Providing care for children with severe acute malnutrition in India: new evidence from Jharkhand

Abstract

Objective: To assess the effectiveness of facility-based care for children with severe acute malnutrition (SAM) in malnutrition treatment centres (MTC). Design: Early detection and treatment of SAM using locally adapted protocols; assessment of programme outcomes, including survival, default, discharge and recovery rates. Setting: All forty-eight MTC in Jharkhand, India. Subjects: Children (n 3595) with SAM admitted to MTC (1 July 2009-30 June 2011). Results: Of children admitted, 55?0 % were girls, 77?7 % were 6-23 months old and 68?6 % belonged to scheduled tribes or castes; 34?4 % had oedema or medical complications. Of the 3418 programme exits, the proportion of children who died was 0?6 % (n 20), the proportion of children who defaulted was 18?4 % (n 628) and the proportion of children discharged was 81?0 % (n 2770). Children's average weight gain was 9?6 (SD 8?4) g/kg body weight per d and their average length of stay was 16?0 (SD 5?7) d. Among the 2770 children who were discharged from the programme, 39?4 % (n 1090) gained 15 % or more of their initial weight while 60?6 % (n 1680) gained less than 15 % of their initial weight. Conclusions: MTC provide live-saving care for children with SAM as demonstrated by high survival rates. However, the protocols and therapeutic foods currently used need to improve to ensure the recovery of all discharged children. MTC should be reserved for children with complicated SAM; children with uncomplicated SAM should be admitted to a community-based programme for the management of SAM, at a lesser risk to children and a lesser cost to families and the health system.

Community-based management of severe acute malnutrition in India: New evidence from Bihar

“…The data also confirmed observations in other published Indian studies that suggested a much higher burden of SAM in children ,2 y old (3,4), which was consistent with data from African settings (23). The severity of stunting correlated directly with the severity of wasting on admission, with a mean (6SD) height-for-age z score of 23.9 6 1.5 for the overall cohort.…”

“…According to the third Indian National Family Health Survey-3 conducted in [2005][2006]19.8% of children ,5 y of age were wasted and 6.4% suffered from severe acute malnutrition (SAM) 4 in India. The situation appeared worse in the state of Bihar, where in children ,5 y of age, 27.1% were wasted and 8.3% suffered from SAM (1).…”

“…The Indian government and a number of nongovernmental organizations (NGOs) are currently implementing various initiatives that address SAM across the country. Although the principal strategy being deployed remains inpatient care through Nutritional Rehabilitation Centers and Malnutrition Treatment Centers (3)(4)(5)(6), there is a growing consensus within India that the adoption of community-based management of acute malnutrition (CMAM) is crucial to achieving widespread, effective coverage and treatment of all children with SAM (7,8). Furthermore, standardized inpatient management of SAM has been associated with worse outcomes than has management in the community, which is attributable partly to the risk of children with SAM acquiring serious infections from other hospitalized patients and partly because of families' lack of acceptance of hospital-based care (9,10).…”

Evaluation of the effects of nutrition intervention measures on admitted children in nutritional rehabilitation center, Gulbarga, India

“…A study done by Aguyo et al showed that 81.6% did not achieve the target weight. 13 The average length of stay at the NRC was 7.17±1.6 days as opposed to the guidelines of 14days of duration. This is far less than that seen in other studies conducted by Rinki Shah et al where the duration was 16 days and G Taneja et al where the duration of stay was 14 days.…”

How effective is the integration of facility and community-based management of severe acute malnutrition in India?

“…Other states, such as Jharkhand, followed a similar model; however, these facilities are called Malnutrition Treatment Centres (MTCs) in Jharkhand. 8 Although broad operational guidelines for facilitybased management of SAM are available at the national level, various states in India have tailored these to their own requirements. 7 However, published literature on the functioning and outcome of NRCs in India is scarce.…”