Nutritional Rehabilitation Centre Research Articles

Impact of Indigenously Prepared Therapeutic Food for Children with Acute Malnutrition at Nutritional Rehabilitation Center

Introduction Malnutrition in all its forms remains unacceptably high across all regions of the world especially in developing countries.1 Malnutrition impairs physical and mental growth of child as well as increases morbidity and mortality depending upon the degree of malnutrition. There is paucity of literature regarding incidence of malnourished children and outcome of nutritional rehabilitation in a hospital based setting, in western Nepal.
 Objective: The objective of the study was to find the incidence and type of acute malnutrition and their outcome in Nutrition Rehabilitation Home (NRH).
 Methodology: This is a descriptive cross-sectional study conducted at nutrition rehabilitation center of Rapti Subregional Hospital (RSRH), in which all children between 6 to 59 months of age with severe and moderate acute malnutrition (SAM and MAM) admitted from July 2017 to June 2018 were enrolled. Variables like age, sex, length/height, weight, weight gain during stay, duration of stay, Z score of weight for length/height (WLZ/WHZ), weight for age (WAZ) and Height for age (HAZ) were recorded. Outcome were recorded as cured, recovered, defaulted, primary failure and referred. Data entered in excel and analysis was performed by using SPSS 20 and the results were expressed as number, proportion vertion and average.
 Result: Among 105 patients admitted, 90 (85.71%) were below the age of 24 months with mean age of study population being 16.82 months and male female ratio M:F of 1.14:1. Proportion of children with SAM and MAM was 59(56.19%) and 46(47.61%) respectively. Among 75 (71.42%) stunted children, 51(68%) were severely stunted. Among the study populations cure rate was 30.47% (32 person), recovery rate 24.76% (26 person). Defaulter rate was 7.6% (8 person) and primary failure were 18.09% (19 person) referred were 1.9% (2 person). No mortality occurred in the rehabilitation center. Average weight gain for the study population was 6.56 mg/kg /day. Average duration of stay was 21.83 days.
 Conclusion: This study highlights the integral role of locally prepared therapeutic diet besides standardized care provided at nutrition rehabilitation center in order to combat malnutrition, a major problem in the developing world. To sustain the achievements and prevent relapse, there is a need to integrate the services at nutrition rehabilitation center with the community-based therapeutic care as well.

Clinicoepidemiological and laboratory profile of children with severe acute malnutrition admitted to a tertiary care centre

Background: Severe Acute Malnutrituon (SAM) is a form of malnutrition where there is an imminent threat of death to the child. The chances of complications are very high and in most case child requires hospitalization for stabilization and rehabiliatation. Objective of study the clinicoepidemiological and laboratory profile of children with severe acute malnutrition (SAM) admitted to a Nutritional Rehabilitation Centre (NRC) of our hospital.Methods: A retrospective chart review of admitted patients. Nutritional Rehabilitation centre (NRC) at GB Pant Hospital Government Medical College Srinagar over a one year period between June 2017 and June 2018.Results: Total of 187 patients of SAM was admitted in NRC during the study period. One hundred and eight (57.7%) were males and 79(42.3%) were females .Patients were equally among various districts. Infants (<12months) constituted the majority of admissions (54.5%). Marasmus was by far the commonest phenotype presenting as SAM (85.5%).Respiratory comorbidity was the commonest present in about 41 (26.3%) followed by daiarrhea in 32(20.5%). Delayed initiation of complimentary feeding was found in 75(40.1%) while early weaning was found in another 55 children (29.4%). Birth order more than three was present in 92 children (49%). Mother’s literacy status had a direct bearing on the prevalence of SAM. Most of the children were from rural background (75%).Most belonged to low economic and income class as around 65.2% had a very meager family income.Conclusions: SAM is more common in Infants and in children from rural background. It is highly associated with faulty feeding practices including lack of breast feeding and presence of mixed and faulty feeding. It is also associated with increasing birth order, low maternal education and low family income Pneumonia and diarrhea are leading comorbidities. Hypoglycemia and hypothermia are leading complications. Marasmus is the commonest phenotype.

