Student Dissertation

Agency : ASHA; AWW; ANM; NRC

Background : Malnutrition is associated with high rates of mortality and morbidity and is an underlying factor in almost one-third to half of all children under five years who die each year of preventable. Many of these deaths are on account of severe malnutrition. Strong evidence exists on the synergism between undernutrition and child mortality due to common childhood illnesses including diarrhea, acute respiratory infections, malaria, and measles. To prevent deaths due to severe acute malnutrition (SAM), specialized treatment and prevention interventions are required. WHO and UNICEF in their joint statement have recommended two major approaches to address Children with SAM: [1] 1. Facility/hospital-based care for children with SAM and medical complications 2. Home/community-based care for children with SAM but without medical complications. Nutrition Rehabilitation Center (NRC) is a unit in a health facility where children with Severe Acute Malnutrition (SAM) are admitted and managed. Children are admitted as per the defined admission criteria and provided with medical and nutritional therapeutic care. Once discharged from the NRC, the child continues to be in Nutrition. Rehabilitation program until she/he attains the defined discharge criteria from the Program (described in technical guidelines).

Methodology : Study location: Narmada District of Gujarat Study population: Health Records of all the Children with Severe Acute Malnutrition admitted to the NRC. (In the reporting period) Inclusion criteria: Children aged 6-59 months having SAM fulfilling the following criteria: (a) bilateral pitting edema and/or (b) weight-for-height <–3 SD and/or (c) mid-Upper-arm circumference <115 mm. Exclusion criteria: Patients discharged on request for personal and social reasons were excluded from the study Study Duration: Feb 2018 to May 2018 Study Design: It is a cross-sectional descriptive study. Quantitative study – Performance Assessment using key output indicators Sample Size: A sample size of 84 children was undertaken for the study. (n=84) Sampling Technique: Total Population Sampling technique was observed as all the children admitted in the financial year 2017-2018 were included in the study.

Findings : a study was conducted on. Performance Assessment of Nutrition Rehabilitation Centre in Narmada District of Gujarat 2017 -18. A study found that around 62 percent of the children admitted to the NRC was in the age group of 13 to 36 months and 8 percent belonged to the age group 37- 60 months. Less number of children are malnourished in the age group of 37-60 months. Males are more than females around 51 percent of male and 48 percent of females were admitted in the NRC. Majority of the beneficiary are belonging to SC/ST i.e. 88 percent. Moreover, around 88 percent of the beneficiary belongs to BPL family. The trends show in month wise distribution of the beneficiary was fluctuating in the month February, April and October it was less than 10 number of admissions. Around 68 percent beneficiary is admitted by self-referral and only 4 percent refer by a medical officer which is very less need to be a focus on this area. The recovery rate is very poor as it is far below the standard criteria. Only one – fourth of the beneficiaries have met the “target weight gain” criteria. The bed occupancy rate is very poor at any point of time6 beds are unoccupied Only 4 are occupied. SAM Criteria at Admission (All the three) (MUAC, Z score & illness) almost half of the respondent does not fulfill the criteria for MUAC >11.5 cm. Govt is also providing financial assistance to the beneficiary family the opportunity cost for the stay of 14 days around Rs 1400 is given to family and 300 rs for every follow-up. It encourages the beneficiary family to bring their child to NRC. They can improve by increasing the referral rate by a medical officer.

Recommendations : There is no doubt to the fact that Nutrition Rehabilitation Centre can play a very vital role in reducing the burden of morbidity and mortality associated with Malnutrition on the community, provided active screening and prompt treatment is done well. For this to happen, it becomes important to strengthen our screening procedures, both at the community and facility level. This study makes us realize the importance of engagement of field level staff in an active screening of SAM cases. The field level staff should be periodically sensitized regarding the program and its associated benefits. Once the screening and referral procedures are taken care of, it becomes necessary to develop effective strategies for supportive supervision and monitoring at the facility level. The “low” Indicator values of Recovery Rates and Average Weight Gain reflects the inadequacy of the treatment methods being offered at the facility. To address this issue, the operational guidelines given by NRHM should be religiously followed to ensure the correct formulation and timely administration of feeds. Also, the staff at the facility should properly counsel the parent on how to prepare feeds and monitor the health of the child during the “Follow-up “phase. The authorities that have the power to bring transformation, as well as the key policymakers, should take a keen interest in developing innovative approaches to address various barriers and challenges affecting the successful implementation of the program at NRC. At the same time, they should be actively involved in solving the various managerial issues related to finance and Human Resources that often go unnoticed and neglected. The budget allocated to NRC under NRHM should be conserved and used rationally. Thus, in conclusion, we can say that, with consolidated efforts from all the key stakeholders at various levels of the healthcare system, Nutrition Rehabilitation Centres be established as an effective intervention to curb the menace of Malnutrition and its associated complications and render good health and well-being to all its beneficiaries.