Declining Child Malnutrition in Maharashtra-5 The Rehab efforts

Child Malnutrition in Child Malnutrition in

Maharashtra (India) Maharashtra (India) August 2013August 2013-- January 2014January 2014

Situation, Efforts, Decline and ChallengesSituation, Efforts, Decline and Challenges

A Review A Review

1

A Review A Review For the State Nutrition MissionFor the State Nutrition Mission

P o w e r P o i n t 5 / 6P o w e r P o i n t 5 / 6

Nutrition Rehab for SAM MAM babiesNutrition Rehab for SAM MAM babies

Dr Shyam Ashtekar, MD (Community Med)

[email protected] feed--Dr Shyam ashtekar jan 2014

NUTRITIONAL REHAB NUTRITIONAL REHAB

EFFORTS IN EFFORTS IN

PowerPoint 5/6PowerPoint 5/6

EFFORTS IN EFFORTS IN

MAHARASHTRA FOR SAM MAHARASHTRA FOR SAM

MAM BABIESMAM BABIES

DR SHYAM ASHTEKAR 2014DR SHYAM ASHTEKAR 2014

Nutritional Rehab Efforts in Maharashtra--Dr Shyam Ashtekar Jan 2014 2

NUTRITIONAL REHAB LEVELS NUTRITIONAL REHAB LEVELS

NRC at District Hospital

2 wk

CDC at Health Center or HospitalHospital3wk

Village level Child Development

Center (VCDC)4 wk

Home level-Rehab


A display of A display of Malnutrition data in AWCMalnutrition data in AWC


SAM & MAMSAM & MAM--Recent MalnutritionRecent Malnutrition

� SAM (severe acute malnutrition) –is wasting below -3SD, also severely low MUAC (red zone)—

� MAM is moderate acute malnutrition, below -2SD (but above -3SD) of wasting or MUAC yellow zone.MUAC (red zone)—

� SAM needs rehab, for risk of child death.

MUAC yellow zone.

� MAM babies are usually not for rehab centers..


Criteria for SAMCriteria for SAM--MAM Nutritional rehabMAM Nutritional rehab

(1) Wasting is defined as underweight for that height.


Criteria for Nutritional rehabCriteria for Nutritional rehab

(2) MUAC >11.5 cm.


Criteria for Criteria for

Nutritional rehabNutritional rehab

(3)Foot Edema


Why not use the Underweight for Age Test?Why not use the Underweight for Age Test?


Nutritional Rehabilitation of MN ChildrenNutritional Rehabilitation of MN Children

� Soon after diagnosis we need to start

rehab efforts.

� Moderate MN children can be managed Moderate MN children can be managed

at home or AWC with some treatment

and special nutrition

� But severe MN child needs help at NRC


NutritionalNutritional RehabRehab

� Appetite must improve first, this

takes about one week.

� Weight gain comes after that.

� Rehab may take 3-4 weeks.


(1) Village Child Development Center(1) Village Child Development Center

� This is held in AWC 2-3 times in

the year as per need.

� Each camp takes 4 weeks.

� Time is 9 to 4pm, with 12 to 2 pm.

recess.

� Initial treatment for infection is

important.


Village Child Development CenterVillage Child Development Center

� Feeds are given in AWC from 9 to 12pm and 2 to 4 pm.

� Various food items are given using THR, milk powder. The

AWC meal of that day, banana, roasted potato etc.

� The mother feeds between 12 to 2 pm at home.� The mother feeds between 12 to 2 pm at home.

� Occasionally eggs are served.

� All this is expected to improve the child’s status.

� Not enough provision to meet the requirements


Village Child Development Village Child Development

Center (VCDC)Center (VCDC)

� In Some blocks they offer special feed

prepared from groundnut flour, oil, milk

powder and sugar mixed together as a

semi-solid meal.


Special Amylase Special Amylase feedsfeeds

� Amylase develops in sprouting grain & legumes

� Amylase helps digestion. For this wheat and green

gram which are sprouted, dried and powdered.

� This flour mixed with groundnut flour, oil, Sugar &

makes a good paste for the child, most children like

this.

� Micronutrient sachet is added to this once daily.


Use of MedicinesUse of Medicines

� Albendazol is used for curing worms.

� Amoxicillin is used for controlling

infections.infections.

