Declining Child Malnutrition in Maharashtra-5 The Rehab efforts

Child Malnutrition in
Maharashtra (India)
August 2013- January 2014
2013-

Situation, Efforts, Decline and Challenges

A Review
For the State Nutrition Mission
PowerPoint5/6

Nutrition Rehab for SAM MAM babies
Dr Shyam Ashtekar,
MD (Community Med)
shyamashtekar@yahoo.comnganwadi-supplementary feed--Dr Shyam
A
ashtekar jan 2014

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PowerPoint 5/6

NUTRITIONAL REHAB
EFFORTS IN
MAHARASHTRA FOR SAM
MAM BABIES
DR SHYAM ASHTEKAR 2014
Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014

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NUTRITIONAL REHAB LEVELS
NRC at District
Hospital
2 wk
CDC at Health
Center or
Hospital
3wk
Village level Child
Development
Center (VCDC)
4 wk
Home levelRehab

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A display of Malnutrition data in AWC


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SAM & MAM-Recent Malnutrition
MAMSAM (severe acute
malnutrition) –is
wasting below -3SD,
also severely low
MUAC (red zone)—
SAM needs rehab, for
risk of child death.

MAM is moderate
acute malnutrition,
below -2SD (but above
-3SD) of wasting or
MUAC yellow zone.
MAM babies are
usually not for rehab
centers..


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Criteria for SAM-MAM Nutritional rehab
SAM(1) Wasting is defined as underweight
for that height.


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Criteria for Nutritional rehab
(2) MUAC >11.5 cm.


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Criteria for
Nutritional rehab

(3)Foot Edema


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Why not use the Underweight for Age Test?


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Nutritional Rehabilitation of MN Children
Soon after diagnosis we need to start
rehab efforts.
Moderate MN children can be managed
at home or AWC with some treatment
and special nutrition
But severe MN child needs help at NRC

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Nutritional Rehab
Appetite must improve first, this
takes about one week.
Weight gain comes after that.
Rehab may take 3-4 weeks.


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(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.

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Village 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.
Occasionally eggs are served.
All this is expected to improve the child’s status.
Not enough provision to meet the requirements


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Village Child Development
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.

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Special Amylase feeds
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.

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Use of Medicines
Albendazol is used for curing worms.
Amoxicillin is used for controlling
infections.
Some Ayurvedic medicines like Shilajit
Iron Folic Acid syrup


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Home 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.

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Home VCDC Info
Sheet in Akola


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Home VCDC Info Sheet


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(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.
Mothers stay there with their child for 3 weeks
The mother is given Rs. 150/- as lost wages.


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CTC in Jawhar block.


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…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.
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).

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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.
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.


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(3) District NRC Nandurbar


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District NRC Nandurbar


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District NRC Nandurbar


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The infanto-meter for height
infantomeasurement in the NRC


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The 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 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.


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The 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
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.


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The Special
Feed Formula


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NICU (Neonatal Intensive Care Unit)


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NICU
NICU admits neonates (under 1 month).
The babies are either premature, very low
birth weight or sick.
These babies need special care.
NICU offers warmth and ultraviolet therapy.

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Surgical 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.
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.

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शभे छा
ु
Dr Shyam Ashtekar (MD, Community
Medicine)

21 Cherry Hills Society, Anandwalli, Nashik
422013
shyamashtekar@yahoo.com
Cell +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

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Declining Child Malnutrition in Maharashtra-5 The Rehab efforts

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