission could identify sociocultural factors that may facilitate nutritional recovery, such as housing conditions and potable water access. Further research is needed to more fully understand the complexities that the COVID-19 pandemic has had on childhood malnutrition recovery.

Influence of gender inequalities in curative and preventive health care use among children between 2 months to 5 years of age and its impact on changing sex ratio of the community

Background: Male preferring mentality of the society has created a discrimination against females in seeking curative and preventive health care and their overall nutritional status. Methods: Prospective observational study that included all the children between the age of 2 months to 5 years. The data collection started from January 2020 from registers in a monthly fashion till December 2020 and were analysed and categorized based on sex difference in admissions, leave against medical advice, mortality, immunisation, and follow-up. Results: The basic descriptive statistics shows that there is gross difference in the frequency of admissions in Inpatient (males- 58.33%, females- 41.67%), follow-up care (males- 56.33%, females- 43.67%) and immunization (males-53.06%, females-46.94%). The number of females children who left against medical advice (10.49%) were more than male children (6.45%) and is also statistically significant. In our study a greater number of female deaths (11.02%) occurred compared to males (10.15%) despite of their survival advantage. The number of female children (48.30%) who were admitted in nutritional rehabilitation centre were less compared to the number of males (51.70%). The hospital sex ratio at birth was 114 males per 100 females which is worse than the national average. Conclusions: Male biased community has put females at risk starting from the time of conception. Gender difference is experienced throughout and in all aspects of social, cultural, healthcare fields and nutritional needs.

A Feasibility Study to Examine Clinical Variables of Childhood Malnutrition in Guatemala.

Introduction: Guatemala is the country with the highest rate of malnutrition in Latin America and fifth highest worldwide. The objective of this pilot study was to determine the feasibility of examining clinical variables of malnutrition among a subset of children at a Guatemalan Nutrition Rehabilitation Center (NRC). Methods: The study was conducted using a secondary dataset of children admitted and discharged at the NRC in 2018. A total of 42 cases were reviewed. The 12 clinical variables were age, gender, height, weight, nutrition status, referral, diet, secondary diagnoses, medications, supplements, discharge disposition, and time-to-discharge. Results: The two major findings were (a) the lack of access to height and weight at discharge and (b) the inability to verify time-to-recovery. Mean age of participants was 23 months (SD = 12.9). All children were discharged home; median time-to-discharge was 48 days. The Kaplan-Meier analyses indicated that children <2 had slower time-to-discharge (51 days), compared to those older than age 2 (32 days); though not statistically significant. Conclusion: Findings of this study provide valuable data to inform ways NRC leadership can better report child health outcomes. International community-academic partnership could contribute to understanding malnutrition and time-to-recovery.

Effect of Community Nutrition Rehabilitation Using a Multi-Ingredient Flour on the Weight Growth of Moderately Acute Malnourished Children in Benin.

Childhood malnutrition remains a public health problem in Benin. This study aimed to assess the nutritional potential of complementary food resources to accelerate the weight growth of moderately malnourished children hosted in learning and nutritional rehabilitation centers (LNRs) in eight municipalities in Benin. A multi-ingredient infant flour (i.e., FARIFORTI), composed of 35% corn flour (Zea mays), 15% malted sorghum (Sorghum bicolor), 30% soybean (Glycine max), 10% shelled and roasted peanuts (Arachis hypogeaea), 7% baobab pulp (Adansonia digitata), and 2% dried fried fish (Stolothrissa tanganyicae), was tested with 289 moderately malnourished children aged 6 to 59 months, selected in LNR sessions. Children were given the FARIFORTI flour porridge over 12 days (based on LNR protocol) in addition to other dishes based on local food resources. The weight and height of the children were measured at entry and at the end of the LNR sessions. The sensory evaluation indicated that the FARIFORTI flour was well-accepted by mothers (97%) and children (98%). The FARIFORTI porridge provided significantly higher intakes of carbohydrates and iron in children with weight gain compared to children without weight gain.