Estimation of serum folate and vitamin B12 levels in children with severe acute malnutrition

Background: Severe acute malnutrition is the important health issue children affected in India. It is often associated with Iron, Vitamin B12 and Folic acid and other micronutrient deficiencies. These reports of declining trend of Iron and folic acid deficiency with implementation of national anemia control programme. Estimation of Serum Folate and Vitamin B12 levels in SAM children aged 6-60 months with anemia was the objective of the study.Methods: A hospital based observational study on 80 children admitted to nutritional rehabilitation center were suffering from severe acute malnutrition (SAM) in the age group of 6-60 months enrolled in the study during the period November 2018 to May 2019 .Data was collected using a predesigned and pretested Proforma, containing details of feeding, socio-economic and development history. Blood samples were sent for measurement of plasma vitamin B12 and serum folate levels. Statistical analysis was done using SPSS version 20.0.Results: Out of 80 children, majority were between the age group of 24-60 months and majority were boys (53.8%). Mean Vitamin B12 and folic acid levels being 384.61 and 8.95 respectively. 45% and 3.8% had vitamin B12 and folic acid deficiencies respectively. Majority of neurological changes and developmental delays were noted in B12 deficient group. Of the 36, B12 deficient children, majority had moderate anaemia (40.2%), normal total count (41.7%), 60% had neutropenia, 44.4% had lymphocytosis, majority had normocytic (30.9%) anemia.Conclusions: There was a moderate to high prevalence of vitamin B12 deficiency among malnourished children. Folate deficiency was found only in few. Efforts should be directed to prevent its deficiency in pregnant and breastfeeding women and their infants with special attention on malnourished children.B12 and folate deficiency shall be considered in all cases with SAM irrespective of blood indices. Treatment will have impact on prognosis of child.

Developmental and behavioural problems in children with severe acute malnutrition in Malawi: A cross-sectional study.

BackgroundEarly childhood development provides an important foundation for the development of human capital. Although there is a clear relation between stunting and child development outcomes, less information is available about the developmental and behavioural outcomes of children with severe acute malnutrition (SAM). Particularly an important research gap exists in Sub–Saharan Africa where there is a high prevalence of SAM and a high rate of co–occurring HIV (human immune deficiency virus) infection. Our first objective was to assess the prevalence and severity of developmental and behavioural disorders on a cohort of children admitted to an inpatient nutritional rehabilitation centre in Malawi. Our second objective was to compare the developmental and behavioural profiles of children with the two main phenotypes of SAM: kwashiorkor and marasmus.MethodsThis was a cross–sectional observational study including all children hospitalized with complicated SAM in Blantyre, Malawi over an 8–month period from February to October 2015. At discharge, children were assessed with the well-validated Malawi Developmental Assessment Tool (MDAT) for gross motor, fine motor, language and social development. In children ≥24 months, emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ).Results150 children (55% boys) with SAM were recruited; mean age of 27.2 months (standard deviation 17.9), 27 children (18%) had pre–existing neurodisabilities (ND) and 34 (23%) had a co–occurring human immune deficiency virus (HIV) infection. All children with SAM experienced profound delays in the gross and fine motor, language and social domains. Linear regression analysis demonstrated that children with kwashiorkor scored 0.75 standard deviations lower (95% confidence interval –1.43 to –0.07) on language MDAT domain than children with marasmus when adjusted for covariates. The prosocial behaviour score of the SDQ was low in children with SAM, indicating a lack of sensitive behaviour in social interactions.ConclusionsChildren with SAM have severe developmental delays after a hospital admission. Our results indicate that there might be a significant difference in developmental attainment between children with kwashiorkor and with marasmus. Future studies exploring longer–term outcomes and testing possible intervention strategies are urgently needed.

Clinical profile and outcome of under nutrition among under five years children at nutritional rehabilitation centre in a tertiary care hospital

Introduction: Malnutrition is the gravest single threat to the world public health. Under nutrition is one of the most concerning health and development issues in India. The main aim was to describe the clinical profile of children aged less than 5 years diagnosed as Severe Acute Malnutrition and outcome of treatment at Nutrition Rehabilitation center. Methods: A descriptive study conducted among 378 subjects for 1 year. Data collection was done on detailed history and examination of the subjects including anthropometry and analysed. Results: The majority of children (51.32%) were of <12 months. Males contribute major proportion in (56.08%). Rural children are about 61.90 %, where most of the children belong to lower economical status (51.86%).Most children recovered 87.30 % and were no deaths during study. Conclusion: There is a need to improve access to health care and need for chain of nutritional care at different levels of the community.