� Some Ayurvedic medicines like Shilajit

� Iron Folic Acid syrup


Home VCDCHome VCDC

� Sometimes a rehab camp is difficult to organize, due to

constraints, or too few children that need help.

� Home VCDC is a better option and costs much less.

� Provisions come from AWC including the THR Packs.

� The AWC Sevika attends 1-2 times daily to home visits.

� Akola and Nagar district used this option for rehab.


Home VCDC Info Home VCDC Info

Sheet in AkolaSheet in Akola


Home VCDC Info SheetHome VCDC Info Sheet


(2) Child Treatment Center (CTC)(2) Child Treatment Center (CTC)

� Children who did not need admission to CTC

� The CTC is held suitably in a Primary Health

Center or Rural Hospital, whenever necessary.Center or Rural Hospital, whenever necessary.

� Mothers stay there with their child for 3 weeks

� The mother is given Rs. 150/- as lost wages.


CTC in Jawhar block.CTC in Jawhar block.


…CTC …CTC

� Medical and nutrition therapy is given here under

medical supervision.

� The special feed is prepared from milk, groundnut flour,

oil and sugar in liquid form.oil and sugar in liquid form.

� This feed is given 8-9 times every day till the child

sleeps at night.

� The feed may be prepared 3-4 times a day depending

on weather (hot weather spoils the food).


CTC in Jawhar CTC in Jawhar

� We saw about 30 children admitted in CTC in August 2013.

� Most children loose weight in the first week due to reduction

of oedema.

� Weight gain starts generally in next week as appetite grows.� Weight gain starts generally in next week as appetite grows.

� With better appetite a thicker formula feed is used. (F 100)

� Gradually liquid diet is replaced with semi solid feeds.

� But the risk of malnutrition at home is still there.


(3) District NRC Nandurbar(3) District NRC Nandurbar


District NRC NandurbarDistrict NRC Nandurbar


District NRC NandurbarDistrict NRC Nandurbar


The infantoThe infanto--metermeter for height for height

measurement in the NRCmeasurement in the NRC


The NRCThe NRC

� The NRC is established at district or block hospital round the year.

� The usual period for stay is 2 weeks

� The NRC ward has 20-30 beds

� The NRC has child specialist, nutritionist and nurses and other staff� The NRC has child specialist, nutritionist and nurses and other staff

� The special feeds are same as in the CTC

� But more investigations and medicines can be employed in the NRC

� At discharge the child follow up arrangements are made.

� NRC is an essential support for tribal districts.


The Benefits of Nutritional RehabThe Benefits of Nutritional Rehab

� Rehab arrests further damage to malnourished children

� Many children improve, some dont.

� Rehab facility is necessary to prevent avoidable child deaths.

� Not all parents are wiling to admit their children in the facility� Not all parents are wiling to admit their children in the facility

� Lost wages are given, but there are some other chores at

home..which make some parents helpless

� Not all parents are equally concerned about the sick child,

some do leave against medical advice.


The Special The Special

Feed FormulaFeed Formula


NICU (Neonatal Intensive Care Unit)NICU (Neonatal Intensive Care Unit)


NICUNICU

� NICU admits neonates (under 1 month).

� The babies are either premature, very low

birth weight or sick. birth weight or sick.

� These babies need special care.

� NICU offers warmth and ultraviolet therapy.


Surgical Treatment for Seriously Ill BabiesSurgical Treatment for Seriously Ill Babies

� Some babies look wasted/non thriving because of serious

illnesses like congenital heart diseases

� This calls for complicated surgeries and care—only available at

some centers. some centers.

� Hundreds of children got this care in the last two years.

� There is Govt assistance for this, esp. the Jeevandayi Yojna.

� This has created a better rapport of the ICDS system with

families and people.


शभुेछाशभुेछा

Dr Shyam Ashtekar (MD, Community

Medicine)

21 Cherry Hills Society, Anandwalli, Nashik

422013

[email protected]

Cell +919422271544Cell +919422271544

Website:

arogyavidya.org,

bharatswasthya.net

A study of Anganwadis and campaign against

malnutrition in Maharashtra for and with support of

Rajmata Jijau Mission,

August to Dec 2013


Health & Medicine

Declining Child Malnutrition in Maharashtra-5 The Rehab efforts