Clinicoepidemiological profile of severe acute malnutrition children admitted to the nutritional rehabilitation center of a tertiary care center in Davangere: A retrospective study

Clinicoepidemiological profile of severe acute malnutrition children admitted to the nutritional rehabilitation center of a tertiary care center in Davangere: A retrospective study

Management of Severe Acute Malnutrition in Day Care Settings: Findings from Innovative Public Private Partnership at Devbhumi Dwarka District, Gujarat

Introduction: Severe Acute Malnutrition (SAM) is a major public health concern that is linked to a high mortality rate in children under the age of five. Government of Gujarat has expanded treatment network from government facilities to private institutions and non-governmental organizations through various initiative in an effort to address the issue of SAM. Objective: To assess the treatment outcome among SAM children (0-5 years) admitted at Niramay Bal Poshan Kendra, Jam Khambhalia, Devbhumi Dwarka District of Gujarat. Method: A longitudinal study was conducted among SAM children admitted at The Niramay Bal Poshan Kendra (Public Private Partnership model under Bal Poshan Yojana) which is a day care center providing treatment to SAM children for 14 days according to the protocol of NRC (Nutrition Rehabilitation Centre). Under Bal Poshan Yojana, RBSK medical officers screened children for SAM and referred them for treatment at empanelled NGO/Private institution. Total 1557 under five children were screened by them between 6th September 2021 and 5th February 2022. Out of them 121 SAM children were identified, 95 children could be mobilized at the study site (Niramay Bal Poshan Kendra). Out of 95 children, 76 SAM children completed the treatment along with all three follow up at the study site. The data of these 76 Children was analyzed. Results: Among 76 children, average weight gain was 566 grams at the time of discharge and 1000 grams at the time of third follow-up. An average weight gain for the cohort is 5.2 gram/kg/day. At the end of treatment, 92% children moved out of the SAM category at the completion of three follow-up, 55% moved to Moderate Acute Malnutrition and 37% to normal weight category. Conclusion: An average weight gain among the study population was satisfactory. Day care treatment model provides advantage of improved treatment completion rate and higher follow-up completion. Similar models of SAM treatment can help in effectively tackling menace of malnutrition in Gujarat.

Clinico-epidemiological profile and outcome of children with severe acute malnutrition

Background: Severe acute malnutrition is a significant crisis which can cause great morbidity and mortality in children. The aim of this study was to study the clinic-epidemiological profile and outcome of these children in a tertiary care hospital.Methods: The study was an observational prospective study conducted from November 2018 to April 2020. A total of 61 patients were enrolled in our study. All Children were managed in nutritional rehabilitation centre as per WHO protocol.Results: Male to female ratio was 1:1.6. Majority of patients were of age less the 2 years (83.4%) and were of birth order 3 or more (65.5%). The mean age of presentation was 12.016±7.72 months. Mean duration of exclusively breast feeding in our study was 3.643±1.81 months. Weight-for-height &lt;-3 SD was the most commonly used diagnostic criteria. 67.2% patients recovered completely, 24.6% patients recovered partially and 8.2% patients were defaulters. Mean duration of hospital stay of patients in our study was 12.918±7.9735 days and average weight gain in our study was 8.808±3.7312 g/kg/day. The most common presenting symptom in our study was fever (45.9%). The most common co-morbidity in our study was bronchopneumonia (27.9%).Conclusions: The problem of severe malnutrition is multi-dimensional and inter-generational in nature. Most of patients come to hospital with complaints like fever, cough, loose motions, vomiting and are then discovered as patients of severe acute malnutrition. Thus, screening the patients who report to hospital with various complaints can help in early detection and proper rehabilitation. NRCs provide live-saving care for children with SAM as demonstrated by the high survival rates in this study.