Building evidence for information surveillance of nutrition rehabilitation center to assess risk factors for severe acute malnutrition in a tertiary hospital of the northern state of India

Background: As community-based surveys require energy and time, information surveillance of nutrition rehabilitation centers (NRCs) can be used to assess the nature and degree of risk factors for children with severe acute malnutrition (SAM). Therefore, the current study was planned to assess the degree of association of known risk factors for SAM among children admitted in NRC of a tertiary hospital from the northern state of India. Materials and Methods: Case–control study design was adopted where 50 children with SAM (cases) were recruited from NRC and 50 without SAM (controls) were from an immunization clinic of a tertiary center. A pretested structured interviewer-administered questionnaire was used to collect data from cases and controls. Results: Type of house, status of water and sanitation, simple exponential smoothing, method of birth, birth order, initiation and frequency of breastfeeding, colostrum intake, and profile of diarrhea and acute respiratory infection were statistically similar among cases and controls. Logistic regression analysis observed SAM had significantly high odds for risk factors like mean age of mother at birth (1.4, 1.0–1.9), low birth weight (LBW) (8.7, 2.1–35.3), and bottle feeding (6.3, 1.2–14.2), whereas exclusive breastfeeding (0.2, 0.4–0.4) and fully immunization (0.07, 0.5–0.001) had significantly low odds. Conclusion: Advancing age of mother at the time of delivery, LBW, poor rate of exclusive breastfeeding, and high rate of bottle feeding are significant associated factors for SAM in the study area. Reasons for LBW and reasons for bottle feeding need to be targeted in the study area to reduce SAM among children <5 years of age.

Anaemia among SAM children and its effect on outcome in nutritional rehabilitation centre at tertiary care centre of Gujarat

Anaemia among SAM children and its effect on outcome in nutritional rehabilitation centre at tertiary care centre of Gujarat

REHABILITATION CENTER FOR NUTRITION: A NOVEL APPROACH

Introduction: Malnutrition is a pathological state of deficiency or excess of nutrients. Under-nutrition indicates a state wherein the weight for age, height for age, and weight for height indices are below-2 Z-score of the National Centre for Health Statistics (NCHS) norms. In children aged &lt;5 years under nutrition is one of the most common causes of morbidity and mortality. There is significant increase in the risk of case fatality rate in severe acute malnutrition (SAM) children suffering from diarrhoea, measles, and pneumonia. Revised estimates with the use of the new WHO Child Growth Standards in developing country situations has resulted in a 2–4 times increase in the number of infants and children falling below-three standard deviation (3SD) weight for height/length as compared to that of using the former NCHS reference.&#x0D; Material and Methods: The study was conducted on sample size of 100 children and were then followed up for the period of 2 months to assess the nutritional status during the period of initial stay and the entire follow-up period using available records of anthropometric indicators of the admitted children recruited in the study at the Nutrition Rehabilitation Center (NRC). Weight at admission and discharge and daily weights were recorded from the NRC registers; average weight gain was calculated.&#x0D; Results: A total of 100 patients were included in the study of which 54 (54%) were girls and 46 (46%) were boys. The mean age duration for the entire group was 26.45 ± 12.23 months; for boys 25.87 ± 12.54 months and for girls 23.66 ± 12.88 months. 51% of the parents of the admitted children were illiterate, 48% had received education up to primary school, and 1% of the parents were graduates. 49% of the parents of the admitted children were daily wage labourers, while 36% of the mothers were housewives. The average weight gain for the study group during their stay at the centers was 9.34 ± 4.33 g/kg/day; for boys the average weight gain being 8.11 ± 5.27 g/kg/day and for girls 10.29 ± 5.99 g/kg/day. The mean MUAC at admission was 11.38 ± 0.96 cm and at discharge it was 11.99 ± 1.68 cm. The difference was observed to be statistically significant (P&lt;0.001). Dropout rates of 10%, 32%, 48%, and 70% were obtained for the four follow-up visits conducted 15 days, 30days, 45 days , and 60 days from the day of discharge.&#x0D; Conclusion: Children belonging to illiterate mothers have the highest rates of malnutrition. There was a significant difference between mean weight at discharge and the mean weight at admission for the entire study group which is really satisfying the need of NRC.

