NUTRITIONAL REHABILITATION CENTRE

Presenter- Dr. Gulrukh Hashmi

Overview:

1. Need for study2. Objectives of study3. Review of literature 4. Materials and methods5. List of references

Need for study:

According to the National Survey (NFHS-3, 2005-06) in India

43 percent children under age of five years are underweight

(low weight for age).

48 percent children under five are stunted (low height for age).

20 percent children under five years of age are wasted (low

weight for height); Over 6 per cent of these children are

severely wasted (<-3SD). Since ‘wasting’ denotes acute

malnutrition, these children are said to have Severe Acute

Malnutrition or SAM.

In Karnataka,

• 44% of children under age five are stunted, or too short

for their age, which indicates that they have been

undernourished for some time.

• 18% of children are wasted, or too thin for their height,

which may result from inadequate recent food intake or a

recent illness.

• 38% are underweight, which takes into account both

chronic and acute under nutrition.

• Moderate Acute Malnutrition (MAM) is defined by

WHO/UNICEF as:

Weight-for-Height Z-score <-2 but >-3SD of the

median WHO child growth standards.

• Severe Acute Malnutrition (SAM) is defined by

WHO/UNICEF as:

I. MUAC<11.5cm

II. Weight-for-Height Z-score <-3 SD of the

median WHO child growth standards

III. Bilateral pitting oedema

IV. Marasmic-kwashiorkor (both wasting and

oedema)

Nutritional rehabilitation centre:The Nutrition Rehabilitation Center(NRC) has

been launched under collaborative scheme

of UNICEF and Govt. of India.

It is a unit for restoring severely acutely

malnourished(SAM)children to good health

while educating their mothers about

nutrition and childcare.

Services provided at NRC:

Treatment & Patient management.

 Nutritional support to inmates.

Capacity building of the primary care givers on

preparation of low cost nutritious diet from locally

available food ingredient, developing feeding habits &

time management in mothers, imparting knowledge

of developing kitchen garden etc

Admission criteria

Children 6-59 months:

Wt/ Ht. or Wt/L<-3Zscores

(WHO 2005 Standards)

AND/OR

MUA C(Mid Upper Arm

Circumference)<115mmA

ND/OR

Presence of bilateral

pitting edema.

Infants < 6 months

• Infant is too weak or

feeble to suckle

effectively

(independently of his/her

weight-for-length). OR

• WfL (weight-for-length)

<–3SD (in infants >45

cm).OR

• Visible severe wasting in

infants <45 cm. OR

• Presence of oedema both

feet

The principles of management of SAM are based on 3 phases:

Stabilization Phase,

Transition Phase and

Rehabilitative Phase.

1. Stabilization Phase: Children without adequate

appetite and/or major complications are first stabilized

and carefully monitored. This phase lasts for 1-2days.

The feeding formula used is F75 which promotes

recovery of normal metabolic function and nutrition-

electrolytic balance.

2.Transition Phase: after stabilization phase there is

transition phase lasting for 2-3days to ensure that the

child is clinically stable and can tolerate an increased

energy and protein intake. There is gradual transition

from Starter diet to Catch up diet (F 100).The quantity of

Catch up diet given is equal to the quantity of Starter

diet given in stabilization Phase.

3. Rehabilitation Phase: when there is no medical

complication and reasonable appetite this phase starts. It

promotes rapid weight gain, and prepare the child for normal

feeding at home

F-75 FEEDS F-100 FEEDS

Milk 300mlSugar 10gms Powdered puffed rice

35gmsVeg oil 20mlWater to make up to

1000ml Energy 75 Kcal/100ml Protein 0.9gm/100ml

Milk 900mlSugar 75gmsVeg oil 20gms Water to make

total vol1000mlEnergy100 Kcal/

100mlProtein 2.9 gm/ 100ml

Discharge criteria:

Discharge criterion for all infants and

children is 15 % weight gain and no signs of

illness.

Mother knows how to prepare appropriate

foods and to feed the child.

Follow-up plan is discussed and understood

Incentives given:

During stay mother is given 65rs/day and

200rs as transportation charges.

Anganwadi worker who brings the child

receives 100rs

During follow up mother gets 65rs and 200rs

transportation cost

accompanying anganwadi worker gets

100rs.

• Many studies have shown that therapeutic

feeding centers and facility based management

of SAM is waste of time and money.

• SAM affected children can be treated with

community based management involving timely

detection and treatment using ready to use

therapeutic food and nutrient dense food at

home.

• Even then in India NRCs are still being

established.

• This study is to analyze the effects of this centre

in improving health of children, evaluate the

services given and to study the effect of health

education given to the mothers/ caretakers

•The National Rural Health Mission (NRHM),

Ministry of Health and Family Welfare facilitates the

states in setting up the NRCs.

•There are total 657 NRCs in India and 15 in

Karnataka.

THANK YOU