Nutritional Qualities and Vitamin Content of Local Flours Used in Nutritional Rehabilitation Centers in Côte d'Ivoire

The goal of this study was to confirm that the protein, micronutrient content, and energy value of specialized food products made from local foods meet international quality criteria for the management of mild acute malnutrition. These local specialized food products are already consumed in nutritional rehabilitation facilities in Côte d'Ivoire under the supervision of the NNP (National Nutrition Program). The NNP-recommended procedures were used to manufacture the replacement flour formulations. These flours' physicochemical and nutritional properties were assessed using established procedures. Protein levels ranged from 11.19 to 18.12 % in 100 g of dry matter, carbohydrates from 51.5 to 73.9 %, lipids from 9.66 to 23.86%, and energy value ranged from 427.36 to 493.33 Kcal/100g. These flours fulfill macronutrient content quality criteria and may thus cover the protein and energy demands of children aged 6 to 59 months with mild acute malnutrition. They are, however, deficient in calcium, sodium, zinc, vitamin A, and vitamin D, with calcium contents ranging from 27.38 to 70.58 mg/100g, sodium contents ranging from 4.6 to 28.13 mg/100g, zinc contents ranging from 0.76 to 1.13 mg/100g, vitamin A contents ranging from 11.07 to 78.63 mg/100g, and vitamin D contents ranging from 0.11 to 0.48 mg/100g.

A comparative study on psychological distress and associated factors among mothers of severely acute malnourished children belonging to urban and rural area of Central India

Background: Psychological distress commonly presents as comorbidities but is often unrecognized in clinical practice or undertreated as comorbidities in mothers of severe malnourished children. There is wide difference in psychological distress and associated factors among rural and urban area. Aims and Objectives: The objective of study was to compare the psychological distress and associated factors among the mothers of severely acute malnourished children belonging to urban or rural areas. Materials and Methods: This cross-sectional study was conducted on total 450 mothers of severely acute malnourished children admitted in nutritional rehabilitation centers (NRCs) of the central India from April 2019 to July 2020 using General Health Questionnaire. Results: Out of total 450 mothers, 94.7% (426) of mothers shown normal psychological state whereas 24 (5.3%) mothers shown probable case of psychological distress. Among the study participants, mean age of the mothers was found 23.54 years (SD 2.43). Majority of mother 311 (69.1%) belongs to rural area followed by 139 (30.9%) from urban area. Majority of the mothers 231 (51.3%) were from Scheduled Tribe caste followed by 123 (27.3%) other Backward Class caste. Majority of the mothers 404 (89.8%) were unemployed in our study. Conclusions: In the rural locality caste of the mother, primary caretaker of the child and money spent at health facility were the significant risk factors for the psychological distress among the rural mothers while in urban locality, wages loss during stay period at NRC and comorbidity present in the child were the significant risk factors for the psychological distress.

Outcome of Nutritional Rehabilitation Centre based care for children with Severe Acute Malnutrition in Uttar Pradesh, India: Cross sectional Study

Background and Aim: Nutritional Rehabilitation Centres (NRCs) have been established for the facility-based management of children with severe acute malnutrition (SAM). The present study was conducted in two such centres in Uttar Pradesh, India to understand the epidemiological and clinical profile of admitted children and their outcome of treatment. Materials and Methods: A facility based cross-sectional study was conducted in the Nutritional Rehabilitation centres at Lucknow and Barabanki district hospitals. All Children aged one to fifty-nine months admitted to these centres from July 1, 2018 to June 30, 2019 were included in the study. Results: Around 28% infants diagnosed with SAM were less than 6 months of age. Majority (64.9%) of the admitted children were discharged with more than 15% of weight at admission, 28.9% were non-responders, 6.2% were defaulters and there were no deaths during the study period. Referrals directly from the community were seen in only 25.8% cases. Conclusion: Considering that around one-fourth of the children were discharged without adequate weight gain, measures to promote follow up should be given more focus. Referral from community level should be strengthened and more attention should be given for prevention of malnutrition in infants less than 6 months.