DEVELOPMENTAL DELAY IN CHILDREN WITH SEVERE ACUTE MALNUTRITION AND ITS ASSOCIATION WITH VITAMIN B12 DEFICIENCY

Background: There are high rates of developmental delay (DD) in children with severe acute malnutrition (SAM). Vitamin B12 is mandatory for the myelination of brain during the early childhood period. Objective: The objective of the study was to find out the percentage of DD in SAM and its association with Vitamin B12 deficiency. Materials and Methods: A prospective, observational study was done in SAM children aged 0–60 months who were admitted in Nutritional Rehabilitation Centre. Developmental assessment was done by Vineland Social Maturity Scale and developmental quotient <70 was considered as DD. Results: DD was found in 55.3% of children. Vitamin B12 deficiency, insufficiency, and sufficiency were found in 14.6%, 24.3%, and 50.5% of children, respectively, and Vitamin B12 level was not significantly associated with DD in children with SAM (p=0.290). Conclusion: More than half of SAM children had DD and it was not significantly associated with Vitamin B12 levels.

Determinants of severe acute malnutrition in children between six months to five year of age enrolled in nutritional rehabilitation centre at a tertiary care level

Background: Indicators showing levels of nutritional status in children are often regarded as representative of the health and general well-being of a society at large. Malnutrition stands as a consequence of several key social and economic factors such as lack of education, inadequate health care services and ill-informed cultural behaviors. In order to holistically address the issues surrounding malnutrition, a comprehensive understanding of the multi-dimensional complexities at play in society is crucial. Objective was to identify determinants of severe acute malnutrition among children with severe acute malnutrition under 5 years (between 6 months to 60 months) of age. Methods: A cross sectional study design involving 64 patients with severe acute malnutrition between 6 to 60 month of age was employed to identify the risk factors of severe acute malnutrition among children admitted in pediatric wards and nutritional rehabilitation centers, Civil hospital Ahmedabad, from April 2018 to march 2019. A detailed history of all the patients were taken and data collected using structured interviewer-administered questionnaire.Results: Thus, from the above study, it is clear that age of the child &lt;2 years, female gender, bigger family size, poverty, illiteracy in mother, poor feeding practices, improper complementary feed introduction, poor nutritional status of mother whose child were breastfed, acute or chronic illness in child and narrow birth spacing were the chief determinants of SAM in under five children.Conclusions: Socio demographic characters, nutrition and child caring practices, infection and other childhood illness as well as obstetric history of mother are important determinants of severe acute malnutrition in children under five years of age. As a result, collaborative efforts should be organized to improve promotion of better child caring practices through appropriate age specific child and maternal feeding practices, prevention and early treatment of acute childhood illnesses and promotion of family planning.

Development delay in children with severe acute malnutrition and its association with Vitamin B12 deficiency

