Will Help Severely Malnourished Children With Medical Complications

Pune: Among the 36,906 severely acute malnourished children in Maharashtra, around 5,000 have medical complications who need specialised therapeutic nourishment and paediatric care.

Waking up to the need, the state government will roll out nine more Nutritional Rehabilitation Centres (NRC) in nine districts by September. These include one centre at the district hospital in Aundh for facilitybased management of these children. The facility will have a qualified paediartician, a nutritionist and a dietician.

"We had proposed 19 NRC in the project implementation plan 2012-13, submitted to the Union government under the National Rural Health Mission (NRHM). The government approved establishment of nine centres. The aim is to attack the scourge of malnutrition head-on," said V K Rokde, assistant director (child health) of state health services.

In 2011-12, the state had established six NRCs in six tribal districts – Thane, Nashik, Nandurbar, Gondia, Gadchiroli and the sub-district hospital in Dharni in Amaravati district. Seriously ill malnourished children requiring paeditric care admitted in these NRCs showed good improvement.

"With this experience, and the recent operational guidelines circulated by Union government for facility–based management of children with severe acute malnutrition, the state plans to scale up NRC at nine more government health facilities in nine high-burden districts," Rokde said.

The Union government has approved Rs 2 lakh for establishment of each NRC.

Childhood under-nutrition is an important public health and development challenge. Besides increasing the risk of death and disease, under-nutrition also leads to growth retardation and impaired psychosocial and cognitive development.

Children with severe acute malnutrition (SAM) have nine times higher risk of dying than well-nourished children. In India, the prevalence of this in children remains high despite overall economic growth.

The national family health survey-3 revealed that 6.4% of all children underfive years of age are severely wasted.

"Programmatically, it is helpful to categorise children with severe acute malnutrition into ‘complicated and uncomplicated’ cases, based on clinical criteria. Children with SAM, when managed in specialised units with skilled manpower and adequate resources for nutrition rehabilitation, have very high levels of survival," Rokde said.

The NRC provides the serious patients identified from SAM with a 14–day treatment consisting of regular feeding with micronutrient rich food and required antibiotics, de-worming, and treatment of underlying illnesses.

At the NRC, serious cases of SAM will be treated with therapeutic food depending on the severity and complications of their condition, and are eased back on to a normal diet by receiving specific amounts of formula, based on weight, during regular feedings. "We will have a resident pediatrician regularly assessing the children and providing treatment for any complications, such as respiratory infections, diarrhea, or other illnesses," Rokde said.

The dedicated staff of one pediatrician, a nutritionist, a dietician, nurses, caretakers, a cook, and a feeding demonstrator, will not only cater to the medical needs of these acute patients, mostly under the age of 5, but will also work closely with the mothers to address the root causes of malnutrition in their child, he added.

"The mothers will stay with their children for the course of the treatment and recovery – usually 14 days. The staff will take full advantage of this time by offering mothers one on one and group counseling and training on important nutritional issues such as breastfeeding, supplementary feeding, local recipes, sanitation, hygiene, and other topics," Rokde said, adding, "Our goal is that each child treated at the NRC not only recovers but also stays well."

Currently, there are children treatment centres at district hospitals and primary health centres across Maharashtra to take care of malnourished children, including SAM. "Since these centres do not have a fulltime nutritionist, a dietician and a resident paeditrician, a calculated administration of nutrients and energy feeds is not given many a times. This problem of calculated as well as therapeutic administration of micronutrients will be taken care of at the NRCs," Rokde said.

The nine NRCs will be established at sub–district hospital, Shirur (Dhule), district hospital, Jalgaon, district hospital, Ahmednagar, women hospital, Daga (Nagpur), sub-district hospital Pandharkawada (Yavatmal), district hospital, Aundh (Pune), district hospital, Raigad, district hospital, Chandrapur and sub-district hospital, Mukhed (Nanded).

What the centres do

• They provide medical and nutritional care to 20 children in one batch. The children are kept at the NRC for 14 days
• Along with medical care, special focus goes on timely, adequate and appropriate feeding to the children and special care has been taken to improveskills and understanding of their mothers with respect to nutrition, health and hygiene issues
• The mothers are given instructions on preparation of low cost, nutritious diets from locally available food stuff

Objectives

• Control medical complications among severely acute malnutrition children by providing facility–based care to nurse them back to health
• Lower the percentage of SAM children in the state by 2015 by admitting 6–5 months children in the district at the NRC
• Improve availability of and access to quality healthcare for people, especially those residing in rural areas