Nutritional rehabilitation centres (NRCs) have been established to ensure the nutritional recovery of severely malnourished children. The long-term nutritional outcomes in children discharged from NRCs have not been described. In this retrospective cohort study, the nutritional status of 514 children was assessed one year after discharge. Household and maternal data, as well as data regarding variables related to the children's stay at the NRC, were collected. A total of 33.4% had moderate malnutrition and 11.7% had severe malnutrition. The mean weight for height Z-score at admission, discharge and one year after discharge were -3.61, -1.90 and -2.34, respectively. Thus, long-term monitoring and follow-up of children discharged from NRCs till they achieve normal nutritional status is mandatory.
The burden of malnutrition is often estimated in terms of 'prevalence' without considering two important contributing factors: incidence and duration. To illustrate this, we conducted a community-based retrospective cohort study involving 24,278 children enrolled in an integrated child development scheme in India. Anthropometric data of study participants from birth to five years of age were collected from the growth charts maintained by Anganwadi workers. Of all the growth charts reviewed, 1460 (6.0%) children died before their fifth birthday and 4013 (16.5%) were excluded after initial screening because either the growth chart was incomplete (4.8%) or had missing entries (11.7%). Of the remaining 20,265 children included in the study, in the first five years of their life, 35.6% suffered from exclusive moderate malnourishment and 9.4% from severe malnourishment. The most common age groups for the onset of moderate and severe malnutrition were 9-11 months and 12-15 months, respectively. The mode, median and mean duration of time spent by children being severely underweight was 3, 7 and 8.4 months respectively, and being moderately underweight was 8, 11 and 15.1 months, respectively. Thus, a comprehensive strategy for preventing the onset of malnutrition (both moderate and severe) among children is urgently needed.
This study was conducted with an aim to determine the Water, Sanitation and Hygiene (WASH) related practices in families having one or more severely malnourished child and comparing them with that of families with non-malnourished children as control. A community based unmatched case-control study was conducted involving 169 cases and 338 controls. Data on different practices related to water, sanitation, and hygiene followed by families of cases and controls were collected. The questions included source, storage and pre treatment of drinking water, hand washing practices, vector protection methods and method of disposing of various kinds of wastes. A multi variable analysis of selected variables was undertaken. The proportion of males and females among cases was 46.7 and 54.3% respectively. The proportion of families of cases and control which practised any kind of disinfection of drinking water was 38.5 and 78.1% respectively. Strongest factor which increased the odds of being severely malnourished were lack of water, disinfection before drinking, no hand washing before feeding a child, not using disinfectant solution for mopping the floor and defecating in the open. To counter severe malnutrition it is necessary need to broaden the focus and move from nutrition based intervention to include water, sanitation and hygienic practices into the prospect of malnutrition elimination.
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