Background: About half of the under five children are malnourished in India and so is morbidity associated with it. Malnutrition is also associated with multiple vitamin deficiency one of which is vitamin B12. Vitamin B12 is essential for DNA, RNA and protein synthesis; and for myelination of brain during the early childhood period. Deficiency of vitamin B12 can lead to megaloblastic anemia and neurological problems. So, authors aimed to look prevalence of vitamin B12 deficiency and; its hematological and neurological effects in severe acute malnourished children.Methods: it was an observational case control study, in which severe acute malnourished (SAM) children aged 0- 59 months who were admitted in Nutritional Rehabilitation Centre (NRC) were enrolled. Vitamin B12 levels were estimated and levels &lt;200 pg/ml, 200-350 pg/ml, and &gt;350 pg/ml were considered deficient, insufficiency and sufficient. Complete blood count was done for hematological effects and; developmental assessment was done to look for neurological effects.Results: Vitamin B12 was deficient, insufficient, normal in 15(16.3%), 25 (27.5%) and 52 (56.5%) children respectively. Vitamin B12 deficiency was significantly associated with hyperpigmentation and glossitis. Infant and young child feeding practices were not associated vitamin B12 deficiency. Macrocytic anemia was found in 23.4% SAM children and macrocytosis was not significantly associated with vitamin B12 deficiency. Developmental delay was found in 55.3 % children and was not significantly associated with severe acute malnutrition. Conclusions: There is high prevalence of Vitamin B12 deficiency and insufficiency in children with severe acute malnourished children. Macrocytic anemia and developmental delay are not significantly associated with vitamin B12 deficiency.

Study on impact of protein energy malnutrition on development in children

Background: Majority of the children in India who live below the poverty line in an environment of deprivation and starvation have physical and developmental retardation. The Objective of this study to study the impact and comparison of protein energy malnutrition on the development with normal children.Methods: This was a hospital based cross sectional study in which total 128 cases of protein energy malnutrition and 30 normal children were enrolled from nutritional rehabilitation center and in patients wards. The study population comprised of children less than 5 years of age, having weight for height/length ≤3 SD, with visible wasting, or bipedal oedema, with mid arm circumference &lt;11.5 cm were assessed for their development in all four domains using Denver II developmental Screening Test (DDST-II).Results: The gross motor milestones are affected in 62.5% with grade4 PEM &amp; 42.85% with grade 3, the fine motor component is affected more in grade 4 with other domains less affected, no significant relation of language delay with PEM was observed in this study, 40% of children with grade 4 PEM shows delay in social domain while 18.18% of the patients with grade 3 PEM show delay in social domain. No patients with grade 1 or grade 2 PEM showed delay in social domain. All four domains are affected in PEM with a maximum effect in gross motor, but the difference does not seem to be significant as the p value is 0.3 i.e. &gt;0.05 which is insignificant.Conclusions: My study on the effect of protein energy malnutrition on development proves that there in increasing delay in all the domains of development with increasing grade of malnutrition. Early detection of malnutrition in community can cause early intervention and increase the productivity of nation.

Study on determinants of nutritional status of a school going children in a village of Tumakuru taluk

Background: Children (0-14 years) contribute to 26% of world population and 28.4% of India’s population. School going age is a formative period, physically as well as mentally, transferring child into a promising adult. Malnourishment in this age group compromises both physical and mental growth. The objective of the study was to assess the nutritional status and morbidity status among school going children.Methods: A cross sectional descriptive study was conducted at Greenberg international school Kannenahalli, Tumkur. After inclusion and exclusion criteria, which comprised children between 3-12 years of age, total 123 students were included in the study. A pre structured and pre tested proforma was used to collect the data on general information of the child, anthropometric measurements, physical examination, personal hygiene and clinical examination and blood grouping was done.Results: Out of 123 study participants, 30.9% were found to be malnourished and 35.77% had various morbidity conditions. Out of the 39 students who had malnutrition, 20 students (51.3%) were having grade 1 malnutrition, 15 students (38.5%) were having grade 2 malnutrition and 4 students (10.3%) were having grade 3 malnutrition.Conclusions: It concluded that, balanced diet for all the malnourished children to improve their nutritional status and also for healthy children to maintain their health and nutrition. Grade 3 malnourished children were referred to NRC (nutritional rehabilitation center) to improve their nutritional status.

