Progress of children with severe acute malnutrition in the malnutrition treatment centre rehabilitation program: evidence from a prospective study in Jharkhand, India

Abstract

BackgroundIn Jharkhand, Malnutrition Treatment Centres (MTCs) have been established to provide care to children with severe acute malnutrition (SAM). The study examined the effects of facility- and community based care provided as part the MTC program on children with severe acute malnutrition.MethodA cohort of 150 children were enrolled and interviewed by trained investigators at admission, discharge, and after two months on the completion of the community-based phase of the MTC program. Trained investigators collected data on diet, morbidity, anthropometry, and utilization of health and nutrition services.ResultsWe found no deaths among children attending the MTC program. Recovery was poor, and the majority of children demonstrated poor weight gain, with severe wasting and underweight reported in 52 and 83% of the children respectively at the completion of the community-based phase of the MTC program. The average weight gain in the MTC facility (3.8 ± 5.9 g/kg body weight/d) and after discharge (0.6 ± 2.1 g/kg body weight/d) was below recommended standards. 67% of the children consumed food that met less than 50% of the recommended energy and protein requirement. Children experienced high number of illness episodes after discharge: 68% children had coughs and cold, 40% had fever and 35% had diarrhoea. Multiple morbidities were common: 50% of children had two or more episodes of illness. Caregiver’s exposure to MTC’s health and nutrition education sessions and meetings with frontline workers did not improve feeding practices at home. The take-home ration amount distributed to children through the supplementary food program was inadequate to achieve growth benefits.ConclusionsRecovery of children during and after the MTC program was suboptimal. This highlights the need for additional support to strengthen MTC program so that effective care to children can be provided.

Mortality and recovery following moderate and severe acute malnutrition in children aged 6–18 months in rural Jharkhand and Odisha, eastern India: A cohort study

“…In other Indian studies assessing progress following inpatient and/or community care for SAM, rates of recovery were often lower than recommended in SPHERE guidance, and relapse was common [42–44]. For example, in a recent follow-up study of 150 children discharged from MTCs in Jharkhand, 52% of children had relapsed into severe wasting 2 months after discharge [45]. In light of these findings, scaling up outpatient RUTF treatment for children over 6 months without concurrently strengthening ICDS, WASH, and the social protection interventions that support the intergenerational prevention of undernutrition may not have the large effects on mortality predicted by the 2013 Lancet Maternal and Child Nutrition Series in India and other South Asian contexts [17].…”

Nutrition rehabilitation of children with severe acute malnutrition: Revisiting studies undertaken by the National Institute of Nutrition

“…Relatively lower rates of weight gain observed in this study could be due to multiple factors such as frequent morbidities in hospitalized children, reducing the weight gain by almost about 40 per cent; admission of moderately wasted children (due to being at high risk of SAM) and lower intake of potassium, magnesium, etc , and have been discussed elsewhere6889. Studies at various Nutritional Rehabilitation Centres (NRCs) have shown rates of weight gain in the range of about 5-10 g/kg/day9091. Due to concerns about disproportionately higher amounts of body fat deposition during rapid weight gain of children recovering from SAM, a study at our ward examined the composition of weight gain during nutrition rehabilitation in 80 children (aged 6-60 months)92.…”

A qualitative assessment of facility readiness and barriers to the facility-based management of childhood severe acute malnutrition in the public healthcare settings in Bangladesh

“…They should also be motivated to translate the acquired knowledge into actions. Prior evidence suggests that caregivers may not adopt the practices even after education sessions by healthcare staff in the facilities (53) . Therefore, multiple sessions on nutrition and health education using behaviour change and communication materials are recommended to overcome this issue.…”