Abstract of Dissertation

Keyword : Severe Acute Malnutrition, Child Malnutrition Treatment Centers, Nutritional Rehabilitation Centre, Facility Based Care

Objective : • To assess the availability of services at Nutritional Rehabilitation Centre(NRC) and Child Malnutrition Treatment Centres (CMTCs) in Tapi District in terms of infrastructure, human resources and equipment according to the Operational Guidelines on Facility Based Management of Children with SAM (Mohfw) • To assess knowledge levels of staff (Nutritionist) regarding admission, feeding and discharge criteria of children with SAM. • To study the output indicators to assess NRC/CMTCs performance in improving the nutritional status of admitted children.

Background : The prevalence of Severe Acute Malnutrition (SAM) in children is very high in spite of overall economic development in India. The NFHS-3 (2006-06) showed that prevalence of severe wasting is around six percent among all under-5 age children. The NFHS-3 data of Gujarat shows that 41.1 percent of under-3 and 45 percent under-5 children are under-weight. Amongst under-3children, 49.2 percent are stunted and 19.7percent are wasted. Rate of under-5 children with (<3SD) weight for height which is a cut off for SAM is around six percent. To reduce morbidity and mortality among children with SAM, particularly those with medical complications, facility based management has been started with the objective to provide clinical management and to promote physical and psychosocial growth of these children.

Methodology : A facility-based cross-sectional study was conducted for 2 months at 1 NRC and 5 CMTCs in Tapi district of Gujarat. Assessment of Infrastructure, Human resources and equipment was done through structured check lists, drawn up in accordance with the guidelines. Interviews were held with the staff using a questionnaire. The data of children admitted from December to February, 2015 with all 3 follow-ups completed was analyzed retrospectively to assess their nutritional status at the time of discharge and after three follow-up visits. Filled interview schedule and records checked for completeness and correctness and analysis done in MS Excel/SPSS.

Findings : All the facilities had adequate infrastructure and human resources but only three facilities (50%) had medical officers (MO’s) who were trained in Facility Based Care of SAM. Staff knowledge was adequate and all the facilities were well-equipped, with only Geyser and Room thermometer lacking in all the facilities. Registers and all the reports were maintained according to the NRHM format. Target weight gain of 15 percent was achieved in 12 percent of the children after 21 days and in 13 percent at third follow up. No death was reported. After three follow-up visits, only about 50 percent of the children had gained weight, rest had either lost weight or there was no change in weight at all. All the Facilities have adequate infrastructure, equipment and knowledgeable staff and are effective in improving the condition of admitted children demonstrated by high survival rates, but there is low recovery rate(weight gain<15%) and effects are not sustained following discharge. This may be due to lack of parental awareness and dietary practices followed in tribal area hence, there is an urgent need to link these facilities with community-based models for follow-up and improve nutritional counseling given to parents to maintain the achieved weight gain.