Perception and knowledge regarding under-nutrition in children among anganwadi workers: a qualitative study in Berhampur of Ganjam district, Odisha

Background: Anganwadi centres (AWCs) remain hub for promoting nutrition in children. For an effective functioning of programs, Anganwadi workers (AWWs) need to have a sound knowledge and perception regarding under-nutrition. A qualitative study (Focus Group Discussion) was conducted with aim to assess perceptions and knowledge of AWWs regarding under-nutrition in 6 domains like about term under-nutrition in children, its causes, identification of it, its community management, advices to be given to parents and knowledge of program related to under-nutrition in their locality.Methods: 2 Focus group discussions (each consisted of 12 members and took around 40-45 minutes) were conducted in December 2018 among AWWs of Berhampur through purposive sampling. One author played role of facilitator who carried out discussions, another acted as recorder who took notes and sociograms were recorded by another author. Audio-visual recordings were done. Data were analysed and a report was created based on grounded theory.Results: Participants had fair knowledge of term under-nutrition. They had good knowledge of causes of under-nutrition in children and knew how to identify. But none of them had proper knowledge of community management of malnutrition (CMAM) in children. Though most of them have knowledge of screening of malnourished children and referral to Nutritional rehabilitation centre, they were unaware of other key components of CMAM. Many AWWs didn’t know much about programs for combating malnutrition; however they were well acquainted with ICDS and VHND.Conclusions: Quality training programs and more sensitisation should be done for Anganwadi workers. Specific training on CMAM should be carried out for them.

Evaluation of anthropometric indicators in malnourished children at Nutritional Rehabilitation Center, Gujarat, India

Background: It is very difficult to recognize the cases with mild-to-moderate malnutrition because clinical criteria for their diagnosis are imprecise and are difficult to interpret accurately. The objective of the study was daily weight gain in gram/kg/day in severely malnourished children.Methods: This was a hospital based cross sectional study in which total of 114 consecutive patients of SAM less than 5 years treated for complications of severe acute malnutrition using WHO protocol. The study design included 114 children from the NRC and then followed up the period of 6 months to assess the nutritional status during the period of initial stage and the entire follow up period using available record of anthropometry indicators of the admitted children recruited in the study at the NRC.Results: Mean weight at admission was 6.4 Kg, 6.5 Kg and 6.2 Kg of overall, boys and girls respectively. Mean weight at discharge was 6.8 Kg, 6.7 Kg and 6.6 Kg of overall, boys and girls respectively. Mean MUAC at admission was 10.7 cm, 10.9 cm and 10.6 cm of overall, boys and girls respectively. Mean MUAC at discharge was 10.9 cm, 10.9 cm and 10.8 cm of overall, boys and girls respectively.Conclusions: For treatment of severe acute malnutrition, systematic guidelines required, thus this study indicates that following WHO guidelines, it has become easier to manage SAM in hospital settings, with least possible stay at hospital. The objective of the study was to know the effect of nutritional intervention measures on selected anthropometric indicators of severe acute malnourished children.

Role of mother’s knowledge and feeding practices in improvement of children from severe acute malnutrition

Background: Under nutrition is significant health problem in India as well as in Chhattisgarh, recent NFHS 4 data shows that there is increase in number of children who are severely wasted from 5.6% in NFHS 3 to 8.4% in Chhattisgarh. Literature shows appropriate feeding practices and break in malnutrition infection cycle help malnourished child to recover, so present study was planned with the objective to find out the role of mother knowledge regarding feeding practices and management of minor ailments related to improvement of severe acute malnourished children discharged cured from nutritional rehabilitation centres in Chhattisgarh.Methods: A community based study was planned among children discharged as cured from NRC between March to December 2017. They were followed in community to find out socio-demographic factor, feeding practice after discharge, mother knowledge score, household dietary diversity using 24 hour recall method &amp; anthropometric measurements.Results: Out of 156 children discharged as cured from March to December 2017, total 132 children were covered during the survey from January to June 2018. It was observed that improvement in nutritional status after discharge was significantly associated with increasing knowledge score for mother regarding nutrition and children who were separately feed after discharge from NRC.Conclusions: Mother knowledge regarding nutrition and management of minor ailments and feeding practice to child after discharge are important factors associated with the improvement of children from SAM.

To Study Serum Total Protein and Serum Albumin in Children with Grade III and Grade IV Protein Energy Malnutrition (Cases) and in Children with Grade I and Grade II Protein Energy Malnutrition (Controls)

Background: This was a hospital based case control study, conducted in the Nutrition Rehabilitation centre in Index Medical College Hospital &amp; Research Centre, Indore, Department of Pediatrics. Subjects and Methods: Children with PEM grade I and II without any other pathological problem.The children admitted in the department. Results: In study group, majority of children had PEM grade III malnutrition while in control group, equal number of children had PEM grade I and grade II malnutrition. This table shows that majority of children in study group had lower level of serum protein levels as compared with control group, and there is progressive fall in its level as the severity of malnutrition increases. This table shows that majority of children in study group had lower level of serum albumin levels as compared with control group, and there is progressive fall in its level as the severity of malnutrition increases. Conclusion: The study concludes that estimation of serum T3, T4 and TSH levels in severely malnourished children admitted and co-relation with serum protein and serum albumin levels. To conclude, altered thyroid profile in PEM is perhaps a defense mechanism against excessive metabolic stimulation and energy consumption. The resultant hypometabolism protect the malnourished child with low calories reserve from an early death.

Outcome of Severe Acute Malnutrition Management at a Tertiary Care Nutrition Rehabilitation Centre

Outcome of Severe Acute Malnutrition Management at a Tertiary Care Nutrition Rehabilitation Centre

Evaluation of the performance of a nutrition rehabilitation centre in a tertiary care hospital in Eastern India

Background: Severe acute malnutrition (SAM) places extraordinary challenges in the way of survival, growth and development of the child under five years of age. Our aim was to evaluate the functioning and performance of facility based management of SAM children admitted in the nutrition rehabilitation centre (NRC) and to identify the existing bottlenecks in the NRC.Methods: Children above 1 month and less than 5 years of age with severe acute malnutrition were included during the study period. Demographic details of the SAM children, clinical features during admission were recorded. Anthropometric measurements like MUAC, weight, height/length and WHZ scores were taken at admission and compared with the findings at discharge. Statistical analysis: the data after collection, compilation was analysed by SPSS.Results: Majority 277 (78.47%) of them belonged to rural areas. 300 (85%) SAM children were referred by medical officers. Bilateral oedema was recorded in 12 (17.9%) admitted children during 2014-2015, 22 (17.9%) children in 2015-2016 and in 37 (22.7%) children during 2016-2017. There was significant improvement in the mean weight (kg) and mean MUAC (cm) at discharge was in comparison to the weight and MUAC of the children at admission and this difference in increase in the mean weight and MUAC were found to be statistically significant.Conclusions: Implementation of WHO feeding guidelines resulted in adequate weight gain of inpatient malnourished children, however the frontline workers in the community and health care providers of PHCs should be trained and given hands on training for early identification and referral of SAM cases.

INFRASTRUCTURE, RESOURCES, SERVICES EVALUATION AND GAP ANALYSIS OF INTEGRATED MATERNAL AND CHILD DEVELOPMENT SERVICES IN INDIA

Background. Integrated Child Development Services (ICDS) is an Indian community-centric government program organized under Anganwadi centres catering to supplementary nutrition, health and preschool education, primary healthcare, growth monitoring and counselling the children under six years old along with their mothers. It is the world’s largest outreach program in a developing country covering a population of 1.35 billion; the variations in service delivery were analysed involving cross-sectional rural and urban Anganwadi centers in New Delhi.&#x0D; Methods. Data were collected by assessment of children and mothers, interview of Anganwadi workers and observation of service delivery parameters and conduction of activities. Infrastructural, beneficiaries, services and content were evaluated by a suitable pre-tested questionnaire based on the National Institute of Public Cooperation and Child Development (NIPCCD) evaluation proforma. The data was analysed by a descriptive statistics.&#x0D; Results. Gaps were found in respect of infrastructure, resources, health and nutrition facilities especially at rural Anganwadi centre which was inadequate in terms of implementation of nutrition and health program, supplementary nutrition, preschool education and nutrition rehabilitation centre for existing beneficiaries. Both Anganwadi centres were not catering for new WHO growth standards and adolescent health.&#x0D; Conclusions. Gaps found in respect of infrastructure, resources, health and nutrition facilities can affect performance of ICDS program and the services delivered by Anganwadi centres, which need a boost. Both urban and rural centres have a direct opportunity towards delivering adolescent health program focusing on nutrition and education of girls prior to their pregnancy, and adoption of new WHO growth standards.